Substance Abuse Disorder | is it due to historical use in Adolescence?

Adolescents who have a history of non-medical use of prescription opioids (NMUPO) have a greater risk of experiencing Substance Use Disorder (SUD).
There is growing evidence suggesting an association between medical use of prescription opioids and subsequent NMUPO during adolescence and young adulthood.

The objective of this study was to examine the association of context of prescription opioid exposure (i.e., medical or non-medical) in adolescence with the subsequent risk of non-medical use of prescription opioids (NMUPO) and substance use disorder (SUD) symptoms at age 35.

Sean E. McCabe, MD, from the Institute for Research on Women and Gender in Ann Arbor, Michigan, and colleagues, selected 2400 high school seniors between 1976 and 1996 to answer questionnaires based on prescription medical or non-medical opioid use.

They hypothesized that SUD symptoms at age 35 were greater among those with a history of medical and non-medical use of prescription opioids.

The study period was between 1993 and 2013 for respondents at age 35; 56.9% were female. The racial/ethnic distribution was 84% white, 7% black, 3.5% Hispanic, and 5.5% other.

Medical and NMUPO at age 18 was based on 2 separate questions:

• Have you “taken any narcotics other than heroin because a doctor told you to use them?”
• Have you “taken any narcotics other than heroin on your own—that is, without a doctor telling you to take them?”

Answer options were: no medical use or NMUPO; medical use only; medical use and NMUPO; and NMUPO only.

An estimated 22% of individuals indicated lifetime medical or nonmedical use of prescription opioids by age 18. More than 90% of individuals who reported any history of NMUPO at age 18 did not engage in past-year NMUPO at age 35.

However, 52.8% of individuals who reported NMUPO at age 18 reported 2 or more SUD symptoms at age 35. SUD symptoms include mental health or drug-related issues. Individuals who had any prescription opioid exposure at age 18 were more likely to report 2 or more alcohol use disorder symptoms than other SUD symptoms at age 35.

• According to the authors, opioids are the leading controlled medication used medically and non-medically by adolescents and young adults in the United States.

Dr McCabe stated, “Any NMUPO in adolescents is a behavior that serves as a strong signal for future SUD and reinforces the importance for health professionals to screen a wide range of substances rather than be opioid-specific when assessing the risk for SUDs among non-medical users of prescription opioids.”

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