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      Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults.

          Methods and findings

          This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12–17 years of age) and 28,213 young adults (18–25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0–28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4–21.6) of adolescents and 32.2% (95% CI 31.4–33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5–4.0) and 2,207 young adults (7.8%; 95% CI 7.3–8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals.

          Conclusions

          Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.

          Abstract

          Joel Hudgins and coworkers study reported use and misuse of prescription opioids and other substances among adolescents and young adults in the United States.

          Author summary

          Why was this study done?
          • Prescription opioid misuse is a leading cause of unintentional injury and death among adolescents and young adults.

          • There is limited information on the source of prescription opioids among adolescents and young adults or whether those misusing prescription opioids engage in use of additional substances and drugs of abuse.

          • Understanding these factors will inform strategies to ensure judicious opioid prescribing and effective treatment approaches.

          What did the researchers do and find?
          • Using the National Survey on Drug Use and Health for the years 2015 and 2016, we determined past-year prevalence of prescription opioid use, sources of prescription opioids, and additional substance use among adolescents and young adults ages 12–25.

          • We found that 27.5% of respondents, corresponding to an estimated 32.8 million individuals, used prescription opioids in the previous year, including 21.0% of adolescents and 32.2% of young adults.

          • The prevalence of opioid misuse was 3.8% among adolescents and 7.8% among young adults.

          • Most individuals misusing prescription opioids obtained them for free from a friend or relative or from a single prescriber.

          • Individuals with prescription opioid misuse reported high prevalence of use of other substances, including cocaine, hallucinogens, heroin, and inhalants.

          What do these findings mean?
          • The prevalence of prescription opioid use is high among adolescents and young adults in the United States despite known risks for progression to opioid and other substance use disorders in this population.

          • Prevention and treatment efforts should take into account that adolescents and young adults misusing prescription opioids obtain these drugs most commonly from friends and relatives or from a single prescriber.

          • Healthcare providers should consider screening all adolescents and young adults with opioid misuse for additional substance use and should have established intervention plans available to maximize the opportunity to provide substance use treatment to this population.

          Related collections

          Most cited references 32

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          Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015.

          The U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999-2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid (1). Illicit opioids are contributing to the increase in opioid overdose deaths (2,3). In an effort to target prevention strategies to address the rapidly changing epidemic, CDC examined overall drug overdose death rates during 2010-2015 and opioid overdose death rates during 2014-2015 by subcategories (natural/semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone).* Rates were stratified by demographics, region, and by 28 states with high quality reporting on death certificates of specific drugs involved in overdose deaths. During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states. A multifaceted, collaborative public health and law enforcement approach is urgently needed. Response efforts include implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (4), improving access to and use of prescription drug monitoring programs, enhancing naloxone distribution and other harm reduction approaches, increasing opioid use disorder treatment capacity, improving linkage into treatment, and supporting law enforcement strategies to reduce the illicit opioid supply.
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            • Record: found
            • Abstract: not found
            • Article: not found

            Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health

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              • Record: found
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              • Article: not found

              Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013.

              Since 1999, the United States has experienced increases in morbidity and mortality associated with nonmedical use of prescription opioids.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: SoftwareRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                5 November 2019
                November 2019
                : 16
                : 11
                Affiliations
                [1 ] Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
                [2 ] Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
                [3 ] Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
                Massachusetts General Hospital, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Article
                PMEDICINE-D-19-01617
                10.1371/journal.pmed.1002922
                6830740
                31689290
                © 2019 Hudgins et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 4, Pages: 15
                Product
                Funding
                Funded by: Burroughs Wellcome Fund
                Award ID: 1017627
                Award Recipient :
                FTB is supported by the Burroughs Wellcome Fund ( https://www.bwfund.org/), grant number 1017627. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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