Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Future Opioid Misuse in Adolescence

Is there a risk with prior legitimate use?

Publish date:

The use of prescription opioids before the 12th grade is independently associated with future opioid misuse among patients with little to no history of drug use and who had strong disapproval of illegal drug use at baseline, according to a study of 6,220 individuals surveyed in school in 12th grade and followed up through age 23 years. Study results also found:

• Legitimate opioid use before high school graduation is independently associated with a 33% increase in the risk of future opioid misuse after high school.

• The association is centered among individuals who have little to no history of drug use and who strongly disapprove of illegal drug use at baseline.

• Clinic-based education and prevention efforts can reduce future opioid misuse in this age group.

Citation: Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. [Published online ahead of print October 26, 2015]. Pediatrics. doi: 10.1542/peds.2015-1364.

Commentary: Deaths from prescription drugs over the last decade have become the second-leading cause of unintentional death in young adults and have exceeded deaths from cocaine and heroin combined.1 Primary care physicians are well acquainted with the risks of opioid prescribing and have incorporated this information into their practice patterns.2 This article suggests a new area of concern that needs more study and attention, which is that legitimate prescribing of opioid analgesics, which is not very common in the pediatric population, may lead to increased levels of abuse. It is hard to understand the mechanism by which this might occur, and one wonders if the prescription of opioid analgesics in a pediatric population might be a marker for those at higher risk rather than causally related to increased abuse. —Neil Skolnik, MD

1. Okie S. A Flood of Opioids, a Rising Tide of Deaths. N Engl J Med 2010; 363;1981-1985. doi:10.1056/NEJMp1011512.

2. Hwang CS, Turner LW, Kruszewski SP, Kolodny A, Alexander GC. Prescription drug abuse: a national survey of primary care physicians. JAMA Intern Med. 2015;175(2):302-304. doi:10.1001/jamainternmed.2014.6520.

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