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Pathways to Heroin Use: Commentary on McCabe et al.
Wilson M Compton1, Marsha F Lopez
1National Institute on Drug Abuse, Bethesda, MD (WMC, MFL).
Journal of Addiction Medicine
|September 29, 2020
Summary
Adolescent nonmedical use of opioid analgesics is linked to heroin use. Recent trends show increased risk, highlighting the need to limit opioid prescriptions and screen young patients.
Area of Science:
- Addiction Medicine
- Public Health
- Adolescent Health
Background:
- Transition from prescription opioid analgesics to illicit opioids like heroin is a significant clinical concern.
- Understanding patterns of transition, differentiating between therapeutic and nonmedical use, is crucial but understudied in longitudinal research.
Purpose of the Study:
- To examine the longitudinal transition from adolescent opioid analgesic use (medical and nonmedical) to heroin use.
- To analyze patterns over a 17-year follow-up period using data from the Monitoring the Future (MTF) study.
Main Methods:
- Utilized data from the Monitoring the Future (MTF) study, following adolescents recruited between 1975 and 2000.
- Analyzed seventeen-year follow-up data to identify transitions from various patterns of opioid analgesic use to heroin initiation.
Main Results:
- Both nonmedical and medical use of opioid analgesics were associated with a transition to heroin use.
- Early nonmedical use of opioid analgesics presented particular concerns for heroin transition.
- More recent adolescent cohorts demonstrated an elevated risk of transitioning to heroin use.
Conclusions:
- Findings underscore the importance of minimizing opioid prescribing and screening youth for prior nonmedical opioid analgesic use.
- Further research is needed to explore the time course, frequency, and dosage of opioid exposure in relation to heroin initiation.
