Responding to what has been termed a “public health crisis” and even an “epidemic” in the United States, a new study examines the magnitude of recent prescriptions, opioid use, and drug abuse among adolescents and young adults. Results from the retrospective analysis of data from the National Survey on Drug Use and Health (NSDUH), published in PLoS Medicine, provide insight into trends and numerous entry points for both prevention and intervention efforts.
The researchers out of Boston Children’s Hospital and Harvard Medical School, Joel D. Hudgins, John J. Porter, Michael C. Monuteaux, and Florence T. Bourgeois, found that 3.8% of adolescents and 7.8% of young adults reported past-year opioid misuse between 2015 and 2016. Approximately one-fifth of adolescents and one-third of young adults had used prescription opioid use within the year. Of individuals misusing prescription opioids, most had gotten them without having to pay from a friend, relative, or provider.
“The prevalence of prescription opioid use is high among adolescents and young adults in the United States despite known risks for progression to opioid and other substance use disorders in this population.”
The authors highlight the drastic increase in associated opioid deaths in the US within the past twenty years. As summarized in this 2017 MIA article, a multitude of intersecting factors have contributed to these trends, including the promotion of opioids in the 80s and 90s as nonaddictive, liberal practices in prescription, efforts to make pills more difficult to crush and snort that increased preferences for injection, and more.
Additionally, heroin maintained a destructive presence in predominately Black communities for decades but was historically regarded in terms of crime as opposed to a broader public health crisis. Increases in heroin use among White youth and young adults has prompted an outcry, garnering attention in public health to patterns previously overlooked and illuminating prejudicial public discourse.
Paradoxically, research has also shown that the heightened awareness of increases in opioid accessibility and misuse has led to a “crackdown” on prescription, translating to forced tapering for some individuals contending with chronic pain. Although opioids can be highly addictive, have been linked to depression, and in some instances may contribute to chronic pain, they are an outlet for pain management for many suffering from chronic conditions, and abrupt discontinuation has its own risks. This topic sensitive, fraught, and multifaceted, and related research requires respect for its complexity.
“Opioid misuse in adults has been linked to several risk factors, including mood and anxiety disorders, male gender, educational attainment, and age at first misuse. Among adolescents and young adults, data are sparser and less consistent, although the prevalence of opioid use disorder appears to be steadily increasing.”
The authors aimed to analyze adolescent and young adult trends in opioid prescription, use, misuse, other substance use patterns, and means of opioid procurement to enhance the relatively vague picture previously available. 2015 to 2016 NSDUH dataset reflected publicly available self-report information regarding drug use, mental health, and other health-related issues from nearly 30 thousand adolescents (aged 12 to 17) and approximately 30 thousand young adults (aged 18 to 25).
Porter, Monuteaux, and Bourgeois used descriptive statistics and stratification of prescription patterns according to use, misuse, as well as sources of access to prescription opioids stratified by the same characteristics to analyze the data. Despite the limitations of compromised reliability related to the sensitive subject matter of survey questions, and the absence of data to reflect trends over time, results have important public health implications.
Findings suggest that most adolescents and young adults who had reported past-year use had opioid prescriptions. In instances of past year misuse, reported by nearly 4% of adolescents and twice as many young adults, opioids had been obtained through friends and family, sometimes an individual prescriber, but not from dealers or multiple prescribers. Both adolescents and young adults who reported past-year opioid misuse were much more likely to report misuse of other substances and drugs “with a third or more reporting prior use of cocaine, hallucinogens, and inhalants and a half or more reporting past-month use of tobacco, alcohol, or cannabis.”
Authors emphasize the importance of prevention initiatives accounting for opioid access in the home and young people’s immediate social circles. They also suggest systematically screening for substance, and drug use could improve awareness of trends and opportunities to intervene, although it remains yet unclear how such a program could be linked to supportive intervention. Further research is needed to continue to establish a more detailed understanding of trends and opportunities for related supports.
“Our findings 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. Prevention and treatment efforts should take into account that greater than half of adolescents and young adults misusing prescription opioids obtain these drugs from friends and relatives.”
Hudgins, J. D., Porter, J. J., Monuteaux, M. C., & Bourgeois, F. T. (2019). Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLOS Medicine, 16(11). DOI: 10.1371/journal.pmed.1002922 (Link)