Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study
Nonmedical Prescription Opioid Use in Childhood and Early Adolescence Predicts Transitions to Heroin Use in Young Adulthood: A National Study
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DOI：
10.1016/j.jpeds.2015.04.071
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发表时间：
2015-09-01
影响因子：
5.1
通讯作者：
Martins, Silvia S.
中科院分区：
文献类型：
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作者：
Cerda, Magdalena;Santaella, Julian;Martins, Silvia S.
目的探讨处方阿片类药物的非医疗使用与儿童期至青年期海洛因成瘾之间的关系，并检验某些年龄、种族/民族和收入群体是否在这种转变中具有更高的风险。研究设计在2004-2011年全国药物使用和健康调查横断面调查中评估的具有全国代表性的美国青少年样本中（n = 223 534名12-21岁的受访者），使用离散时间危害模型来估计海洛因起始与既往非医疗使用处方阿片类药物相关的年龄特异性危害。估计处方阿片类药物非医疗使用史与处方阿片类药物开始非医疗使用的年龄、种族/民族和收入之间的相互作用。结果非医疗使用处方阿片类药物的既往史与海洛因成瘾密切相关（风险比13.12,95% CI 10.73, 16.04）。那些在1012岁开始非医疗使用处方阿片类药物的人过渡到海洛因使用的风险最高；这种联系没有因种族/民族或收入群体而异。结论：无论使用者的种族/民族或收入群体如何，先前非医疗使用处方阿片类药物是青少年和青年期海洛因使用的一个强有力的预测因素。儿童期后期非医疗使用处方类阿片的初级预防可以防止更严重类型的药物使用，如在以后的年龄开始使用海洛因。此外，由于海洛因开始使用的高峰期发生在17-18岁，如果把重点放在已经开始使用处方阿片类药物的年轻青少年身上，预防海洛因使用的二次努力可能最有效。
Objectives To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition.Study design Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223 534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income.Results A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 1012 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group.Conclusions Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the user's race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.