Nonmedical Prescription Opioid Use Motivated by Pain Relief in Adolescence Predicts Later SUD

A set of characteristics of nonmedical use of prescription opioids in adolescents may help identify youth at high risk for substance use disorder, including opioid misuse, in early midlife, according to a study published in Drug and Alcohol Dependence.

A total of 8373 randomly selected US high school seniors were surveyed each year starting in 1975 and up to age 35 years in this prospective study dubbed, “Monitoring the Future.” Questionnaires dealing with medical and nonmedical use of prescription opioids were delivered at baseline, and participants at age 35 were surveyed on symptoms of substance use disorder (ie, involving alcohol, cannabis, and other drugs).

Engaging in occasional or frequent nonmedical use of prescription opioids, use of prescription opioids for nonanalgesic purposes, co-ingestion of nonmedical prescription opioids and other medications, use of opioid analgesics with high misuse potential, and use of several opioid analgesic types were practiced by the majority of participants reporting nonmedical use of prescription opioids.

Participants reporting simultaneous co-ingestion of prescription opioids for nonmedical purposes with ≥1 other substance during adolescence had the highest rate of substance use disorder at age 35 compared with those with no history of nonmedical use of prescription opioids. Participants reporting medical use of prescription opioids following vs prior to initiation of nonmedical use of prescription opioids during adolescence had higher odds of exhibiting symptoms of cannabis use disorder (adjusted odds ratio [aOR], 4.06; 95% CI, 1.72-9.58; P <.001), other drug use disorder (aOR, 4.75; 95% CI, 2.02-11.2; P <.001), and any substance use disorder (aOR, 1.98; 95% CI, 1.11-3.53; P <.05) at age 35 years.

Study limitations include its reliance on survey data.

“From a public policy perspective, healthcare assessment and interventions need to be tailored to at-risk populations as opposed to blanket statements and policies around drug classes such as opioids that may have unintended consequences,” noted the study authors. “Accordingly, policymakers need to continue to promote measures to adequately treat pain while limiting the amount of leftover opioid medications by encouraging appropriate education, prescribing, monitoring and disposal of opioid medications.”

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Reference

McCabea SE, Veliz PT, Boyd CJ, Schepis TS, McCabe VV, Schulenberg JE. A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife. Drug Alcohol Depend. 2019;194:377-385.