• Sean Esteban McCabe, Carol J Boyd, Rebecca J Evans-Polce, Vita V McCabe, John E Schulenberg, and Philip T Veliz.
• Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing University of Michigan, Ann Arbor, MI (SEM, CJB, RJEP, VVM, PTV); Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI (SEM, CJB, PTV); Institute for Social Research, University of Michigan, Ann Arbor, MI (SEM, JES, PTV); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (SEM); Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI (CJB); Department of Psychiatry, University of Michigan, Ann Arbor, MI (VVM); Department of Surgery, Medical School, University of Michigan, Ann Arbor, MI (VVM); Department of Psychology, University of Michigan, Ann Arbor, MI (JES).
• J Addict Med. 2021 May 1; 15 (3): 241-244.

ObjectivesTo examine the longitudinal relationships between US adolescents' prescription opioid use and misuse and any subsequent heroin use in adulthood.MethodsNationally representative samples of adolescents from 25 independent cohorts were surveyed via self-administered questionnaires and followed from ages 18 to 35 (n = 11,012). Adolescents were divided into 5 subgroups based on survey responses at age 18: no lifetime exposure to prescription opioids (population controls), medical prescription opioid use without a history of nonmedical misuse (medical use only), medical use followed by nonmedical misuse, nonmedical misuse followed by medical use, and nonmedical misuse only. These 5 subgroups were compared on their risk for any heroin use through age 35 (1993-2017). Adolescents who reported lifetime heroin use at age 18 were excluded.ResultsAdolescents who reported nonmedical prescription opioid misuse followed by medical use or nonmedical misuse only had greater odds of any heroin use in adulthood than population controls. More recent cohorts of adolescents who reported nonmedical misuse or medical use only (compared to older cohorts) had greater odds of any heroin use in adulthood relative to population controls. Nearly 1 in 3 adolescents in recent cohorts who reported nonmedical prescription opioid misuse transitioned to any heroin use.ConclusionsThere is increased risk for heroin use among adolescents who initiated nonmedical misuse or adolescents prescribed opioids in more recent cohorts. These findings indicate historical variation and reinforce the critical role of vigilant monitoring and drug screening to detect high-risk individuals who would benefit from an intervention to reduce later heroin use.Copyright © 2020 American Society of Addiction Medicine.

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