Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study

Abstract

The objective of this study was to examine the association of context of prescription opioid exposure (i.e., medical and/or nonmedical) in adolescence with the subsequent risk of nonmedical use of prescription opioids (NMUPO) and substance use disorder (SUD) symptoms at age 35. Multiple cohorts of nationally representative probability samples of U.S. high school seniors (n = 4072) were surveyed via self-administered questionnaires and followed longitudinally from adolescence (modal age 18, graduating classes 1976–1996) to age 35 (1993–2013). Main outcome measures were past-year NMUPO and SUD symptoms. The medical and nonmedical use of prescription opioids during adolescence was significantly associated with NMUPO at age 35. Relative to no prescription opioid exposure, medical use of prescription opioids without any history of NMUPO during adolescence was not associated with SUD symptoms at age 35. In contrast, compared with no prescription opioid exposure during adolescence, the adjusted odds ratios (AORs) associated with SUD symptoms at age 35 were greater among those with a history of both medical use of prescription opioids and NMUPO during adolescence, AOR = 1.49 (95% confidence interval [CI], 1.13–1.97); and among those who reported NMUPO only, AOR = 2.61 (95% CI, 1.88–3.61). The findings indicate medical use of prescription opioids without any history of NMUPO in adolescence is not associated with SUD symptoms at age 35 while any NMUPO in adolescence predicts SUD symptoms at age 35. Screening instruments and preventative intervention programs to reduce NMUPO and SUDs must account for the context associated with prescription opioid exposure during adolescence.

Sources of Prescription Medication Misuse Among Young Adults in the United States

“…24 Regional and national studies have demonstrated PDM involving each drug class is associated with short-term and long-term consequences, including neuropsychological functioning, depressed mood, sleep problems and higher rates of SUD symptoms in adulthood. 25–29 Clinicians can easily assess educational status when screening for PDM among young adults and make their patients aware of the growing evidence for adverse consequences associated with PDM.…”

Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015

“…1,3–7 Four studies have examined the association between medical use of prescription opioids and NUPO among adolescents and found that the majority of medical users reported no history of NUPO. 10,13–15 In contrast, most adolescents who report NUPO have a history of medical use of prescription opioids. 10,13–15 Despite the aforementioned studies aimed at determining the associations between medical use of prescription opioids and NUPO, there is a paucity of research using repeated national samples that assesses the long-term trends, correlations, and patterns of medical use of prescription opioids and NUPO among adolescents.…”

“…10,13–15 In contrast, most adolescents who report NUPO have a history of medical use of prescription opioids. 10,13–15 Despite the aforementioned studies aimed at determining the associations between medical use of prescription opioids and NUPO, there is a paucity of research using repeated national samples that assesses the long-term trends, correlations, and patterns of medical use of prescription opioids and NUPO among adolescents. 16–19 Furthermore, previous studies have examined race and sex differences in medical use of prescription opioids, and generally found that female and white adolescents were more likely to be prescribed opioid analgesics than male and African-American adolescents, respectively.…”

Taking adolescent prescription opioid use in context: risk stratification in early mid-life based on medical and nonmedical use

“…McCabe et al conducted a study which helps to address these diverse aspects of opioid prescribing [8] They characterized risk of nonmedical use of PO (NMUPO) and SUD symptoms at age 35 based on the context of adolescent PO exposure. PO exposure during adolescence can be used to augment current screening efforts for risk-stratification when initiating opioid therapy in older adults.…”

“…McCabe et al provide valuable insight into the prevalence of legitimate and NMUPO in adolescence [8]. Even more concerning is the high prevalence of polysubstance use amongst adolescents reporting NMUPO, which should be addressed in both public education and more targeted interventions.…”