Adolescent prescription opioid misuse, illicit opioid use and overdose

Michele K. Bohm; Heather Clayton

摘要

Objective Given the evolving opioid overdose epidemic, we examined the interrelationships between nonmedical use of prescription opioids and illicit opioid use in adolescents. Introduction The number of overdose deaths involving illicit opioids such as heroin and illicitly-manufactured fentanyl (IMF) is now higher than deaths involving prescription opioids. Adolescents misusing prescription opioids are more likely to use heroin. Although nonmedical use of prescription opioids (NUPO) among adolescents is decreasing,there is still relatively high prevalence of this behavior. Such high prevalence, along with the evolving epidemiology of the drug overdose epidemic as well as the association between NUPO and heroin use, signal that NUPO in adolescents is still an important issue. Understanding the interrelationships between NUPO and illicit opioid use in adolescents can inform prevention efforts. The purpose of this study is to: 1) present the magnitude of the drug overdose problem in adolescents, 2) compare the prevalence of heroin use and injection drug use (IDU) between students reporting NUPO and those not reporting NUPO, and 3) determine whether a dose-response relationship exists between these behaviors among adolescents. This information will be beneficial when focusing on adolescents at risk for heroin use by helping to determine whether any NUPO is associated with heroin use or if such risk is only noted at a higher frequency of NUPO behavior. Methods We analyzed data from two surveillance sources to capture adolescent overdose mortality and behavioral risk factors. Overdose death data for decedents aged 15 to 19 years were obtained for 2010 and 2016 from CDC WONDER, an online database with national mortality data based on death certificates for U.S. residents. We identified deaths involving prescription and illicit opioids using International Classification of Disease, 10th revision (ICD-10) codes for drug overdose deaths. Each death is assigned one underlying cause of death code and the following identified overdoses: X40-44 (unintentional), X60-64 (intentional), X85 (homicide), or Y10-14 (undetermined intent). Additionally, for overdose deaths attributed to specific drugs or drug categories, ICD-10 multiple cause of death codes were used to determine the number of deaths involving any opioid, either prescription or illicit (T40.1-T40.4 and T40.6), prescription opioids (T40.2 or T40.3), heroin (T40.1), and heroin and/or synthetic opioids (e.g., fentanyl) excluding methadone (T40.1 or T40.4). We compared the proportion of overdose deaths involving prescription opioids that also involved heroin or synthetic opioids in 2010 and 2016. The second data source, the 2017 national Youth Risk Behavior Survey (YRBS), a nationally representative cross-sectional survey of high school students, was analyzed to look at behavioral risk factors. We assessed lifetime NUPO (LNUPO) and calculated frequency of LNUPO by heroin use, injection drug use (IDU), and heroin/IDU using logistic regression models to generate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CI). We used linear contrast analysis to determine dose-response relationships between frequency of LNUPO and heroin use, IDU and heroin/IDU. Results The number of adolescents aged 15 to 19 years who died of drug overdose increased from 831 in 2010 (3.8 per 100,000) to 873 in 2016 (4.1 per 100,000). While the proportion of overdose deaths involving prescription opioids declined during this time period, the proportion involving heroin and/or synthetic opioids, such as fentanyl increased. In 2016, two-thirds of overdose deaths among decedents aged 15 to 19 years involved either a prescription or illicit opioid. The percent of deaths involving prescription opioids that also involved heroin and/or synthetic opioids, such as fentanyl increased from 5% in 2010 to 25% in 2016. Using the 2017 YRBS sample, we estimate that 14% of high school students nationwide have ever used prescription opioids nonmedically in their lifetime. Compared to students reporting no LNUPO, students reporting LNUPO were more likely to report heroin use (9.2% vs. 0.4%), IDU (7.8% vs. 0.4%), and heroin/ IDU (10.1% vs. 0.7%). We observed a positive dose-response relationship with frequency of LNUPO. Adjusted prevalence ratios for heroin, IDU and heroin/IDU increased with increasing frequency of LNUPO and were even significantly higher among those reporting just one or two occasions of LNUPO than among those reporting no LNUPO. Conclusions Our findings on opioid-involved drug overdose mortality and opioid use patterns confirm NUPO is still a concern for adolescents. We report a five-fold increase, from 2010 to 2016, in the percent of adolescent overdose deaths involving prescription opioids that also involved illicit opioids such as heroin and/or IMF. This may reflect deliberate polysubstance use among adolescents using prescription opioids nonmedically, but should also

