Risk factors for teen nonprescription opioid use


Nonprescription opioid use can significantly increase the risk of opioid overdose. What factors may lead teenagers to this high-risk behavior?

Opioid overdoses are the number 1 cause of accidental death among teenagers in the United States and hospitalizations for such overdoses has significantly increased over the past 10 years. Nonprescription opioid use in adolescents can increase the risk of addiction, injury, and death. However, the risk factors in this group remain understudied. Behavioral health problems are often linked to nonprescription use in adults, but is this also true in teenagers?1

The investigators utilized data from a prospective cohort study that included high school students from Los Angeles, California. Every student was asked to do a self-report screening measure that asked about problem use of alcohol, cannabis, and other drugs as well as 6 mental health problems, which were major depression, generalized anxiety, panic disorder, social phobia, obsessive-compulsive disorder, and hypomania or mania. The students were asked about past 6-month nonmedical prescription use of opioids at 7 semiannual follow-up appointments.

Among the students who were never users of nonmedical prescription opioids at baseline, the average past 6-month prevalence of new nonmedical prescription opioid use across the 42-month follow-up period was 4.4 (range 3.5%–6.1%). When co-adjusting for the 9 baseline behavioral problems, major depression, hypomania or mania, cannabis, alcohol, and other drug use problems were linked to increased odds of nonmedical prescription opioid use at follow-ups. Investigators found there were greater odds of subsequent nonmedical prescription opioid use for students who have 1 (odds ratio [OR]: 3.74; 95% confidence interval [CI]: 2.79–5.01), 2 (OR: 8.79; 95% CI: 5.95–12.99), or 3 (OR: 9.69; 95% CI: 5.63–16.68) versus 0 baseline substance use problems.

The investigators concluded that behavioral health problems may be tied to an increased risk of later nonmedical prescription opioid use in mid to late adolescents. Using behavioral health screeners could be a helpful was to identify teenagers who are high risk of nonmedical prescription opioid use.


1. Cho J, Kelley-Quon L, Barrington-Trimis J, Kechter A, Axeen S, Leventhal A. Behavioral health risk factors for nonmedical prescription opioid use in adolescence. Pediatrics. August 16, 2021. Epub ahead of print. doi:10.1542/peds.2021-051451

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