Quick Take: Association of nonmedical prescription opioid use with subsequent heroin use initiation in adolescents

It is not uncommon for adolescents to inappropriately access prescription opioids from friends or family members. Recently, concerns surrounding the use of opioids that are not medically indicated, and an increased risk of initiating heroin use, have surfaced. In this prospective cohort study, 3298 high school students from Los Angeles, California, were surveyed and followed up for 42 months to estimate the association between non-medical prescription opioid use and subsequent heroin initiation. Surveys were administered semi-annually from grade 9 to 12, over the course of 4 years. Cox regression models assessed nonmedical prescription opioid use at survey waves 1 through 7, as a time-varying and time-lagged regressor and subsequent heroin use initiation across waves 2 to 8 as the outcome. Based on multivariate analyses for waves 1 to 7, researchers found that prior non-medical prescription opioid use, when compared to no use, was associated with an increased likelihood of subsequent heroin use (HR 3.18, 95% CI 1.68 to 6.02, p<0.001). Current alcohol use (HR 2.04, 95% CI 1.10 to 3.92) and other substance use (HR 1.54, 95% CI 0.92 to 2.62) were also associated with an increased likelihood of subsequent heroin use. This study therefore shows that prior non-medical prescription opioid use may be associated with subsequent heroin use in adolescence.

Click to read the study in JAMA Pediatrics

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