机译：目的鉴于不断发展的阿片类药物过量使用流行病，我们研究了青少年非处方类阿片药物的使用与非法类阿片药物之间的相互关系。引言现在，涉及海洛因和非法制造的芬太尼等非法阿片类药物的过量死亡人数高于涉及处方阿片类药物的死亡人数。青少年滥用处方阿片类药物更有可能使用海洛因。尽管青少年的非医学处方阿片类药物（NUPO）使用量正在减少，但这种行为的患病率仍然较高。如此高的流行率以及药物过量流行病的流行病学发展以及NUPO和海洛因使用之间的联系，表明青少年NUPO仍然是一个重要问题。了解NUPO与青少年非法使用阿片类药物之间的相互关系可以为预防工作提供信息。这项研究的目的是：1）介绍青少年用药过量问题的严重程度; 2）比较报告NUPO和未报告NUPO的学生之间的海洛因使用和注射药物使用（IDU）的患病率，以及3）确定青少年之间的这些行为之间是否存在剂量反应关系。当重点关注有海洛因使用风险的青少年时，该信息将有助于确定是否有任何NUPO与海洛因使用有关，或者仅以较高的NUPO行为频率注意到这种风险，这将是有益的。方法我们分析了来自两个监测来源的数据，以捕获青少年用药过量死亡率和行为危险因素。从CDC WONDER获得了2010和2016年15至19岁死者的过量用药数据，CDC WONDER是一个在线数据库，其中包含基于美国居民死亡证明的国家死亡率数据。我们使用《国际疾病分类》第10版（ICD-10）代码确定了过量用药引起的处方药和非法阿片类药物死亡。每位死亡都被分配了一个潜在的死亡原因代码，并确定了以下过量剂量：X40-44（无意），X60-64（有意），X85（凶杀）或Y10-14（不确定）。此外，对于归因于特定药物或药物类别的药物过量死亡，使用ICD-10多种死亡原因代码来确定涉及处方或非法阿片类药物的死亡人数（T40.1-T40.4和T40.6），处方阿片类药物（T40.2或T40.3），海洛因（T40.1）和海洛因和/或合成阿片类药物（例如芬太尼），但不含美沙酮（T40.1或T40.4）。我们比较了2010年和2016年涉及处方阿片类药物也涉及海洛因或合成阿片类药物的过量死亡的比例。第二个数据来源，即2017年全国青少年风险行为调查（YRBS），该调查是全国性的高中生横断面调查，分析以查看行为危险因素。我们评估了终生NUPO（LNUPO），并使用Logistic回归模型通过海洛因使用，注射毒品使用（IDU）和海洛因/ IDU计算了LNUPO的频率，以生成调整后的患病率（aPR）和相应的95％置信区间（CI）。我们使用线性对比分析来确定LNUPO频率与海洛因使用，IDU和海洛因/ IDU之间的剂量反应关系。结果因药物过量死亡的15至19岁青少年人数从2010年的831人（每100,000人中增加3.8人）增加到2016年的873人（每100,000人中4.1人）。虽然在此期间，涉及处方阿片类药物的过量死亡的比例有所下降，但涉及海洛因和/或合成阿片类药物（例如芬太尼）的比例有所增加。 2016年，在15至19岁的死者中，三分之二的过量死亡涉及处方药或非法阿片类药物。涉及处方阿片类药物（还涉及海洛因和/或合成阿片类药物，例如芬太尼）的死亡百分比从2010年的5％增加到2016年的25％。使用2017年YRBS样本，我们估计全国有14％的高中生一生都在非医学上使用处方阿片类药物。与没有LNUPO的学生相比，报告LNUPO的学生更有可能报告海洛因的使用（9.2％比0.4％），IDU（7.8％比0.4％）和海洛因/ IDU（10.1％比0.7％）。我们观察到与LNUPO频率呈正剂量反应关系。随着LNUPO频率的增加，海洛因，IDU和海洛因/ IDU的调整患病率增加，在仅报告一次或两次LNUPO的人群中，调整后的患病率甚至比未报告LNUPO的人群中的调整后患病率显着更高。结论我们对阿片类药物涉及的药物过量死亡率和阿片类药物使用模式的发现证实NUPO仍然是青少年关注的问题。我们报告称，从2010年到2016年，涉及处方阿片类药物的青少年过量用药死亡百分比增加了五倍，这些阿片类药物还涉及海洛因和/或IMF等非法阿片类药物。这可能反映了青少年在非医学上使用处方阿片类药物故意使用多物质，但也应

Adolescent prescription opioid misuse, illicit opioid use and overdose

摘要

著录项

相似文献

相关主题

期刊订阅