Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study

English version

Autoři: Joel D. Hudgins ^aff001; John J. Porter ^aff001; Michael C. Monuteaux ^aff001; Florence T. Bourgeois ^aff001
Působiště autorů: Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America ^aff001; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America ^aff002; Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America ^aff003
Vyšlo v časopise: Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002922
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002922

Souhrn

Background

Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults.

Methods and findings

This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12–17 years of age) and 28,213 young adults (18–25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0–28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4–21.6) of adolescents and 32.2% (95% CI 31.4–33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5–4.0) and 2,207 young adults (7.8%; 95% CI 7.3–8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals.

Conclusions

Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.

Klíčová slova:

Adolescents – Cocaine – Drug abuse – Heroin – Medical doctors – Opioids – Young adults – Hallucinogens

Zdroje

1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65: 1445–1452. doi: 10.15585/mmwr.mm655051e1 28033313

2. National Institute on Drug Abuse (NIDA). Overdose Death Rates [cited 2018 Aug 13]. Available from: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

3. Curtin SC, Tejada-Vera B, Warner M. Drug Overdose Deaths Among Adolescents Aged 15–19 in the United States: 1999–2015 Key findings. 1999 [cited 2018 Sep 4]. Available from: https://www.cdc.gov/nchs/data/databriefs/db282.pdf.

4. Tadros A, Layman SM, Davis SM, Bozeman R, Davidov DM. Emergency department visits by pediatric patients for poisoning by prescription opioids. Am J Drug Alcohol Abuse. 2016;42: 550–555. doi: 10.1080/00952990.2016.1194851 27398815

5. Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. JAMA Pediatr. 2016;170: 1195. doi: 10.1001/jamapediatrics.2016.2154 27802492

6. Kane JM, Colvin JD, Bartlett AH, Hall M. Opioid-Related Critical Care Resource Use in US Children’s Hospitals. Pediatrics. 2018;141: e20173335. doi: 10.1542/peds.2017-3335 29507166

7. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Netw Open. 2018;1: e180217. doi: 10.1001/jamanetworkopen.2018.0217 30646062

8. Curtin SC, Heron M, Miniño AM, Warner M. National Vital Statistics Reports Volume 67, Number 4 June 01, 2018 Deaths: Recent Increases in Injury Mortality Among Children and Adolescents Aged 10–19 Years in the United States: 1999–2016. 2018;67 [cited 2018 Nov 10]. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_04.pdf.

9. Lee LK, Mannix R. Increasing Fatality Rates From Preventable Deaths in Teenagers and Young Adults. JAMA. 2018;320: 543. doi: 10.1001/jama.2018.6566 29852050

10. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167: 293. doi: 10.7326/M17-0865 28761945

11. Martins SS, Fenton MC, Keyes KM, Blanco C, Zhu H, Storr CL. Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychol Med. 2012;42: 1261–72. doi: 10.1017/S0033291711002145 21999943

12. Kessler RC, Aguilar-Gaxiola S, Berglund PA, Caraveo-Anduaga JJ, DeWit DJ, Greenfield SF, et al. Patterns and predictors of treatment seeking after onset of a substance use disorder. Arch Gen Psychiatry. 2001;58: 1065–71. Available: http://www.ncbi.nlm.nih.gov/pubmed/11695954 doi: 10.1001/archpsyc.58.11.1065 11695954

13. Han B, Compton WM, Jones CM, Cai R. Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003–2013. JAMA. 2015;314: 1468. doi: 10.1001/jama.2015.11859 26461997

14. Hadland SE, Wharam JF, Schuster MA, Zhang F, Samet JH, Larochelle MR. Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001–2014. JAMA Pediatr. 2017;171: 747. doi: 10.1001/jamapediatrics.2017.0745 28628701

15. Gaither JR, Shabanova V, Leventhal JM. US National Trends in Pediatric Deaths From Prescription and Illicit Opioids, 1999–2016. JAMA Netw Open. 2018;1: e186558. doi: 10.1001/jamanetworkopen.2018.6558 30646334

