Teens and young adults who smoke or use alcohol, marijuana, and other non-prescription substances are more likely than non-smokers and drinkers to misuse opioids, according to a survey of more than 100,000 individuals age 12 to 25.

While studies on opioid use abound, the researchers wanted to look at the overlap in youth and young adults who misuse opioids instead of, or in addition to, other drugs. They published their findings in Family Medicine and Community Health.

The researchers used data from the National Survey of Drug Use and Health (NSDUH). The analysis included youth aged 12-17 and adults aged 18 to 25. The sample sizes were 54,866 for youth and 55,690 for young adults.


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The researchers assessed past-year use, medical use, and misuse of opioids, stimulants, tranquilizers, and sedatives. The researchers also assessed past 30-day and past-year use of non-prescription substances, including alcohol, tobacco, marijuana, cocaine, heroin, inhalants, and hallucinogens.

Among youth, 25% used at least one of the psychoactive prescription medications assessed; 5.7% used at least 2 in the past year. Of those who used any psychoactive prescription medication, 20.9% reported misuse. Of the youth that used more than one medication, 46.1% reported misuse.

Among adults, 41% used at least one of the psychoactive prescription medications assessed; 13.4% used at least 2 in the past year. Of those who used any psychoactive prescription medication, 34.7% reported misuse. Of the youth that used more than one medication, 60.7% reported misuse.

Recent use of non-prescription substances was strongly associated with misuse of psychoactive prescription medications. Compared with those who never used a non-prescription substance, corresponding prevalence ratios for the past ≤30 days, ≤12 months, >12 months were as follows: misuse of opioids (adjusted prevalence ratios (APRs)=8.26, 2.75 and 2.41 (all statistically significant)), stimulants (APRs=34.42, 6.11 and 1.83 (first 2 statistically significant)), tranquilizers (APRs=27.42, 5.66 and 2.93 (all statistically significant)) and sedatives (APRs=5.79, 1.62 and 1.52 (first statistically significant)).

Limitations of this study included its cross-sectional design and self-reported measures. Also, the term “misuse” is broad. In addition, the time frame in which certain variables were measured was not clear.

“Having serious psychological distress was consistently associated with misuse of every assessed psychoactive prescription medication,” the researchers noted. “Mental health and medical providers would benefit from using a team approach and having open communication with other healthcare providers to ensure evidence-based guidelines are used when assessing for and treating mental health and substance use difficulties.”

Reference

Agaku I, Odani S, Nelson J. Medical use and misuse of psychoactive prescription medications among US youth and young adults. Fam Med Community Health. 2021 Jan;9(1):e000374. doi:10.1136/fmch-2020-000374