Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
School of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; School of Psychology, Bangor University, Bangor, United Kingdom; School of Community and Global Health, Claremont Graduate University, Claremont, CA, United States.
Prev Med. 2021 Feb;143:106383. doi: 10.1016/j.ypmed.2020.106383. Epub 2020 Dec 24.
In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.
近年来，美国超过一半的药物过量死亡与阿片类药物有关。为了解决这一流行问题，必须确定阿片类药物滥用的前兆，并通过实证加以验证。本研究的目的是检验在滥用物质流行率较高的弱势群体中，青少年的非法药物使用是否与非处方阿片类药物的使用存在前瞻性关联。在加利福尼亚州南部的 29 所替代高中中，对 1060 名青少年进行了一项基于人群的队列研究，为期两年。共有 929 名青少年（平均年龄 17.5 岁，49.9%为女性，76.4%为西班牙裔）在基线评估时没有尝试过非处方阿片类药物，他们被纳入分析样本。结果是在两年内自我报告使用非处方阿片类药物。测试的预测因子是非法药物使用、非法药物使用（不包括大麻）和非医用大麻的使用。协变量包括年龄、性别、种族、社会经济地位、父母教育程度、周收入、感觉寻求、压力、焦虑、抑郁以及酒精和尼古丁产品的使用。多层次、协变量调整的逻辑回归模型表明，使用非法药物或非法药物（不包括大麻）的青少年尝试非处方阿片类药物的几率更高。单独使用非医用大麻在未调整的模型中是一个具有统计学意义的预测因子，但在协变量调整的模型中则不然。虽然先前的研究已经检验了从尼古丁、酒精和大麻使用到非处方阿片类药物使用的进展，但本研究结果强调了非法药物使用作为未来阿片类药物滥用的可检测和经验支持的风险因素的重要性。
