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Prescription drug misuse during adolescence increases risk for substance abuse later

Researchers identified any high-frequency prescription drug misuse during the transition from adolescence to adulthood as a strong risk factor for substance use disorders during adulthood.

“Long-term longitudinal research is needed to understand prescription drug misuse trajectories from adolescence to adulthood across multiple prescription drug classes (ie, opioids, stimulants, and sedatives or tranquilizers), to consider long-term associations with substance use disorder symptoms, and to determine the characteristics of prescription drug misuse trajectories that are most problematic,” Sean Esteban McCabe, PhD, from the Center for the Study of Drugs, Alcohol, Smoking and Health at University of Michigan, and colleagues wrote in Lancet Psychiatry.

In their longitudinal, multicohort study, McCabe and colleagues examined questionnaire data from 51,223 adolescents in the U.S. across eight waves (from age 18 years to age 35 years) to identify prescription drug misuse trajectories for these three drug classes from adolescence into adulthood. They also evaluated the extent to which different trajectories were tied to substance use disorder symptoms and ascertained factors tied to high-risk prescription drug misuse trajectories.

McCabe and colleagues identified five prescription drug misuse trajectories, which were differentiated by the age when past-year prescription drug misuse high frequency peaked: rare or no misuse at any age and peak at age 18 years, at ages 19 to 20 years, at ages 23 to 24 years, and at ages 27 to 28 years.

The researchers identified similar misuse trajectories for each drug class. Participants whose misuse peaked between age 27 to 28 years and 35 years had significantly greater risk for two or more symptoms of alcohol use disorder, cannabis use disorder, opioid or any other substance use disorder than those in the rare drug misuse trajectory. For sedatives and tranquilizers, the misuse trajectory peaked at age 35 years than that for the other drug classes.

Controlled analyses also indicated some risk factors linked to the high-risk latest peak prescription drug misuse trajectory: heavy drinking in high school, cigarette smoking, marijuana use, poly-prescription drug misuse, white race and not finishing a 4-year college degree.

“Based on the high rates of polysubstance use and peer diversion associated with prescription drug misuse, there is an urgent need to educate adolescents at the time of prescription about the risks associated with drug misuse and sharing these medications, and to incentivize proper medication disposal to reduce leftover excess medication, diversion, and prescription drug misuse,” McCabe and colleagues concluded. – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.