美国从青少年晚期到成年期过渡阶段的处方药滥用轨迹：一项全国性纵向多队列研究
Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: a national longitudinal multicohort study.
作者信息
McCabe Sean Esteban, Veliz Philip T, Dickinson Kara, Schepis Ty S, Schulenberg John E
机构信息
Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, MI, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, MI, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA; School of Nursing, University of Michigan, Ann Arbor, MI, USA.
出版信息
Lancet Psychiatry. 2019 Oct;6(10):840-850. doi: 10.1016/S2215-0366(19)30299-8. Epub 2019 Sep 11.
BACKGROUND
Prescription drug misuse is most prevalent during young adulthood (ages 18-25 years). We aimed to identify prescription drug misuse trajectories for three drug classes (opioids, stimulants, and sedatives or tranquilisers) from adolescence into adulthood, assess the extent to which different trajectories are associated with symptoms of substance use disorder, and identity factors associated with high-risk prescription drug misuse trajectories.
METHODS
For this longitudinal multicohort study, nationally representative probability samples of 51 223 adolescents in the USA were followed up across eight waves from age 18 years (cohorts 1976-96) to age 35 years. Data were collected via self-administered paper questionnaires.
FINDINGS
Five prescription drug misuse trajectories were identified and the defining characteristic that differentiated the five trajectories was the age when past-year prescription drug misuse high frequency peaked: rare or no misuse at any age, peak at age 18 years, peak at ages 19-20 years, peak at age 23-24 years, and peak at ages 27-28 years. Similar prescription drug misuse trajectories were identified for each prescription drug class. The later peak misuse trajectory for sedatives and tranquilisers crested at an older age (35 years) than that for the other drug classes. Prescription drug misuse trajectories were all associated with significantly greater odds of having two or more substance use disorder symptoms at age 35 years, especially the later peak trajectories. In controlled analyses, risk factors associated with the high-risk latest peak prescription drug misuse trajectory included high school heavy drinking, cigarette smoking, marijuana use, poly-prescription drug misuse, white race, and not completing a 4-year university degree.
INTERPRETATION
Prescription drug misuse trajectories are heterogeneous, and any high-frequency prescription drug misuse is a strong risk factor for development of substance use disorders during adulthood, especially later-peak prescription drug misuse trajectories. These findings might help practitioners identify individuals at greatest risk for substance use disorders and target intervention strategies.
FUNDING
National Institute on Drug Abuse, National Institutes of Health.
背景
处方药滥用在青年期（18 - 25岁）最为普遍。我们旨在确定从青春期到成年期三种药物类别（阿片类药物、兴奋剂以及镇静剂或 tranquilizers）的处方药滥用轨迹，评估不同轨迹与物质使用障碍症状的关联程度，并确定与高风险处方药滥用轨迹相关的因素。
方法
在这项纵向多队列研究中，对美国51223名青少年具有全国代表性的概率样本进行了跟踪，从18岁（1976 - 1996年队列）到35岁进行了八轮随访。数据通过自行填写的纸质问卷收集。
结果
确定了五条处方药滥用轨迹，区分这五条轨迹的定义特征是过去一年处方药滥用高频峰值出现的年龄：任何年龄都很少或没有滥用、18岁达到峰值、19 - 20岁达到峰值、23 - 24岁达到峰值以及27 - 28岁达到峰值。每种处方药类别都确定了类似的处方药滥用轨迹。镇静剂和tranquilizers的后期峰值滥用轨迹达到峰值的年龄（35岁）比其他药物类别更大。处方药滥用轨迹在35岁时都与出现两种或更多物质使用障碍症状的显著更高几率相关，尤其是后期峰值轨迹。在对照分析中，与高风险最晚峰值处方药滥用轨迹相关的风险因素包括高中时大量饮酒、吸烟、使用大麻、多种处方药滥用、白人种族以及未完成四年制大学学位。
解读
处方药滥用轨迹是异质性的，任何高频处方药滥用都是成年期物质使用障碍发展的强大风险因素，尤其是后期峰值处方药滥用轨迹。这些发现可能有助于从业者识别物质使用障碍风险最高的个体，并确定干预策略的目标。
资助
美国国立卫生研究院药物滥用研究所。
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