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

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).

Below:  Fitted HRs of heroin initiation associated with prior nonmedical prescription opioid use, by age of nonmedical prescription opioid use initiation (NSDUH, 2004-2011)

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

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Nonmedical Use of Prescription Medication among Adolescents Using Drugs in Quebec

OBJECTIVE:

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec.

METHOD:

Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors.

RESULTS:

Among adolescents who had used drugs in the previous 12 months, 5.4% reported NMUPM. Based on multivariate analyses, having an ADD, anxiety disorder, low self-esteem, low self-control, low parental supervision, regular alcohol use, and polysubstance use were associated with increased odds of reporting NMUPM.

CONCLUSIONS:

The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.

Purchase full article at:   http://goo.gl/OoJbjq

By:   Roy É1, Nolin MA2, Traoré I3, Leclerc P4, Vasiliadis HM5.

• 1Full Professor, Faculty of Medicine, Université de Sherbrooke (http://www.usherbrooke.ca/), Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec.
• 2Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec.
• 3Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec.
• 4Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec.
• 5Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec.
• Can J Psychiatry. 2015 Dec 1;60(12):556-63.
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Racial And Ethnic Trends & Correlates of Non-Medical Use of Prescription Opioids among Adolescents in the United States 2004-2013

PURPOSE:

Our objective was to elucidate the trends in non-medical use of prescription opioids (NMUPO) among whites, African-Americans, and Hispanic adolescents in the United States. An additional aim was to examine the sociodemographic, behavioral, and psychosocial correlates of NMUPO across each of these aforementioned racial and ethnic groups.

METHODS:

Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic white, African American, and Hispanic respondents ages 12-17 (n = 164,028) and spanning the years 2004-2013. Consistent with prior NSDUH-based studies, respondents reporting use within the previous 12 months were classified as nonmedical prescription opioid users. Logistic regression was used to examine significance of trend year and correlates of NMUPO.

RESULTS:

Non-Hispanic white youth consistently reported higher levels of NMUPO as did older adolescents (ages 15-17) and females. However, there was a decrease in the prevalence of NMUPO overall driven largely by a significant decline (p < 0.001) in NMUPO among non-Hispanic whites of approximately 35% over the study period such that by 2013 no statistically significant differences across race/ethnicity remained. Further, logistic regression models found that externalizing behaviors such as comorbid drug use and fighting was associated with NMUPO and religiosity and parental involvement were identified as protective correlates.

CONCLUSIONS:

To our knowledge, this is the first study to identify a declining trend in NMUPO among adolescents. Although the present study findings provide a source for optimism, there is still a relatively high prevalence of NMUPO and it remains to be seen whether our findings portend a long-term decline. Given the harm done by NMUPO, continued awareness and targeted prevention efforts should be implemented.

Purchase full article at:   http://goo.gl/5FX9G6

By:   Vaughn MG1, Nelson EJ2, Salas-Wright CP3, Qian Z4, Schootman M4.

• 1School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Blvd, St. Louis, MO 63103, United States. Electronic address: mvaughn9@slu.edu.
• 2College for Public Health and Social Justice, 3545 Lafayette Avenue, St. Louis, MO 63104, United States. Electronic address: nelsonej@slu.edu.
• 3School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd D3500, Austin, TX 78712-0358, United States. Electronic address: salaswright@utexas.edu.
• 4College for Public Health and Social Justice, 3545 Lafayette Avenue, St. Louis, MO 63104, United States. 

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