Sep. 30 2016

Upswing in Prescription Opioid Use Disorder and Heroin Use Among Young Adults

Odds of prescription opioid use disorder rises 37 percent among adults age 18 to 25 who are nonmedical users

Researchers at Columbia University’s Mailman School of Public Health found there was an increase in the probability of having a prescription opioid use disorder in the past year among 18-to 34-year-old nonmedical prescription opioid users in 2014 compared to 2002. This is the first study to investigate time trends and increases over the last decade in prescription opioid use disorder, defined as meeting the criteria for DSM (clinical) abuse and dependence and needing treatment. Study participants included adolescents (12 to 17 years), emerging adults (18 to 25 years), and young adults (26 to 34 years) who used prescription opioids for nonmedical purposes.  Results are published online in the journal Addictive Behaviors.
 
Emerging adults had a 37 percent increase in the odds of having the disorder, and young adults doubled their odds from 11 percent to 24 percent. Among adolescents, the prevalence of prescription opioid use disorder remained relatively stable during the same period. Data originated from the 2002 to 2014 National Survey on Drug Use and Health.
 
The researchers also found a four-fold and nine-fold increase over time in the odds of heroin use among emerging adults and young adults who used opioids without a medical prescription, respectively. “We see an increasing trend from 2002 to 2014 among both groups,” noted first author Silvia Martins, MD, PhD, associate professor of Epidemiology.

The odds of past-year heroin use among emerging adults rose from 2 percent to 7 percent and from 2 percent to 12 percent among young adults. Nearly 80 percent of 12-to 21-year-olds who reported initiation of heroin use had previously started using prescription opioids between the ages of 13 and 18.
 
“Given this and the high probability of nonmedical use among adolescents and young adults in general, the potential development of prescription opioid use disorder among youth and young adults represents an important and growing public health concern,” noted Dr. Martins.
 
Overall, however, the past-year prevalence of nonmedical prescription opioid use significantly decreased from 2002 to 2014 among adolescents (from 8 percent to 5 percent), and emerging adults ages (from 11 percent to 8 percent), and remained unchanged among young adults at 6 percent.
 
“Our analyses present the evidence to raise awareness and urgency to address these rising and problematic trends among young adults,” said Dr. Martins. “While increases in prescription opioid use disorder might be rooted in health policy, medical practice, pharmaceutical industry interests, and patient behavior, it is critical that the general public, particularly youth, are informed about the related harms and disorders that can occur when prescription opioids are used without regular medical supervision.”
 
Co-authors are: Luis E. Segura, Julian Santaella-Tenorio, Alexander Perlmutter, and Katherine M. Keyes, all of the Mailman School of Public Health; Magdalena Cerdá, University of California, Davis; Miriam C. Fenton, Rutgers University Institute for Health; Lilian A. Ghandour, American University of Beirut; Carla L. Storr, University of Maryland School of Nursing; and Deborah S. Hasin, Mailman School of Public Health and New York State Psychiatric Institute and the Department of Psychiatry, Columbia University.
 
The study was supported by the national Institute on Drug Abuse DA031099; 1R01HD060072; 1R01DA037866-01; K01 AA021511, New York State Psychiatric Institute.
 
Dr. Hasin is principal investigator of a study on a measure of addiction to prescription opioids funded by InVentive Health Consulting, which combines support from nine pharmaceutical companies. The other authors declare no financial conflicts of interest.