Does Adolescent Prescription Drug Abuse Predict Substance Abuse?

Prescription drug abuse (PDM) at any age carried a risk of developing symptoms of substance use disorders in adulthood – with some models posing greater threats – according to a new study.

In a sample of almost 27,000 people followed through adulthood, 45.7% reported PDM in the previous year at least once during the 32-year study period, and 40% reported poly-PDM (abuse of more than one class of prescription drugs in the same time period), Sean Esteban McCabe, PhD, of the University of Michigan School of Nursing in Ann Arbor, and his colleagues wrote in JAMA network open.

After interviewing respondents for the first time at the age of 18 (start of the 1976-1986 study) and following them until the age of 50 (2008-2018), the researchers were able to determine unique PDM trajectory models falling into three main categories: early peak trajectories (around 18 years old), later peak trajectories (around 40 years old) and a high risk trajectory (high frequency abuse at many ages) .

For a large portion of those who reported PDM in the previous year of any class of drug – opioids, stimulants, and tranquilizers or sedatives – their abuse peaked at age 18.

While all trajectories were related to symptoms of substance use disorder (SUD), some trajectories were stronger predictors than others. SUD symptoms were measured (at age 35, 40, 45, and 50) using DSM criteria for alcohol, cannabis, and other drug use disorders. .

People falling into the high-risk trajectory saw the greatest chance of developing symptoms of SUD in middle adulthood (adjusted odds ratio [aOR] 12.41, 95% CI 8.47-18.24) compared to those with an early peak trajectory. Overall, those people on the high-risk trajectory had an estimated prevalence of 94% for having at least two symptoms of SUD in their 40s.

Likewise, those with a later peak trajectory also had a higher risk of developing symptoms of SUD in their 40s compared to an early peak (aOR 5.17, 95% CI 3.97-6.73) .

“Most individuals who were classified as belonging to the PDM peak at age 40 or later had symptoms consistent with SUD in adulthood; furthermore, these PDM trajectories showed relatively strong increases until their peaks. “McCabe’s group noted.

“These peak PDM ages coincide with the highest rates of overdose involving prescription opioids, which affects people aged 45 to 54, followed closely by those aged 35 to 44,” they continued. . “Considering the age at which PDM occurs, as well as the frequency of abuse, is essential when assessing an individual’s risk for developing substance-related problems. “

Of all the trajectories, those whose PDM peaked early – especially at age 18 – had the lowest estimate of prevalence for two or more symptoms of SUD in midlife (48%) .

The group argued that “comprehensive screening for a history of substance use can alert clinicians to the subsequent risk of CDD and substance-related problems at specific ages and improve precision medicine efforts.”

Several baseline characteristics were also predictive of his PDM, McCabe’s group found. Abuse was significantly more common among those who smoked cigarettes or marijuana, and among those who drank alcohol. And when it comes to specific PDM trajectories, people who turned 18 in the mid-1980s were more likely to belong to later peak trajectories. On the flip side, teens in the mid-1970s were more likely to have an early peak.

Unsurprisingly, medical prescription drug use at age 18 was linked with a spike in abuse in young adults, but was also a common theme across all PDM trajectories.

People who identified as non-Hispanic black saw a lower risk of prescription drug abuse at any age.

For the cohort study, the researchers included 11 groups of adolescents from the Monitoring the Future study. All participants were first interviewed in grade 12 via self-administered questionnaires in classrooms with identical questions asked at each follow-up. About half of all participants identified as female and almost 80% of the sample was Caucasian. The cohort was representative of all regions and cities in the United States.

The authors recognized that the most important limitations of the study were the differential attrition and limitations of investigative measures that are often observed when dealing with large-scale prospective investigative studies of behavior. at high risk. The baseline response rate over the study period ranged from 77% to 84%, and the retention rate at age 32 was 53%.

  • Kara Grant joined the Enterprise & Investigative Reporting team at MedPage Today in February 2021. She covers psychiatry, mental health, and medical education. To follow

Disclosures

The study was funded by research grants and awards from the FDA, the National Institute on Drug Abuse, and the National Institutes of Health.

McCabe did not report any disclosures. Other co-authors have reported relationships with Arbor Pharmaceuticals, Ironshore, KemPharm, Vallon, the Gavin Foundation, Bay Cove Human Services, the National Football League, Major League Baseball, and White Rhino / 3D.


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