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Persistence of extra-medical prescription pain reliever use and alcohol involvement among United States 12-20 year olds.

ABSTRACT: The peak risk of first extramedical use of prescription pain relievers (PPRs) is in mid-adolescence, often after underage drinking has begun. This research aims to investigate discrete classes of similar young people based on their newly incident extramedical use of PPR and alcohol involvement, with empirical evaluation of the underlying structure of identified subgroups and their epidemiological distributions in the United States. The U.S. National Surveys on Drug Use and Health, 2002-2013, sampled, recruited, and assessed 24,789 newly incident extramedical PPR users ages 12-20 years, with self-interviews on PPR, alcohol, and covariates. Latent classes of persistence were formed using PPR and alcohol status variables. Then, age and sex were studied as potentially important predictors of class membership. Analysis-weighted estimates and delta method variances were derived. Three classes were distinguished by extramedical PPR and alcohol use patterns: (a) nonpersistent (79%), (b) intermittent (15%), and (c) persistent (6%). There were no differences across classes by age, but being female was associated with greater odds of being in the intermittent class or persistent class compared to the nonpersistent class. Presenting clinical features of alcohol and/or opioid dependence that have become manifest at or near time of first PPR use can be indicators of persisting in extramedical use of PPR, particularly for young people who have recently started extramedical PPR use. Persistent adolescent and young adult extramedical PPR users require tailored public health prevention and intervention strategies based on their vulnerability to continue use over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

SUBMITTER: Parker MA

PROVIDER: S-EPMC6785979 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Persistence of extra-medical prescription pain reliever use and alcohol involvement among United States 12-20 year olds.

Parker Maria A MA

Experimental and clinical psychopharmacology 20190314 5

The peak risk of first extramedical use of prescription pain relievers (PPRs) is in mid-adolescence, often after underage drinking has begun. This research aims to investigate discrete classes of similar young people based on their newly incident extramedical use of PPR and alcohol involvement, with empirical evaluation of the underlying structure of identified subgroups and their epidemiological distributions in the United States. The U.S. National Surveys on Drug Use and Health, 2002-2013, sam ...[more]

PMID: 30869981

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Project description:Importance:The use of benzodiazepines or alcohol together with opioids increases overdose risk, but characterization of co-involvement by predominant opioid subtype is incomplete to date. Understanding the use of respiratory depressants in opioid overdose deaths (OODs) is important for prevention efforts and policy making. Objective:To assess the prevalence and number of alcohol- or benzodiazepine-involved OODs by opioid subtypes in the United States from 1999 to 2017. Design and Setting:This repeated cross-sectional analysis used data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database of all opioid-involved poisoning deaths from January 1, 1999, to December 31, 2017, for the United States. State-level binge drinking prevalence rates for 2015 to 2017 were obtained from the Behavior Risk Factor Surveillance System of the Centers for Disease Control and Prevention, and benzodiazepine prescribing rates for 2012 (most recent available data) were obtained from IMS Health, a commercial database. Data were analyzed from July 10, 2018, to May 16, 2019. Main Outcomes and Measures:Prevalence of alcohol or benzodiazepine co-involvement for all OODs and by opioid subtype, nationally and by state. Results:From 1999 to 2017, 399 230 poisoning deaths involved opioids, of which 263 601 (66.0%) were male, and 204 560 (51.2%) were aged 35 to 54 years. Alcohol co-involvement for all opioid overdose deaths increased nonlinearly from 12.4% in 1999 to 14.7% in 2017. By opioid subtype, deaths involving heroin and synthetic opioids (eg, fentanyl; excluding methadone) had the highest alcohol co-involvement at 15.5% and 14.9%, respectively, in 2017. Benzodiazepine co-involvement in all OODs increased nonlinearly from 8.7% in 1999 to 21.0% in 2017. Benzodiazepines were present in 33.1% of prescription OODs and 17.1% of synthetic OODs in 2017. State-level rates of binge drinking were significantly correlated with alcohol co-involvement in all OODs (r = 0.34; P = .02). State benzodiazepine prescribing rates were significantly correlated with benzodiazepine co-involvement in all OODs (r = 0.57; P < .001). Conclusions and Relevance:This study found that alcohol and benzodiazepine co-involvement in opioid-involved overdose deaths was common, varied by opioid subtype, and was associated with state-level binge drinking and benzodiazepine prescribing rates. These results may inform state policy initiatives in harm reduction and overdose prevention efforts.

Project description:Background and aimsIn the United States, the availability of prescription opioids has decreased in recent years. Whether there have been corresponding changes in the likelihood of people with prescription opioid use disorder (POUD) to engage in illegal behaviors related to drug use remains unknown. We examined changes in prevalence of illegal behaviors between people with and without POUD over time, and how transactions for obtaining opioids have changed among people with POUD over time.DesignTemporal trend analysis of repeated cross-sectional data.SettingUnited States household dwelling population from all 50 states and District of Columbia.ParticipantsAdult subsamples from the 2002-14 National Survey of Drug Use and Health (n = 5393 people with POUD; n = 486 768 people without POUD).MeasurementsOutcome variables were selected illegal behaviors and sources of opioids used non-medically. POUD was defined using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Time was treated as a continuous variable. The variable of interest for each illegal behavior analysis was the interaction between POUD diagnosis and time. Covariates included age, sex and race/ethnicity.FindingsDuring the 13-year period examined, the adjusted interaction odds ratio (AIOR) describing the change in association between POUD and selling illicit drugs increased by a factor of 2.41 [95% confidence interval (CI) = 1.56-3.71, P < 0.001]. Similar trends were noted for stealing (AIOR = 2.12, 95% CI = 1.31-3.44, P = 0.002) and for life-time history of arrest (AIOR = 1.53, 95% CI = 1.06-2.19, P = 0.021). People with POUD became less likely to receive opioids for free from friends and family [adjusted odds ratio (AOR) = 0.42, 95% CI = 0.25-0.71, P = 0.001] and more likely to buy them from friends and family (AOR = 3.29, 95% CI = 1.76-6.13, P < 0.001) from 2005 to 2014.ConclusionsIn the United States, against a backdrop of a decreasing prescription opioid supply, rates of some crimes potentially related to drug use increased among people with prescription opioid use disorder compared with those without prescription opioid use disorder from 2002 to 2014.

Dataset Information

Persistence of extra-medical prescription pain reliever use and alcohol involvement among United States 12-20 year olds.

Publications

Persistence of extra-medical prescription pain reliever use and alcohol involvement among United States 12-20 year olds.

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