Prescription drug (PD) misuse associated with increased risk of heroin-use

Introduction: Prescription drug misuse is a growing epidemic in the United States, especially among adolescents, with current lifetime prevalence estimates at approximately 20%. While some studies demonstrate an increased risk of heroin use in relation to prescription opioid abuse among adults, there is limited research exploring the relationship between PD use in general and heroin use in adolescents. Methods: Weighted analyses were conducted using nationally-representative data from high-school students surveyed through the 2011 Youth Risk Behavior Survey (YRBS). Multivariable logistic-regression analyses were conducted to examine the association between PD use among students (never, 1-9 times, and ≥10 times) and lifetime heroin use. Restricting the sample to students aged ≥14 with a lifetime prevalence of drinking alcohol, smoking cigarettes or smoking marijuana yielded 12,001 participants. Results: 2.7% of the sample had reported ever using heroin, and 12.0% reported using PD 1-9 times and 7.8% reported using PD ≥10 times. In the final multivariable logistic-regression model, which controlled for demographics (grade, gender, race/ethnicity), depression, suicidal ideation, current alcohol use, regular drug use, and risky behavior and protective factor profile variables, compared to students who never used PD, those who used PD 1-9 times (AOR: 2.68; CI:1.35-5.30;p<0.01) and those who used PD ≥10 times (AOR: 4.94; CI:2.61-9.37;p<0.001) had a greater odds of ever using heroin. Conclusions: Developing effective preventative strategies that address PD misuse will be important in preventing further risky substance-related behaviors, including heroin use, among adolescents. Additional studies that explore the relationship between PD use and heroin use are recommended.