Trajectories of nonmedical use of prescription opioids among adolescents in primary care

Background: Rise in nonmedical use of prescription opioids (NMUPO) is an emerging public health problem in adolescents. To better understand risk factors for NMUPO and patterns of use over time, we examined trajectories of NMUPO among a sample of adolescents who presented to primary care clinics.Methods: Data were from 1076 adolescents ages 12-18, primarily African-American (62.6%) enrolled in a randomized controlled trial. Data were collected at baseline, 3, 6 and 12 months. Group-based trajectory modeling was used to empirically distinguish trajectory patterns of NMUPO over one year.Results: Trajectory analysis identified the following three NMUPO groups: nonusers (n=969), decreasing users (n=63) and high-sustained users (n=44). Bivariate analyses showed African-American race was more common in nonusers (65%, N=630) than in decreasing (41%, N=26) and sustained users (41%, N=18). All substance use and all other risk factors, except for lower class grades and less participation in school activities, were more common in decreasing users and sustained users. Multinomial logistic regression showed depressive symptoms and non-medical sedative and stimulant misuse were associated with the NMUPO trajectory groups (both decreasing and high sustained use); only friends' drug use and less depressive symptoms significantly differentiated the high sustained group from the decreasing use group.Conclusions: Adolescents with NMUPO have more psychosocial risk factors and those who continue to misuse prescription opioids over time may constitute a distinctive subgroup that may be at higher risk of developing psychosocial problems. Future interventions may need to account for heterogeneity of use patterns over time.