Prescription Opioid Misuse and Risky Adolescent Behavior

Abstract

OBJECTIVES: Misuse of opioid medications (ie, using opioids differently than how a doctor prescribed the medication) is common among US adolescents and associated with preventable health consequences (eg, severe respiratory depression, seizures, heart failure, and death).1 New guidelines and recommendations have made providers more attuned to overprescribing and more vigilant about screening for opioid misuse.2 We hypothesized that youth who misused prescription opioids were more likely to report engaging in a broad range of other risky behaviors. METHODS: We used the Centers for Disease Control and Prevention’s 2017 Youth Risk Behavior Surveillance Survey (n = 14 765), a cross-sectional, nationally representative survey of high school students. Students were sampled by using a 3-stage random cluster design. We conducted weighted logistic regressions to determine the strength of the association between our independent variable, ever misusing prescription opioids, and 22 dependent variables in the following categories: risky driving behaviors (4 variables), violent behaviors (3 variables), risky sexual behaviors (4 variables), substance use (10 variables), and suicide attempt (1 variable). RESULTS: In 2017, 14% of US adolescents reported ever misusing opioids. Those who misused prescription opioids were significantly more likely to have engaged in all 22 risky behaviors (adjusted odds ratios ranged from 2.0 to 22.3; P < .0001 for all tests) compared with other adolescents. CONCLUSIONS: Adolescents reporting ever misusing prescription opioids were more likely to have engaged in a broad range of risky behaviors. Health care providers screening for prescription opioid misuse may be ideally positioned to identify these high-risk youth and initiate early interventions.

Behavioral Health Risk Factors for Nonmedical Prescription Opioid Use in Adolescence

“…8 Previous longitudinal studies of administrative claims data also highlight an association between preexisting mental health disorders and new onset of long-term prescription opioid use among adolescents. 9,10 The only existing data on the association of behavioral health problems and nonmedical prescription opioid use in youth are cross-sectional 8,[11][12][13][14] and leave key evidence gaps. First, because the mechanisms of this association could be bidirectional (ie, opioid misuse may result from or lead to other behavioral health problems), 11,14 it is imperative that researchers on this topic apply prospective longitudinal designs that preclude reverse causality explanations.…”

Social-Ecological Predictors of Opioid Use Among Adolescents With Histories of Substance Use Disorders

“…We found no evidence that adolescents' past year substance use (tobacco, marijuana, or alcohol) was associated with their lifetime opioid use, nor any evidence that adolescents' prior mental health symptoms of MDD, GAD, or PTSD, nor peer attitudes favorable toward drugs, were predictive of lifetime opioid use. Given that previous studies have consistently reported significant associations between substance use and mental health histories and subsequent opioid use outcomes (Barnett et al, 2019;Griesler et al, 2019;Bhatia et al, 2020;Bonar et al, 2020), further research is warranted to replicate the null findings reported herein.…”

“…Extending from the social-ecological model, prior empirical research has found strong evidence for diverse ecological factors predictive of substance use and other related behaviors in adolescence across diverse populations (Arthur et al, 2002;Bränström et al, 2008;Cleveland et al, 2008;Hemphill et al, 2011). Among individual-level predictors, prior tobacco, marijuana, and alcohol use have been consistently identified as salient indicators for subsequent opioid misuse among the general adolescent population (Sung et al, 2005;Back et al, 2010;Palamar et al, 2015;Vaughn et al, 2016;Barnett et al, 2019;Griesler et al, 2019;Bhatia et al, 2020;Bonar et al, 2020;Osborne et al, 2020). Specifically, the odds of reporting having ever misused opioids were three times higher among adolescents with histories of alcohol use (vs. those without), and two times higher among those with histories of cigarette and marijuana use (vs. those without; Barnett et al, 2019).…”

“…In 2018, an estimated 699,000 (2.8%) of U.S. adolescents aged 12-17 reported past year opioid misuse and 169,000 reported past month misuse (Substance Abuse and Mental Health Services Administration, 2019). In 2019, the Centers for Disease Control and Prevention's 2017 Youth Risk Behavior Surveillance Survey-a nationally representative survey that provides data of 9th through 12th grade students in public and private schools in the United Statesfound that approximately 14% of U.S. adolescents reported ever misusing opioids (Bhatia et al, 2020). Although U.S. adolescents aged 12-17 are less likely to report opioid use compared to older age groups (Back et al, 2010), adolescence represents a critical developmental stage for initiation of drug use, characterized by increased risk-taking as well as novelty and sensation seeking behaviors.…”

“…Compared to adolescents with cannabis or alcohol use disorders, those with opioid use disorders may also exhibit poorer long-term prognoses, including higher rates of school drop-out and multiple SUDs (Subramaniam et al, 2009;Godley et al, 2017). Among U.S. high school students, nonmedical prescription opioid use is associated with increased odds of engaging in concurrent risky behaviors, including risky driving behaviors, violent behaviors, risky sexual behaviors, substance use, and suicide attempts (Bhatia et al, 2020). Given the wideranging short-and long-term consequences of adolescent opioid use, it is essential to identify the malleable risk and protective factors underlying early opioid misuse to develop more effective preventive interventions.…”