Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor.
Institute for Social Research, University of Michigan, Ann Arbor.
JAMA Netw Open. 2022 Jan 4;5(1):e2141995. doi: 10.1001/jamanetworkopen.2021.41995.
US adults born from 1965 to 1996 had high exposure to controlled medications, yet little is known about how this exposure has affected them over time. Prescription drug misuse (PDM) has increased among adults in the past 2 decades, with related increases in emergency department visits, overdoses, and deaths.
To identify 32-year PDM trajectories involving opioids, stimulants, and sedatives or tranquilizers and to examine associations between these PDM trajectories and substance use disorder (SUD) symptoms in adulthood as well as between baseline characteristics and PDM trajectories.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 11 cohorts of adolescents who were followed up longitudinally from age 18 years (study start, 1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study, which included a national multistage random sample of US 12th grade students. Baseline surveys (modal age 18) were self-administered in classrooms. Ten follow-ups were conducted by mail. Data analysis was conducted from December 2020 to October 2021.
Sociodemographic variables were measured at baseline. PDM and SUD symptoms were measured at baseline and every follow-up. Latent profile analysis (LPA) was used to create PDM trajectory profiles. Associations between these PDM trajectories, SUD symptoms, and baseline sociodemographic characteristics were examined.
The sample of 26 575 individuals was 50.8% (95% CI, 50.2%-51.4%) female and 79.3% (95% CI, 78.8%-79.8%) White. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. In adjusting for attrition, 45.7% (95% CI, 44.9%-46.4%) of the respondents reported past-year PDM at least once during the 32-year reporting period. Among those who reported PDM, the prevalence of poly-PDM was 40.3% (95% CI, 39.3%-41.3%). Based on LPA, the number of class-specific PDM trajectories ranged from 4 (prescription opioids) to 6 (prescription stimulants). For the class-combined analyses, we identified 8 PDM trajectories consisting of early peak trajectories (eg, age 18 years), later peak trajectories (eg, age 40 years), and a high-risk trajectory (eg, high frequency PDM at multiple ages). All PDM trajectories were associated with increased odds of developing SUD symptoms in middle adulthood, especially the later peak and high-risk trajectories compared with early peak trajectories (eg, peak at age 40 years: adjusted odds ratio [aOR], 5.17; 95% CI, 3.97-6.73; high-risk: aOR, 12.41; 95% CI, 8.47-18.24). Baseline characteristics associated with a high-risk trajectory were binge drinking (aOR, 1.69; 95% CI, 1.13-2.54), cigarette smoking (aOR, 2.30; 95% CI, 1.60-3.29), and marijuana use (aOR, 3.78; 95% CI, 2.38-6.01). More recent cohorts (eg, 1985-1986) had a higher risk of belonging to later peak PDM trajectories (ages 40 and 45 years) than the 1976-1978 cohort (age 40 years peak: aOR, 2.49; 95% CI, 1.69-3.68).
In this cohort study, adults with later peak PDM trajectories were at increased risk of SUD symptoms in middle adulthood. These findings suggest the need to screen for PDM and SUD from adolescence through middle adulthood.
1965 年至 1996 年出生的美国成年人曾大量接触过管制药物，但关于这种接触对他们随时间推移产生的影响知之甚少。在过去的 20 年里，成年人中药物滥用（PDM）的现象有所增加，相关的急诊就诊、过量用药和死亡人数也有所增加。
确定涉及阿片类药物、兴奋剂和镇静剂或安定剂的 32 年 PDM 轨迹，并研究这些 PDM 轨迹与成年期物质使用障碍（SUD）症状之间的关联，以及与基线特征和 PDM 轨迹之间的关联。
设计、地点和参与者：这项队列研究包括 11 项青少年队列，他们从 18 岁（研究开始，1976-1986 年）开始纵向跟踪到 50 岁（2008-2018 年），该研究在监测未来（MTF）研究中进行，该研究包括全国多阶段随机抽样的美国 12 年级学生。基线调查（模态年龄 18 岁）在教室里进行自我管理。通过邮件进行了 10 次随访。数据分析于 2020 年 12 月至 2021 年 10 月进行。
在基线时测量了社会人口统计学变量。在基线和每次随访时测量了 PDM 和 SUD 症状。使用潜在剖面分析（LPA）创建 PDM 轨迹图。研究了这些 PDM 轨迹、SUD 症状与基线社会人口统计学特征之间的关系。
共有 26575 名个体参加了研究，其中 50.8%（95%CI，50.2%-51.4%）为女性，79.3%（95%CI，78.8%-79.8%）为白人。基线应答率范围为 77%至 84%，32 年保留率为 53%。在考虑到流失的情况下，45.7%（95%CI，44.9%-46.4%）的受访者在 32 年的报告期间至少报告过一次过去一年的 PDM。在报告 PDM 的人群中，多药滥用的患病率为 40.3%（95%CI，39.3%-41.3%）。基于 LPA，特定药物的 PDM 轨迹数量从 4 种（处方阿片类药物）到 6 种（处方兴奋剂）不等。对于组合分析，我们确定了 8 种 PDM 轨迹，包括早期高峰轨迹（例如，18 岁）、后期高峰轨迹（例如，40 岁）和高危轨迹（例如，多个年龄的高频率 PDM）。所有 PDM 轨迹都与成年中期 SUD 症状发生的几率增加有关，尤其是与早期高峰轨迹相比，后期高峰和高危轨迹的关联更大（例如，高峰年龄 40 岁：调整后的优势比[OR]，5.17；95%CI，3.97-6.73；高危：OR，12.41；95%CI，8.47-18.24）。与高危轨迹相关的基线特征包括狂欢性饮酒（OR，1.69；95%CI，1.13-2.54）、吸烟（OR，2.30；95%CI，1.60-3.29）和大麻使用（OR，3.78；95%CI，2.38-6.01）。较新的队列（例如，1985-1986 年）比 1976-1978 年队列（高峰年龄 40 岁：OR，2.49；95%CI，1.69-3.68）更有可能属于后期高峰 PDM 轨迹。
在这项队列研究中，后期高峰 PDM 轨迹的成年人在成年中期出现 SUD 症状的风险增加。这些发现表明，从青春期到成年中期都需要对 PDM 和 SUD 进行筛查。