16. Jordan AE, Blackburn NA, Des Jarlais DC, Hagan H. Past-year prevalence of prescription opioid misuse among those 11 to 30 years of age in the United States: A systematic review and meta-analysis. J Subst Abuse Treat. 2017;77: 31–37. doi: 10.1016/j.jsat.2017.03.007 28476268

17. Centers for Disease Control and Prevention: National Center for Health Statistics. Youth Risk Behavior Survey Questionnaire. 2015 [cited 2018 Aug 31]. Available from: www.cdc.gov/yrbs.

18. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use: 1975–2017: Overview, key findings on adolescent drug use. 2018 [cited 2018 Sep 1]. Available from: http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2017.pdf.

19. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription Opioids in Adolescence and Future Opioid Misuse. Pediatrics. 2015;136: e1169–e1177. doi: 10.1542/peds.2015-1364 26504126

20. Schepis TS, Teter CJ, McCabe SE. Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. Drug Alcohol Depend. 2018;189: 172–177. doi: 10.1016/j.drugalcdep.2018.05.017 29960204

21. Groenewald CB, Law EF, Fisher E, Beals-Erickson SE, Palermo TM. Associations Between Adolescent Chronic Pain and Prescription Opioid Misuse in Adulthood. J Pain. 2018; doi: 10.1016/j.jpain.2018.07.007 30098405

22. Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse. JAMA Intern Med. 2019;179: 145. doi: 10.1001/jamainternmed.2018.5419 30508022

23. McKnight ER, Bonny AE, Lange HLH, Kline DM, Abdel-Rasoul M, Gay JR, et al. Statewide opioid prescriptions and the prevalence of adolescent opioid misuse in Ohio. Am J Drug Alcohol Abuse. 2017;43: 299–305. doi: 10.1080/00952990.2016.1216999 27646841

24. Burghardt LC, Ayers JW, Brownstein JS, Bronstein AC, Ewald MB, Bourgeois FT. Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings. Pediatrics. 2013;132: 18–27. doi: 10.1542/peds.2012-2978 23733792

25. Osborne V, Striley CW, Nixon SJ, Winterstein AG, Cottler LB. Sex differences in patterns of prescription opioid non-medical use among 10–18 year olds in the US. Addict Behav. 2019;89: 163–171. doi: 10.1016/j.addbeh.2018.10.009 30316142

26. Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Methodological summary and definitions. 2017 [cited 2018 Oct 3]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-MethodSummDefs-2016/NSDUH-MethodSummDefs-2016.htm#seca.

27. Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables, Prevalence Estimates, Standard Errors, P Values, and Sample Sizes [cited 2018 Oct 4]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf.

28. Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health (NSDUH): Final Approved CAI Specifications for Programming [cited 2018 Oct 10]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUHmrbCAIquex2016v2.pdf.

29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, D.C.: American Psychiatric Association, Washington, DC; 2000.

30. Hedden SL, Kennet J, Lipari R, Medley G, Tice P, Copello EA, et al. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health [cited 2018 Dec 8]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf.

31. Substance Abuse and Mental Health Services Administration. Reliability of Key Measures in the National Survey on Drug Use and Health. 2010 [cited 2018 Dec 8]. Available from: https://www.samhsa.gov/data/sites/default/files/2k6ReliabilityP/2k6ReliabilityP.pdf.

32. Kennet J, Painter D, Hunter SR, Granger RA, Bowman KR. Assessing the reliability of key measures in the National Survey on Drug Use and Health using a test-retest methodology [cited 2018 Nov 3]. Available from: https://pdfs.semanticscholar.org/7218/49d3fb6340708b3914ebe512b7b6c8caf654.pdf.

33. Singh AC, Grau EA, Folsom RE. Predictive Mean Neighborhood Imputation with Application to the Person-Pair Data of the National Household Survey on Drug Abuse [cited 2018 Jan 8]. Available from: http://www.asasrms.org/Proceedings/y2001/Proceed/00460.pdf.

