Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing University of Michigan, Ann Arbor, MI (SEM, CJB, RJEP, VVM, PTV); Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI (SEM, CJB, PTV); Institute for Social Research, University of Michigan, Ann Arbor, MI (SEM, JES, PTV); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (SEM); Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI (CJB); Department of Psychiatry, University of Michigan, Ann Arbor, MI (VVM); Department of Surgery, Medical School, University of Michigan, Ann Arbor, MI (VVM); Department of Psychology, University of Michigan, Ann Arbor, MI (JES).
J Addict Med. 2021;15(3):241-244. doi: 10.1097/ADM.0000000000000741.
To examine the longitudinal relationships between US adolescents' prescription opioid use and misuse and any subsequent heroin use in adulthood.
Nationally representative samples of adolescents from 25 independent cohorts were surveyed via self-administered questionnaires and followed from ages 18 to 35 (n = 11,012). Adolescents were divided into 5 subgroups based on survey responses at age 18: no lifetime exposure to prescription opioids (population controls), medical prescription opioid use without a history of nonmedical misuse (medical use only), medical use followed by nonmedical misuse, nonmedical misuse followed by medical use, and nonmedical misuse only. These 5 subgroups were compared on their risk for any heroin use through age 35 (1993-2017). Adolescents who reported lifetime heroin use at age 18 were excluded.
Adolescents who reported nonmedical prescription opioid misuse followed by medical use or nonmedical misuse only had greater odds of any heroin use in adulthood than population controls. More recent cohorts of adolescents who reported nonmedical misuse or medical use only (compared to older cohorts) had greater odds of any heroin use in adulthood relative to population controls. Nearly 1 in 3 adolescents in recent cohorts who reported nonmedical prescription opioid misuse transitioned to any heroin use.
There is increased risk for heroin use among adolescents who initiated nonmedical misuse or adolescents prescribed opioids in more recent cohorts. 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.
研究美国青少年处方类阿片使用和滥用与成年后任何后续海洛因使用之间的纵向关系。
通过自我管理问卷对 25 个独立队列的全国代表性青少年样本进行调查，并从 18 岁随访至 35 岁（n=11012）。根据 18 岁时的调查回答，将青少年分为 5 个亚组：从未接触过处方类阿片（人群对照）、有医疗用途但无非医疗滥用史的处方类阿片使用（仅医疗使用）、医疗使用后出现非医疗滥用、非医疗滥用后出现医疗使用和仅非医疗滥用。通过比较到 35 岁时（1993-2017 年）任何海洛因使用的风险，对这 5 个亚组进行比较。排除在 18 岁时报告有终身海洛因使用史的青少年。
报告非医疗处方类阿片滥用后出现医疗使用或仅非医疗滥用的青少年在成年后使用海洛因的可能性大于人群对照。与年龄较大的队列相比，报告非医疗滥用或仅医疗使用的最近队列的青少年在成年后使用海洛因的可能性更大。在最近的队列中，近三分之一报告非医疗处方类阿片滥用的青少年已经过渡到使用任何海洛因。
对于开始非医疗滥用或在最近队列中开处阿片类药物的青少年，海洛因使用风险增加。这些发现表明存在历史差异，并强化了加强监测和药物筛查以发现高危人群的重要性，高危人群可能受益于减少后期海洛因使用的干预措施。
