There were 62,560 youth between 13–24 years who met study inclusion criteria. 3,407 youth with a diagnosis of cancer and 76 people with HIV were excluded from the final sample, leaving a final sample of 59,077. Among these, 321 (0.5%) met criteria for new onset chronic opioid use in the 18 months following diagnosis, 16,172 (27.4%) had some opioid use but did not meet criteria for chronic opioid use, and 42,584 (72.1%) had no opioid use.
Chronic use was more common among males, older youth, and youth who lived in communities that were poorer, had more White residents, and had fewer residents who had attended college (). Among all opioid use categories (no use, non-chronic use and chronic use), the most common qualifying index pain diagnoses, in order of prevalence, were back pain, headache, neck pain, and arthritis. When compared to non-opioid users, youth who had received opioids (chronic or non-chronic users) had significantly higher numbers of pain conditions in the 6-months prior to the index pain condition.
Demographic and Health Indicators by Opioid Use Category
Mental health diagnoses were almost twice as common among youth with chronic use when compared to the non-use category and substance use diagnoses were over 5 times more likely amongst youth with chronic use compared to those in the no use category. Overall, 17.1% of youth in the chronic use category had a mental health or substance use diagnosis compared to 10.6% in the non-chronic use category and 8.2% for those in the non-user category. The main difference in prevalence of mental health diagnoses was attributable to higher rates of anxiety disorders and major depressive disorders among chronic users and non-chronic users when compared to non-users ().
shows the results of adjusted analyses of 3 pair-wise comparisons based on a full model. After adjusting for relevant covariates, male sex, older age, and community factors (higher percent white residents and lower rate of college educated residents) remained significant predictors of chronic opioid use. The type of index pain condition and number of pain conditions were not significant predictors of chronic use while presence of a mental health diagnosis continued to be a strong predictor of chronic use. In these adjusted models, youth with a mental health diagnosis were more than 2 times as likely to be a chronic user than a non-user (OR = 2.36, 95% CI – 1.73 – 3.23) and were 1.8 times more likely to be a chronic user than a non-chronic user (OR = 1.83, 95% CI – 1.34 – 2.50).
Adjusted Odds ratios for Pair-wise Comparisons based on a Full Model
There was slightly different pattern of factors associated with being a non-chronic user. Like chronic users, youth in the non-chronic use category were significantly older, and were more likely to come from communities with a higher percentage of white residents and a lower percentage of residents who had at least some college education than those in the non-user category. However, unlike chronic users, youth in the non-chronic user category were more likely to be female, had significantly higher Charlson Comorbidity Index scores, and had significantly more pain conditions than non-users. There was a negative association between having neck pain or back pain as a qualifying diagnosis and being in the non-chronic use category. The association between mental health disorders and non-chronic use was of lower magnitude than that seen for chronic user versus non-use (OR = 1.26, 95% CI – 1.18–1.34) but was still significant. Substance use diagnoses were too few to be examined independently in logistic regression analyses and were not included in the final adjusted models.