Advertisement

Prescription Opioid Misuse Associated With Risk Behaviors Among Adolescents

  • Heather B. Clayton
    Correspondence
    Address correspondence to: Heather B. Clayton, PhD, MPH, Survey Operations and Dissemination Team, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail Stop E-75, Atlanta GA 30329.
    Affiliations
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Michele K. Bohm
    Affiliations
    Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Richard Lowry
    Affiliations
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Carmen Ashley
    Affiliations
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Kathleen A. Ethier
    Affiliations
    Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author

      Introduction

      With the ongoing opioid overdose epidemic in the U.S., it is important to explore how prescription opioid misuse correlates with health behaviors that increase the risk for adverse health outcomes among adolescents. The objective of this study is to determine if lifetime nonmedical use of prescription opioids is associated with health risk behaviors among adolescents.

      Methods

      Data from the 2017 nationally representative Youth Risk Behavior Survey (14,765 high school students in Grades 9–12) were used to explore associations between lifetime nonmedical use of prescription opioids and 29 health risk behaviors. Logistic regression models (adjusted for sex, race/ethnicity, grade, and sexual identity) estimated adjusted prevalence ratios and 95% CIs. Analyses were completed in 2018.

      Results

      Nonmedical use of prescription opioids was associated with all but 1 of the health risk behaviors included in the analyses. Substance use ranged from adjusted prevalence ratio=2.46 (current alcohol use) to adjusted prevalence ratio=17.52 (heroin use); violence victimization from adjusted prevalence ratio=1.80 (bullied at school) to adjusted prevalence ratio=3.12 (threatened or injured with a weapon); suicidal thoughts/behaviors from adjusted prevalence ratio=2.23 (considered suicide) to adjusted prevalence ratio=3.45 (attempted suicide); and sexual behavior from adjusted prevalence ratio=1.06 (did not use a dual pregnancy prevention method) to adjusted prevalence ratio=3.42 (4 or more sexual partners). Poor academic performance (adjusted prevalence ratio=1.53), receiving an HIV test (adjusted prevalence ratio=1.77), and having persistent feelings of sadness/hopelessness (adjusted prevalence ratio=1.80) were also associated with nonmedical use of prescription opioids.

      Conclusions

      Nonmedical use of prescription opioids is associated with many health risk behaviors. Opportunities to reduce nonmedical use of prescription opioids include screening pediatric patients for opioid use disorder, improved prescribing practices, and, from a primary prevention perspective, integrated evidence-based health education programs in schools.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Case A
        • Deaton A
        Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.
        Proc Natl Acad Sci USA. 2015; 112: 15078-15083
        • Paulozzi LJ
        • Jones CM
        • Mack KA
        • Rudd RA
        Vital Signs: overdoses of prescription opioid pain relievers – United States, 1999‒2008.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1487-1492
        • Johnson K
        • Jones C
        • Compton W
        • et al.
        Federal response to the opioid crisis.
        Curr HIV AIDS Rep. 2018; 15: 293-301
        • Edlund MJ
        • Martin BC
        • Fan M-Y
        • et al.
        Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study.
        Drug Alcohol Depend. 2010; 112: 90-98
        • McCabe SE
        • West BT
        • Morales M
        • Cranford JA
        • Boyd CJ
        Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study.
        Addiction. 2007; 102: 1920-1930
        • McCabe SE
        • West BT
        • Wechsler H
        Trends and college-level characteristics associated with the non-medical use of prescription drugs among U.S. college students from 1993 to 2001.
        Addiction. 2007; 102: 455-465
        • Jordan AE
        • Blackburn NA
        • Des Jarlais DC
        • Hagan H
        Past-year prevalence of prescription opioid misuse among those 11 to 30 years of age in the United States: a systematic review and meta-analysis.
        J Subst Abus Treat. 2017; 77: 31-37
        • McCabe SE
        • Veliz PH
        • Schulenberg JE
        Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study.
        Pain. 2016; 157: 2173-2178
        • Palamar JJ
        • Shearston JA
        • Dawson EW
        • Mateu-Gelabert P
        • Ompad DC
        Nonmedical opioid use and heroin use in a nationally representative sample of U.S. high school seniors.
        Drug Alcohol Depend. 2016; 158: 132-138
        • Cerdá M
        • Santaella J
        • Marshall BD
        • Kim JH
        • Martins SS
        Nonmedical prescription opioid use in childhood and early adolescence predicts transitions to heroin use in young adulthood: a national study.
        J Pediatr. 2015; 167 (605‒612.e2)
        • Brener ND
        • Kann L
        • Shanklin S
        • et al.
        Methodology of the youth risk behavior surveillance system−2013.
        MMWR Recomm Rep. 2013; 62: 1-23
        • Brener ND
        • Kann L
        • McManus T
        • et al.
        Reliability of the 1999 Youth Risk Behavior Survey questionnaire.
        J Adolesc Health. 2002; 31: 336-342
        • Edlund MJ
        • Forman-Hoffman VL
        • Winder CR
        • et al.
        Opioid abuse and depression in adolescents: results from the National Survey on Drug use and Health.
        Drug Alcohol Depend. 2015; 152: 131-138
        • McCabe SE
        • Veliz P
        • Patrick ME
        High-intensity drinking and nonmedical use of prescription drugs: results from a national survey of 12th grade students.
        Drug Alcohol Depend. 2017; 178: 372-379
        • Jessor R
        • Jessor SL
        Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth.
        Academic Press, New York, NY1977
        • Knight JR
        Substance use, abuse, and dependence and other risk taking behaviors.
        in: Carey WB Crocker AC Feldman HM Developmental-Behavioral Pediatrics. 4th edition. Elsevier, Philadelphia, PA2009
        • Felitti VJ
        • Anda RF
        • Nordenberg D
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study.
        Am J Prev Med. 1998; 14: 245-258
        • Hodder RK
        • Freund M
        • Wolfenden L
        • et al.
        Systematic review of universal school-based ‘resilience’ interventions targeting adolescent tobacco, alcohol or illicit substance use: a meta-analysis.
        Prev Med. 2017; 100: 248-268
      1. Stone D, Holland K, Bartholow B, et al. Preventing suicide: a technical package of policy, programs, and practices. www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf. Accessed August 24, 2018.

        • Griffin KW
        • Botvin GJ
        Evidence-based interventions for preventing substance use disorders in adolescents.
        Child Adolesc Psychiatr Clin N Am. 2010; 19: 505-526
        • Kann L
        • McManus T
        • Harris WA
        • et al.
        Youth risk behavior surveillance — United States, 2017.
        MMWR Surveill Summ. 2018; 67: 1-114
      2. Johnston LD, Miech RA, O'Malley PM, et al. Monitoring the Future national survey results on drug use, 1975-2017: Overview, key findings on adolescent drug use. https://doi.org/10.3998/2027.42/148123.

        • National Survey on Drug Use and Health
        Source of the last pain reliever that was misused.
        Published 2016
        • Harbaugh CM
        • Lee JS
        • Mei Hu H
        • et al.
        Persistent opioid use among pediatric patients after surgery.
        Pediatrics. 2018; 141e20172439