A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife

Abstract

Background: This longitudinal study assesses characteristics associated with adolescents’ nonmedical use of prescription opioids (NMUPO) including: frequency, co-ingestion, motives, specific opioid type; sequence of initiation of medical use of prescription opioids and NMUPO in relationship to subsequent substance use disorder (SUD) symptoms. Methods: Twenty-one independent national cohorts of U.S. high school seniors (n = 8,373) were surveyed and followed 17 years from adolescence to age 35. Results: The majority of adolescents who engaged in NMUPO reported occasional/frequent NMUPO, non-pain relief motives for NMUPO, simultaneous co-ingestion involving NMUPO and other drugs, opioid analgesics with high misuse potential, and multiple types of opioid analgesics. Adolescents who reported NMUPO for pain relief, NMUPO involving opioid analgesics with high misuse potential, or multiple prescription opioids had significantly greater odds of symptoms of SUD symptoms at age 35, relative to those who had no history of NMUPO during adolescence. In addition, medical use of prescription opioids after initiating NMUPO (or NMUPO only) during adolescence was associated with significantly greater odds of subsequent SUD symptoms at age 35 relative to those who reported the medical use of prescription opioids only or had no medical use or NMUPO during adolescence. Conclusions: This is the first U.S. national prospective study to examine the relationships between adolescents’ NMUPO characteristics and later SUD symptoms in early midlife. Several characteristics (frequency, co-ingestion, motives, opioid type, and medical/NMUPO initiation history) were identified that could be used to screen and detect high-risk youth for indicated interventions to reduce prescription opioid misuse and SUDs.

Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: a national longitudinal multicohort study

“…15 Several characteristics associated with prescription opioid misuse (e.g., frequency, co-ingestion, multiple opioids) have been shown to increase the risk of SUD symptoms. 16 While most youth cease prescription opioid misuse over time, there is evidence that about one-third continue to misuse prescription opioids, placing themselves at high risk for adverse consequences such as overdose and SUD. 12,16 Prescription stimulants:…”

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

“…[18][19][20][21][22] At the same time, exposure to opioids has been associated with future opioid misuse. 4,23 This poses a great challenge for providers in managing both short-and long-term welfare of patients. We therefore find it imperative to describe and understand current opioid administration practices during hospitalization so opportunities for improvement in patient care can be identified.…”

“…Rates of opioid-related hospitalization and death are increasing, particularly among children, [1][2][3] and significant national attention is focused on opioid misuse. Previous studies have shown that opioid addiction frequently begins in adolescence or young adulthood, 4 and onequarter to one-third of young adults who report nonmedical prescription opioid use had an earlier history of prescribed medical opioid use. [5][6][7] Unintentional injury is the leading cause of death and disability among children, with more than 8 million children treated for injury in emergency departments (ED) each year.…”

“…[11][12][13][14][15][16][17] Inadequately managed pain can lead to significant long-term consequences, such as post-traumatic stress and substance abuse 7,[18][19][20][21][22] ; however, early exposure to opioids has also been linked to similar outcomes. 4,23,24 Opioids are often first-line treatment for moderate and acute pain after trauma, yet many trauma centers lack clear guidelines for when opioids are indicated in the pediatric trauma population and for the maximum cumulative amount of opioid to administer to pediatric patients. Although there is some guidance for managing pain in children treated in the ED, 25 children with chronic pain, 17 and children with acute postoperative pain, 26 to our knowledge there are no published, evidence-based, pediatric-specific guidelines for pain management after pediatric trauma.…”

Polydrug use among people who use opioids, national survey on drug use and health 2002 to 2017.

“…148 were the highest for adolescents who either: 1) reported the medical use of prescription opioids after initiating NMUPO or 2) reported only NMUPO. 149 Furthermore, adolescents in these two groups had significantly higher odds of alcohol use disorder (AUD), cannabis use disorder (CUD), and the other drug use disorders (ODUD) compared to adolescents who had no history of medical or nonmedical use of prescription opioids (refer to Table 2.3 for all adjusted odds ratios). 149 2.47 (1.74, 3.52)** (n = 7158) b p < 0.05*, p < 0.001** a All analyses control for race/ethnicity, sex, the highest level of parental education, geographic region, metropolitan statistical area, baseline cohort year, and baseline measures of past-year alcohol use, past-year marijuana use, and past-year other drug use.…”