Non-medical prescription opioid use among high school students in 38 U.S. States

Background: Lifetime prevalence of non-medical prescription opioid use (NMPOU) among adolescents exceeds 10%. Building on that work, we estimate lifetime and recent (i.e., past 30-day) NMPOU and examine associations with alcohol and cannabis use. Methods: We used 2019 YRBS data from 38 states with a question on lifetime NMPOU (n = 151,910), a subsample of 8 states also inquired about recent NMPOU (n = 28,439). We estimated the prevalence and frequency of NMPOU for boys and girls in each state. Multivariable logistic regression was used to derive odds ratios (OR) and 95% confidence intervals (CIs) representing recent NMPOU in association with alcohol and cannabis use adjusting for state, race/ethnicity, and grade. Results: The prevalence of lifetime NMPOU ranged from 9.4% to 22.7% for girls and 8.6% to 23.2% for boys; significant sex difference in Florida. Recent NMPOU among lifetime users ranged from 33.0% to 50.7% for girls and 40.7% to 52.3% for boys, no significant sex differences. Students reporting recent NMPOU had significantly higher odds of recent alcohol (OR: 5.1, 95% CI: 4.3–6.1) and cannabis use (OR: 3.7, 95% CI: 2.8–4.8). Higher frequency (1–2 and ≥ 3 times vs. 0 times) of NMPOU had significantly greater odds of alcohol (3–9-fold) and cannabis use (3–5-fold). The magnitude of association was higher for boys compared to girls. Conclusion: The prevalence of recent NMPOU among lifetime users is high and is associated with alcohol and cannabis use. NMPOU can be a steppingstone towards other forms of opioid use therefore, opioid prevention programs should emphasize prescription drug misuse and consider socio-contextual and geographical variations.