Substance use in young adulthood increases risk for subsequent prescription drug misuse
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Binge drinking, cigarette smoking and marijuana use at age 18 years were associated with increased odds of prescription drug misuse later in life, according to findings published in JAMA Network Open.
Among 26,575 study participants, “nearly one-half of all people reported prescription drug misuse between ages 18 and 50 years,” Sean Esteban McCabe, PhD, the director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan, told Healio.
“Prescription drug misuse at any age is a signal for developing a substance use disorder, especially frequent misuse between the ages of 35 and 50,” he said. “Knowing these facts can allow health care providers to feel more comfortable exploring potential misuse or risk of misuse with their patients.”
As part of the Monitoring the Future study, McCabe and colleagues followed 11 cohorts of adolescents from 18 years of age (enrolled from 1976 to 1986) to 50 years of age. The 26,575 participants completed self-administered surveys that measured potential substance use disorder symptoms and past-year prescription drug misuse (PDM). Baseline surveys were conducted in a high school classroom setting, with subsequent surveys conducted by mail.
McCabe and colleagues used latent profile analyses to map estimated trajectory profiles of PDM based on the number of past-year instances when respondents misused opioids, stimulants and/or sedatives or tranquilizers in addition to composite PDM measures. The follow-up retention rate was 53%.
Baseline characteristics
Among the respondents, 79.3% were white, 10.7% were non-Hispanic Black and 3.6% were Hispanic; 50.8% were women. At baseline, 42.2% lived in a suburban area, 31.2% lived in a rural area and 26.6% lived in an urban area. Also, 45.6% of respondents planned to attend college and 69.8% had a grade point average of a B- or higher. Moreover, 39.5% reported cigarette use and 42.6% reported marijuana use within 30 days while 47.7% reported binge drinking within the past 2 weeks of the baseline survey.
Trajectory profiles
During the 32-year follow-up period, 45.7% (95% CI, 44.9-46.4) of respondents reported at least one occasion of PDM, and among these individuals, 40.3% (95% CI, 39.3-41.3) reported misuse of more than one prescription drug class in the same period.
Based on latent profile analyses, the number of class-specific PDM trajectories the researchers developed ranged from four (opioids) to six (stimulants). During drug class-combined analyses, McCade and colleagues identified eight PDM trajectories, including early-peak trajectories at age 18 years, later-peak trajectories at age 40 years and a high-risk trajectory with high frequency PDM at multiple ages. The researchers defined a peak trajectory as the age at which an individual misused prescription drugs most frequently, with older age of misuse carrying a higher risk.
All estimations were associated with increased odds of developing substance use disorder symptoms in middle adulthood, especially the later peak and high-risk trajectories compared with early peak trajectories (peak at age 40 years: adjusted OR = 5.17; 95% CI, 3.97-6.73; high-risk: aOR = 12.41; 95% CI, 8.47-18.24).
Binge drinking (aOR = 1.69; 95% CI, 1.13-2.54), cigarette smoking (aOR = 2.3; 95% CI, 1.6-3.29) and marijuana use (aOR = 3.78; 95% CI, 2.38-6.01) at baseline were associated with a high-risk PDM trajectory. Medical use of prescription drugs at age 18 years was associated with a greater risk for belonging to young adulthood peak PDM trajectories, while PDM at age 18 years was associated with a greater risk for belonging to most PDM trajectories, according to the researchers.
Cohorts enrolled later in the study (1985 to 1986) had a higher risk for belonging to later peak PDM trajectories (ages 40 and 45 years) compared with earlier enrolled cohorts (1976 to 1978), according to McCabe and colleagues. Also, Black respondents had a lower expected risk for any of the PDM trajectories.
In general, all PDM trajectories were linked to significantly increased odds for developing substance use disorder symptoms in adulthood, the researchers noted.
“PCPs play a key role in screening for PDM because they are most likely to have an established relationship with the patient and they are most likely to have the opportunity to see the patient in their office,” McCabe said. “PCPs are also in an ideal position to discuss how to store and use prescription drugs more safely within households.”
Having one person in a household with a prescription increases the risk for PDM for the entire household, he added.