@article{ref1,
title="Prevalence and childhood precursors of opioid use in the early decades of life",
journal="JAMA pediatrics",
year="2020",
author="Shanahan, Lilly and Hill, Sherika N. and Bechtiger, Laura and Steinhoff, Annekatrin and Godwin, Jennifer and Gaydosh, Lauren M. and Harris, Kathleen Mullan and Dodge, Kenneth A. and Copeland, William E.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="IMPORTANCE: Opioid use disorder and opioid deaths have increased dramatically in  young adults in the US, but the age-related course or precursors to opioid use among  young people are not fully understood. <br><br>OBJECTIVE: To document age-related changes in  opioid use and study the childhood antecedents of opioid use by age 30 years in 6  domains of childhood risk: sociodemographic characteristics; school or peer  problems; parental mental illness, drug problems, or legal involvement; substance  use; psychiatric illness; and physical health. DESIGN, SETTING, AND PARTICIPANTS:  This community-representative prospective longitudinal cohort study assessed 1252  non-Hispanic White individuals and American Indian individuals in rural counties in  the central Appalachia region of North Carolina from January 1993 to December 2015. Data were analyzed from January 2019 to January 2020. EXPOSURES: Between ages 9 and  16 years, participants and their parents were interviewed up to 7 times using the  Child and Adolescent Psychiatric Assessment and reported risk factors in 6 risk  domains. MAIN OUTCOMES AND MEASURES: Participants were assessed again at ages 19,  21, 25, and 30 years for nonheroin opioid use (any and weekly) and heroin use using  the structured Young Adult Psychiatric Assessment. <br><br>RESULTS: Of 1252 participants,  342 (27%) were American Indian. By age 30 years, 322 participants had used a  nonheroin opioid (24.2%; 95% CI, 21.8-26.5), 155 had used a nonheroin opioid weekly  (8.8%; 95% CI, 7.2-10.3), and 95 had used heroin (6.6%; 95% CI, 5.2-7.9). Childhood  risk markers for later opioid use included male sex, tobacco use, depression,  conduct disorder, cannabis use, having peers exhibiting social deviance, parents  with legal involvement, and elevated systemic inflammation. In final models,  childhood tobacco use, depression, and cannabis use were most robustly associated  with opioid use in young adulthood (ages 19 to 30 years). Chronic depression and  dysthymia were strongly associated with any nonheroin opioid use (OR. 5.43; 95% CI,  2.35-12.55 and OR, 7.13; 95% CI, 1.99-25.60, respectively) and with weekly nonheroin  opioid use (OR, 8.89; 95% CI, 3.61-21.93 and OR, 11.51; 95% CI, 3.05-42.72,  respectively). Among young adults with opioid use, those with heroin use had the  highest rates of childhood psychiatric disorders and comorbidities. <br><br>CONCLUSIONS AND  RELEVANCE: Childhood tobacco use and chronic depression may be associated with  impaired reward system functioning, which may increase young adults' vulnerability  to opioid-associated euphoria. Preventing and treating early substance use and  childhood mental illness may help prevent later opioid use.<p /> <p>Language: en</p>",
language="en",
issn="2168-6211",
doi="10.1001/jamapediatrics.2020.5205",
url="http://dx.doi.org/10.1001/jamapediatrics.2020.5205"
}