Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors

Abstract

Background Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use. Methods Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009–2013, Weighted N = 67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined. Results 12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use. Discussion Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.

Heroin use onset among nonmedical prescription opioid users in the club scene

“…Variables that distinguished heroin initiators from non-initiators (p-values <=.10) were selected for inclusion in a Cox proportional hazard regression analysis to determine the associations between baseline predictors in relation to likelihood of heroin initiation. In addition to controlling for intervention arm, the Cox regression model included demographic variables that have been associated with NMPOU and heroin use in prior research (Palamar et al, 2016). Kaplan-Meier survival estimates were used to calculate probabilities of time to heroin initiation.…”

“…National trend data demonstrate consistent connections between NMPOU and transition to heroin use, with heroin incidence some 19 times higher among those reporting prior nonmedical prescription opioid use than among those who do not (Muhuri et al, 2013). Adolescents and young adults appear to be especially vulnerable to the migration from prescription opioids to heroin (Cerda et al, 2015; Palamar et al, 2016). Trend data from 2002 to 2014 documented a significant temporal increase in the odds of heroin use among young adults reporting prior non-medical prescription opioid use (Martins et al, 2017).…”

“…Key predictors of transition included route of opioid administration, early age of prescription opioid administration, and lifetime prescription opioid dependence (Carlson et al, 2016). Additional explanatory factors posited in prior research to impact this transition include frequency of NMPOU (Jones, 2013; Palamar et al, 2016), tolerance and dependence (Daniulaitye et al, 2006, Haracopos et al, 2016), market dynamics, and subjective aspects of the user experience (Cicero et al, 2014; Cicero and Ellis, 2015). …”

Trends in heroin access among adolescents in the United States, 2002–2014

“…Despite well-founded concerns regarding the use of heroin and other opiates among adolescents, little is known regarding trends in adolescent views of access to heroin (Martin et al, 2016;Palamar et al, 2016). Thus, it is important to examine changes in the difficulty (or ease) of obtaining heroin.…”

Nonmedical Prescription Opioid and Heroin Use Among Adolescents Who Engage in Sports and Exercise

“…Indeed, the association between NPOU and heroin use is quite robust among adolescents and young adults. 9,12–13 For instance, the past-year heroin incidence rate was 19 times higher among those who reported prior NPOU than among those who did not report NPOU. 9 Moreover, more than half of past-year heroin initiates reported NPOU before starting heroin, while roughly 1% of past-year NPOU initiates had used heroin before starting NPOU.…”