Does Teen Prescription Drug Misuse Predict Later Substance Abuse?

Prescription drug misuse (PDM) at any age posed a risk for developing substance use disorder symptoms in adulthood — with some patterns posing bigger threats — a new study suggested.

In a sample of nearly 27,000 individuals followed throughout adulthood, 45.7% reported past-year PDM at least once during the 32-year study period with 40% reporting poly-PDM (misuse of more than one prescription drug class in the same time period), Sean Esteban McCabe, PhD, of the University of Michigan School of Nursing in Ann Arbor, and colleagues wrote in JAMA Network Open.

After first surveying respondents at age 18 (study start 1976-1986) and following up with them through age 50 (2008-2018), researchers were able to determine unique PDM trajectory patterns falling into three main categories: early peak trajectories (around age 18), later peak trajectories (around age 40), and a high-risk trajectory (high frequency misuse at many ages).

For a large portion of those who reported past-year PDM from any drug class — opioids, stimulants, and tranquilizer or sedatives — their misuse peaked at age 18.

While all trajectories were linked to substance use disorder (SUD) symptoms, some trajectories were stronger predictors than others. SUD symptoms were measured (at ages 35, 40, 45, and 50 years) using DSM criteria for alcohol use disorder, cannabis use disorder, and other drug use disorder.

People falling into the high-risk trajectory saw the largest chance of developing SUD symptoms in middle adulthood (adjusted odds ratio [aOR] 12.41, 95% CI 8.47-18.24) versus those with an early peak trajectory. Overall, these individuals on the high-risk trajectory had a 94% estimated prevalence for having two or more SUD symptoms by midlife.

Likewise, those with a later peak trajectory also had a higher chance of developing SUD symptoms by midlife compared with an early peak (aOR 5.17, 95% CI 3.97-6.73).

“Most individuals who were classified as belonging to the peak PDM at age 40 or later trajectories had symptoms consistent with an SUD in adulthood; in addition, these PDM trajectories showed relatively sharp increases to their peaks,” McCabe’s group noted.

“These peak PDM ages coincide with the highest rates of prescription opioid-involved overdose, which are among individuals aged 45 to 54 years, followed closely by those aged 35 to 44 years,” they continued. “Accounting for the age when PDM occurs, as well as frequency of misuse, is critical when assessing an individual’s risk of developing substance-related problems.”

Out of all trajectories, those whose PDM peaked early — specifically by age 18 — had the lowest prevalence estimate for two or more SUD symptoms in midlife (48%).

The group argued that “a comprehensive screening for substance use history can alert clinicians to subsequent risk for PDM and substance-related problems at specific ages and enhance precision medicine efforts.”

Several baseline characteristics were also predictive of one’s PDM, McCabe’s group found. Misuse was significantly more common among those who smoked cigarettes or marijuana, and among those who binged on alcohol. And as for specific PDM trajectories, individuals who turned 18 in the mid-1980s were more likely to belong to later-peak trajectories. On the other hand, teens in the mid-1970s were more likely to have an early peak.

Not surprisingly, medical use of prescription drugs at age 18 was tied to a young-adulthood misuse peak, but was also a common theme among all PDM trajectories.

Individuals who identified as non-Hispanic Black saw a lower risk of prescription drug misuse at any age.

For the cohort study, the researchers included 11 groups of adolescents from the Monitoring the Future study. All participants were first surveyed in 12th grade via self-administered questionnaires in classrooms with identical questions asked at each follow-up. About half of all participants identified as female and nearly 80% of the sample was white. The cohort was representative of all U.S. regions and urbanicities.

The most significant limitations to the study, the authors acknowledged, were differential attrition and survey measure limitations that are often seen when it comes to large-scale prospective survey studies of high-risk behaviors. The baseline response rate during the study period ranged between 77% to 84%, and the 32-year retention rate was 53%.