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.
Below: Fitted probability of A, heroin initiation and B, survival by prior nonmedical prescription opioid use among adolescents and young adults, NSDUH (2004-2001).
Full article at: http://goo.gl/PZjglp
By: Magdalena Cerdá, DrPH, MPH,1,2 Julián Santaella, DVM, MSc,1 Brandon D. L. Marshall, PhD,3 June H. Kim, MHS,1and Silvia S. Martins, MD, PhD1
1Department of Epidemiology, Mailman School
of Public Health (https://www.mailman.columbia.edu/), Columbia University, New York, NY
2Department of Emergency Medicine,
University of California, Davis, Sacramento, CA
3Department of Epidemiology, Brown
University, Providence, RI
Reprint requests: Magdalena Cerdá, DrPH, MPH, Department of
Epidemiology, Mailman School of Public Health, Columbia University, 722 West
168th St, Rm 527, New York, NY, 10032. ude.aibmuloc@6223cm
More at: https://twitter.com/hiv insight
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