Persistence of Extra-Medical Prescription Pain Reliever Use and Alcohol Involvement Among United States 12–20 Year Olds

Abstract

The peak risk of first extra-medical use of prescription pain relievers (PPR) is in mid-adolescence, often after underage drinking has begun. This research aims to investigate discrete classes of similar young people based on their newly incident extra-medical use of PPR and alcohol involvement, with empirical evaluation of the underlying structure of identified subgroups and their epidemiological distributions in the United States (US). The US National Surveys on Drug Use and Health, 2002-2013, sampled, recruited, and assessed 24,789 12-20-year-old newly incident extra-medical PPR users, with self-interviews on PPR, alcohol, and covariates. Latent classes of persistence were formed using PPR and alcohol status variables. Then, age and sex were studied as potentially important predictors of class membership. Analysis-weighted estimates and delta method variances were derived. Three classes were distinguished by extra-medical PPR and alcohol use patterns: (1) Non-persistent (79%), (2) Intermittent (15%), and (3) Persistent (6%). There were no differences across classes by age, but being female was associated with greater odds of being in the Intermittent class or Persistent class compared to the Non-persistent class. Presenting clinical features of alcohol and/or opioid use disorder that have become manifest at or near time of first PPR use can be indicators of persisting in extra-medical use of PPR, particularly for young people who have recently started extra-medical PPR use. Persistent adolescent and young adult extra-medical PPR users require tailored public health prevention and intervention strategies based on their vulnerability to continue use over time.