National Longitudinal Study Charts Trajectories of Prescription Drug Misuse in the United States

A young male drug addict stealing prescriptions off the shelf of a pharmacy.
Investigators extracted data from 8 waves of the Monitoring the Future study, which annually surveyed approximately 17,000 US high school students starting in 1975.

Prescription drug misuse in adolescence is a strong risk factor for the development of substance use disorders in adulthood, according to study data published in the Lancet Psychiatry. Sean Esteban McCabe, PhD, from the Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, and colleagues followed 51,223 American adolescents from age 18 to 35 years.

Investigators extracted data from 8 waves of the Monitoring the Future study, which annually surveyed approximately 17,000 US high school students starting in 1975. After the baseline survey, 2450 students from each cohort were randomly selected to complete a biennial follow-up questionnaire. The present analytical sample comprised 21 cohorts of high school students who were surveyed over the course of 8 years: at 18 years, 19 to 20 years, 21 to 22 years, 23 to 24 years, 25 to 26 years, 27 to 28 years, 29 to 30 years, and 35 years of age.

Prescription drug misuse was measured at each wave, including type of substance and frequency of use. Substance use disorder symptoms were assessed when participants were 35 years of age. Survey data were used to create general trajectories of drug misuse. Adjusted odds ratios (ORs) were estimated for the relationship between prescription drug misuse trajectory and later substance use disorder. Analyses were adjusted for sociodemographic characteristics and other drug use covariates.

Among the participants (75.6% white; 48.3% men), 5 prescription drug misuse trajectories were identified: rare prescription drug misuse, peak at age 18 years, peak at ages 19 to 20 years, peak at ages 23 to 24 years, and peak at ages 27 to 28 years. Trajectories were similar across drug classes, except the later peak trajectory for sedatives and tranquilizers, which crested at an older age (35 years).

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Compared with the rare misuse trajectory, all other trajectories were associated with significantly increased odds of alcohol use disorder, cannabis use disorder, and other drug use disorder symptoms at age 35 years. Prescription drug misuse trajectories were all related to significantly higher chances of having 2 or more substance use disorder symptoms at age 35 years. Later peak trajectories carried the highest risk for substance use disorder symptoms.

Factors associated with the high-risk trajectories included heavy drinking in high school, cigarette smoking, marijuana use, misuse of multiple different prescriptions, and not having completed a 4-year university degree. Notably, black participants had significantly lower odds of belonging to the late-peak trajectories compared with white participants.

The study may be limited by the self-administered nature of the surveys and potential omission of high- and low-risk subgroups. The investigators wrote, “This national longitudinal multicohort study is, to the best of our knowledge, the first to examine prescription drug misuse trajectories involving prescription stimulants, opioids, and sedatives or tranquilisers from late adolescence to adulthood.”

They concluded, “The prevalence of prescription drug misuse is highest during late adolescence and young adulthood and these developmental periods remain important to intervene and prevent progression to severe consequences associated with prescription drug misuse.” Potential solutions involve adolescent education at the time of prescription and incentivizing proper drug disposal.


McCabe SE, Veliz PT, Dickinson K, Schepis TS, Schulenberg JE. Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: a national longitudinal multicohort study [published online September 11, 2019]. Lancet Psychiatry. doi:10.1016/S2215-0366(19)30299-8