Sleep Disturbance in Adolescence Associated With Opioid Misuse in Adulthood

Adolescent sleep deficiency as an increased future risk for prescription opioid misuse was examined in a large nationally, representative database designed to track health behaviors and outcomes from adolescence to early adulthood.

Sleep deficiency in adolescence may be an independent risk factor for the development of prescription opioid misuse, according to results of a study published in Sleep. Sleep deficiency is common among individuals with problematic opioid behaviors, but whether sleep problems precede or are caused by opioid use has not yet been determined.

To estimate the association between sleep deficiency in adolescence and subsequent prescription opioid misuse in adulthood, longitudinal data from 12,213 individuals (51% women) over a 12-year period were analyzed. Individuals were an average of 16±1.7 years of age at the start of the study and an average of 29±1.7 years of age at the final time point.

During adolescence, 59.2% of participants reported sleep deficiency. Prescription opioid misuse was defined as taking opioids that were not prescribed to that person, taking them in larger amounts than prescribed, taking them for longer periods than prescribed, or taking them only for the feeling or experience they caused.

When controlling for covariates, opioid misuse was more common among individuals who had reported insufficient sleep (P =.033), chronic unrestful sleep (P =.004), and insomnia symptoms (P =.032) during adolescence compared with those who did not. Short sleep duration was not significantly associated with prescription opioid misuse.

The results of this study showed a longitudinal association between sleep disturbances during adolescence and prescription opioid misuse in adulthood. There may be biological or psychological mechanisms underlying the directional impact of sleep deficiency in adolescence on future opioid misuse. The lack of connection between short sleep duration and future opioid misuse is odd in light of the fact that short sleep duration has previously been associated with an increased risk of other substance use behaviors.

Limitations to this study include the inability to determine a causal relationship between sleep disturbance in adolescence and future opioid misuse. In addition, self-report data is inherently biased and may be unreliable.

Future studies including objective sleep measurements and detailed information on opioid misuse are warranted.


Groenewald CB, Law EF, Rabbitts JA, Palermo T. Associations between adolescent sleep deficiency and prescription opioid misuse in adulthood. [published online September 26, 2020]. Sleep. doi: 10.1093/sleep/zsaa201