Drug-Naive Teenagers at Greater Risk for Opioid Misuse

Susan London

October 26, 2015

Adolescents who used legitimately prescribed opioids before the 12th grade had an overall 33% greater risk for future opioid misuse, and this risk was surprisingly greatest among those who had little to no drug experience or who strongly disapproved of marijuana use, according to a longitudinal cohort study published online October 26 in Pediatrics.

In drug-naive individuals, it is likely that "the initial experience of pain relief is pleasurable, and a safe initial experience with opioids may reduce perceived risk," write Richard Miech, PhD, from the Survey Research Center, University of Michigan, Ann Arbor, and colleagues.

"Clinic-based education and prevention efforts have substantial potential to reduce future opioid misuse among these individuals, who begin opioid use with strong attitudes against illegal drug use," they add.

"This increase in the future risk of opioid misuse should be considered when determining the risks and benefits of opioid prescriptions to youth."

The investigators studied 6220 teenagers surveyed in school in the 12th grade to identify risk factors for opioid misuse, defined as nonmedical use of a prescription opioid, at ages 19 to 23 years. The students completed questionnaires that asked whether they had ever taken any narcotics other than heroin without a physician's instruction and were provided with a list of examples. If they responded yes, they were asked to select from a list of reasons they had done so.

In adjusted analyses, teenagers given a legitimate prescription for opioids before the 12th grade were significantly more likely to misuse opioids at follow up (relative risk, 1.33). The elevation of risk was greatest among teenagers who had reported more frequent past use of marijuana and cigarettes, misuse of prescription opioids, and misuse of prescription barbiturates and sedatives, and those who did not disapprove of regular marijuana use.

However, when the researchers stratified participants into eight groups according to their baseline probability of future opioid misuse, based on currently known risk factors, and compared those who received a legitimate prescription vs those who did not, the concentration of risk shifted. The relatively drug-naive individuals with a low, 1.75% to 3% probability of misuse actually had a threefold higher risk for future misuse if they were given a prescription (risk ratio, 3.01). In addition, risk was nearly doubled for those with a baseline probability of from 3% to less than 5% (risk ratio, 1.95). In contrast, receipt of a prescription did not significantly increase risk for teenagers in groups having a higher baseline probability of future misuse.

Overall, 69% of teenagers who reported misusing opioids at follow-up said they do so to feel good or get high or to relax or relieve tension.

Here again, teenagers having a low, 1.75% to 3% baseline probability of future opioid misuse had a nearly threefold higher risk of misusing for these reasons if they had been given an opioid prescription by the 12th grade (risk ratio, 2.7). None of the other groups had a significantly elevated risk.

This study is the first population-based estimate on the risk for future opioid misuse among teenagers with little drug experience and who disapprove of illegal drug use.

"Novelty of drug use effects may help explain why an opioid prescription predicts future opioid misuse most strongly among individuals with little to no experience with use of illegal drugs," the investigators suggest.

"In contrast, among individuals with more extensive drug experience, the legitimate use of prescription opioids may be expected to make relatively less of an impression in comparison with the other controlled substances they have used."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online October 26, 2015.

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