Behavioral Health Risk Factors for Nonmedical Prescription Opioid Use in Adolescence

Abstract

BACKGROUND: Adolescent nonmedical prescription opioid use is associated with overdose and other adverse outcomes, but its risk factors are poorly understood.METHODS: Data were drawn from a prospective cohort study of Los Angeles, California, high school students. At baseline (mean age 5 14.6 years), students completed self-report screening measures of problem alcohol, cannabis, and drug use and 6 mental health problems (major depression, generalized anxiety, panic disorder, social phobia, obsessive-compulsive disorder, and hypomania or mania). Past 6-month nonmedical prescription opioid use (yes or no) was assessed across 7 semiannual follow-ups.RESULTS: Among baseline never users of nonmedical prescription opioids (N 5 3204), average past 6-month prevalence of new nonmedical prescription opioid use across the 42-month follow-up was 4.4% (range 3.5%-6.1%). In a multivariable model co-adjusting for 9 baseline behavioral problems and other factors, major depression, hypomania or mania, cannabis, alcohol, and other drug use problems were associated with increased odds of nonmedical prescription opioid use over follow-ups. Cumulative indices of behavioral health comorbidity showed successively greater odds of subsequent nonmedical prescription opioid use for students with 1

Longitudinal associations between anxiety sensitivity and substance use in adolescents: Mediation by depressive affect.

“…To our knowledge, this is the first study to examine if longitudinal associations between AS and substance use are mediated by depressive affect. Though current findings are novel, they are generally consistent with prior work among adolescents that prospectively related AS to depression (Qi et al, 2021;Zavos et al, 2012) and depression to substance use (Cho et al, 2021;M. Fluharty et al, 2017;Schleider et al, 2019), as well as with the hypothesis of McNally (1996), which posited that AS will tend to be associated with the use of substances that decrease arousal (e.g., depressants) but not with the use of substances that increase arousal (e.g., stimulants).…”

“…It is also interesting that AS cognitive concerns prospectively predicted all categories of substance use except for stimulant use. Given that adolescent depression (vs. anxiety) has more consistently been shown to predict later substance use (Cho et al, 2021; M. Fluharty et al, 2017; Schleider et al, 2019), the wider range of longitudinal associations between AS cognitive concerns and substance use in the present study may be related in part to the cognitive concerns aspect of AS (vs. other aspects of AS) having been most closely associated with depression (Brown et al, 2014; Naragon-Gainey, 2010; Olthuis et al, 2014).…”

“…In relation to this, longitudinal studies of adolescents that assessed AS with the CASI or the original Anxiety Sensitivity Index (ASI; Reiss et al, 1986) have associated both general AS (Qi et al, 2021; Zavos et al, 2012) and AS cognitive concerns (Ho et al, 2018) with depressive symptoms, and adolescent depression (vs. anxiety) more consistently has been shown to prospectively predict alcohol (Schleider et al, 2019), tobacco (M. Fluharty et al, 2017), cannabis (Wittchen et al, 2007), and opioid use (Cho et al, 2021). Also, longitudinal studies that assessed AS with the CASI or ASI have associated general AS with alcohol use problems among adolescents (Conrod et al, 2006; Paulus et al, 2021).…”

We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis

“…Mental health problems are associated with risk-taking behaviour and nonmedical opioid use during adolescence (Boyd et al, 2014). There is clear, longitudinal association between pre-existing mental health conditions and subsequent persistent or problematic opioid use in adolescents who received their first opioid prescription for acute/chronic pain (Cho et al, 2021; Groenewald et al, 2019b; Quinn et al, 2019b; Quinn et al, 2018). Albeit with some differences (Schepis et al, 2020), younger and older populations likely share many of the same risk factors and assumptions related to chronic pain, mental health, and opioid use behaviour.…”

Exploring the Significance of Pharmaceutical Care in Mental Health: A Spotlight on Cannabis

“…An assessment of previous medical history is essential before any decision is made to prescribe Cannabis , allowing for a comprehensive assessment of individual risks, comorbidities, and possible drug interactions. Cho et al’s [ 23 ] research clearly illustrates this need by linking problematic health behaviors in adolescence to subsequent inappropriate use of opioids [ 23 ]. Therefore, the choice of treatments, whether traditional or innovative, can be improved to be more efficient and safer by strengthening the relationship between patients and health professionals.…”