High school students with nonmedical opioid misuse may have an increased risk for heroin use later in life, according to research published in the Journal of Addiction Medicine.
“This national study is the first known to examine the transition from prescription opioid use and misuse during adolescence to adult heroin use,” Sean Esteban McCabe, PhD, a professor and director of the Center for the Study of Drugs, Alcohol, Smoking and Health in the department of health behavior and biological sciences at the University of Michigan School of Nursing, told Healio Primary Care. “It is a very timely study given the number of adolescents and young adults who were overprescribed opioids and who are now aging into adulthood.”
McCabe and colleagues conducted a prospective study using a nationally representative sample of adolescents from 25 cohorts of 12th-graders who participated in the Monitoring the Future study and completed self-administered questionnaires from 1976 to 2000. Participants were followed from 1993 through 2017, or from the ages of 18 years to 35 years.
McCabe and colleagues evaluated and compared the risk for any heroin use in subgroups based on adolescents’ opioid exposure: those with no lifetime exposure to prescription opioids; those with medical prescription opioid use with no history of nonmedical misuse; those who initially had medical opioid use and later had nonmedical misuse; those with nonmedical use followed by medical use; and those who only had nonmedical misuse of opioids.
The researchers found that among all 11,012 adolescents included in the study, heroin use was reported by 2.1% of those who reported no medical or nonmedical opioid exposure.
In comparison, McCabe and colleagues found that heroin use was reported by 3.7% (aOR = 1.65; 95% CI, 1.06-2.57) of those who reported medical use and did not have a history of nonmedical misuse, 5.5% (aOR = 1.93; 95% CI, 1.05-3.55) of those who reported nonmedical misuse after medical use, 15.1% (aOR = 4.30; 95% CI, 2.41-7.67) of those who reported nonmedical opioid misuse before medical use, and 16.4% (aOR = 5.52; 95% CI, 3.67-8.29) of those who reported only nonmedical prescription misuse.
The researchers determined that risk for heroin use was higher among adolescents in the 1997 to 2000 cohorts, with heroin use reported by 9.2% of those who reported nonmedical use after medical use, 21.6% of those who reported nonmedical opioid misuse before medical use, and 31.8% of those with nonmedical opioid use without medical use. They noted these associations were significantly stronger in the 1997 to 2000 cohorts compared with earlier groups.
“These findings indicate historical variation and reinforce the critical role of vigilant monitoring and drug screening to detect high-risk individuals who would benefit from an intervention to reduce later heroin use,” McCabe said.
McCabe said primary care physicians should closely screen and monitor patients with a history of prescription opioid misuse, as they are the most effective tools for detecting those who develop substance-abuse issues.
“The reality is that most people who misuse prescription opioids do not transition to heroin, but we need to use all the effective tools in our toolbox to detect the individuals early who are vulnerable to developing substance-related problems,” he said.
