Prescribed Opioid Use May Lead to Nonmedical Use by Adolescents

Nonmedical use of prescription opioids is associated with prescribed use among adolescents, but the relationship has not been clearly elucidated. This study used independent cross-sectional data from the nationally representative Monitoring the Future survey to investigate trends in medical and nonmedical use of opioids by US high school seniors from 1976 to 2015.

  • Peaks in lifetime prevalence of opioid prescription occurred in 1989 and 2002 and remained high until a decline starting in 2013.
  • Nonmedical use of opioids was associated with medical use for the entire duration of the study.
  • Medical use of opioids was significantly more likely to precede nonmedical use among adolescents who reported both.

Comments: Medical use of opioids by adolescents is common, although recent efforts to reduce opioid prescribing appear to be having an impact. The role of exposure to prescription opioids in the pathway to opioid use disorder remains poorly understood, although this study suggests a possible link through non-medical use. Leftover opioids may later be used with the intention of treating pain or “recreationally,” or medical use may “prime” adolescents for non-medical use. These findings raise caution about prescribing opioids to adolescent patients, and underscore the need for anticipatory guidance and advice for all adolescents treated with prescription opioids.

Sharon Levy, MD, MPH

Reference: McCabe SE, West BT, Veliz P, et al. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics. 2017;139(4).

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