34. Center for Behavioral Health Statistics and Quality. 2015 National Survey on Drug Use and Health Methodological Resource Book Section 11: Person-Level Sampling Weight Calibration. 2017 [cited 2018 Nov 5]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUHmrbSamplingWgt2015.pdf.

35. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health. 2015 [cited 2018 Nov 5]. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-RedesignChanges-2015.pdf.

36. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief, 329. 2018 [cited 2018 Jan 5]. Available from: https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#3.

37. McCabe SE, West BT, Morales M, Cranford JA, Boyd CJ. Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction. 2007;102: 1920–1930. doi: 10.1111/j.1360-0443.2007.02015.x 17916222

38. McCabe SE, Veliz PT, Boyd CJ, Schepis TS, McCabe V V., 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. doi: 10.1016/j.drugalcdep.2018.10.027 30481692

39. Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141: e20172439. doi: 10.1542/peds.2017-2439 29203521

40. Cerdá M, Santaella J, Marshall BDL, Kim JH, Martins SS. Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study. J Pediatr. 2015;167: 605–612.e2. doi: 10.1016/j.jpeds.2015.04.071 26054942

41. Muhuri PK, Gfroerer JC, Davies MC. CBHSQ Data Review: Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States [cited 2018 Dec 10]. Available from: http://www.samhsa.gov/data/.

42. McCabe SE, West BT, Boyd CJ. Motives for Medical Misuse of Prescription Opioids Among Adolescents. J Pain. 2013;14: 1208–1216. doi: 10.1016/j.jpain.2013.05.004 23954519

43. Boyd CJ, McCabe SE, Cranford JA, Young A. Prescription Drug Abuse and Diversion Among Adolescents in a Southeast Michigan School District. Arch Pediatr Adolesc Med. 2007;161: 276. doi: 10.1001/archpedi.161.3.276 17339509

44. McCabe SE, West BT, Teter CJ, Boyd CJ. Co-ingestion of prescription opioids and other drugs among high school seniors: Results from a national study. Drug Alcohol Depend. 2012;126: 65–70. doi: 10.1016/j.drugalcdep.2012.04.017 22609061

45. Cunningham RM, Walton MA, Goldstein A, Chermack ST, Shope JT, Bingham CR, et al. Three-month Follow-up of Brief Computerized and Therapist Interventions for Alcohol and Violence Among Teens. Acad Emerg Med. 2009;16: 1193–1207. doi: 10.1111/j.1553-2712.2009.00513.x 20053240

46. Bernstein E, Edwards E, Dorfman D, Heeren T, Bliss C, Bernstein J. Screening and Brief Intervention to Reduce Marijuana Use Among Youth and Young Adults in a Pediatric Emergency Department. Acad Emerg Med. 2009;16: 1174–1185. doi: 10.1111/j.1553-2712.2009.00490.x 20053238

47. Spirito A, Sindelar-Manning H, Colby SM, Barnett NP, Lewander W, Rohsenow DJ, et al. Individual and Family Motivational Interventions for Alcohol-Positive Adolescents Treated in an Emergency Department. Arch Pediatr Adolesc Med. 2011;165: 269–74. doi: 10.1001/archpediatrics.2010.296 21383276

48. Brinkley-Rubinstein L, Zaller N, Martino S, Cloud DH, Mccauley E, Heise A, et al. Criminal justice continuum for opioid users at risk of overdose. Addict Behav. 2018;86: 104–110. doi: 10.1016/j.addbeh.2018.02.024 29544869

49. Spinelli MA, Ponath C, Tieu L, Hurstak EE, Guzman D, Kushel M. Factors associated with substance use in older homeless adults: Results from the HOPE HOME study. Subst Abus. 2017;38: 88–94. doi: 10.1080/08897077.2016.1264534 27897965