Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study

Abstract

Objectives To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition. Study design Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223 534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income. Results A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 10-12 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group. Conclusions Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the user's race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

“…Use of prescribed opioid pain medication before high school graduation is associated with a 33% increase in the risk of later opioid misuse (41). Misuse of opioid pain medications in adolescence strongly predicts later onset of heroin use (42). Thus, risk of opioid medication use in pediatric populations is of great concern.…”

Current Data Raises Toxicity and Safety Concerns about Today’s High THC Content Cannabis

“…Second, credible research has shown marijuana leads to an increase in prescription drug abuse by young people, such as oxycontin [12]. We know from research [13] and accounts from heroin addicts themselves, that once hooked on oxycontin, kids will resort to less expensive heroin to achieve their opiate high. Now investigators have demonstrated that, by dosing adolescent rats with THC, allowing these F 1 animals to breed at maturity, the offspring's mRNA expressed an altered reward system and receptors in the striatum.…”

“…Most critical, emerging adults with heavy use backgrounds show size effects in brain areas that are involved in cognition, such as the prefrontal cortex and parietal region [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Acknowledging Heroin Dependence as a Preventable Pediatric Chronic Medical Condition

“…6 In this issue of The Journal, Cerd a et al provide us with some context as to how and why the rates of heroin deaths in this age group have increased. 7 Using the National Survey on Drug Use and Health 2004-2011 data on 12-to 21-year olds, these investigators demonstrate that a prior history of nonmedical prescription use of opioids was strongly associated with heroin initiation, and that the risk of heroin initiation was greatest among individuals who were first exposed to nonmedical use of prescription opioids between ages 10 and 12 years. 8 Of note, over 13% of those in the study stated that their first nonmedical prescription opioid use was between ages 8 to 12 years.…”