title: Incidence and antecedents of nonmedical prescription opioid use in four US communities. The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study.
abstract: BACKGROUND
  Nonmedical use of prescription opioids has emerged as a major public health problem during the last decade, but direct measures of incidence and predisposing factors are lacking.
  
  
  METHODS
  We prospectively measured incidence and antecedents of nonmedical prescription opioid use in The Coronary Artery Risk Development in Young Adults study among 28-40-year-old African- and European-American men and women with no prior history of nonmedical opioid use.
  
  
  RESULTS
  Among 3163 participants, 23 reported new nonmedical prescription opioid use in 2000-2001 (5-year incidence 0.7%; 95%CI: 0.4-1.0%). All 23 had previously reported marijuana use (p<0.001). Five-year incidence was significantly higher among European-American men (OR=3.3; 95%CI: 1.3-8.3), and among participants reporting a history of amphetamine use (OR=24; 95%CI: 6.9-83) or medical opioid use for treatment of pain (OR=8.6; 95%CI: 2.5-30). These associations remained strong when examined among marijuana users and after adjusting for demographics, social factors, and other antecedent substance use. Amphetamine use was the best single predictor of future nonmedical use (sensitivity 87%, specificity 79%).
  
  
  CONCLUSIONS
  Initiation of nonmedical prescription opioid use is generally rare in 28-40-year-old adults, but is observed to be more common with a previous history of substance abuse and legal access to opioids through prescription by a physician.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA. mpletcher@epi.ucsf.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Pletcher
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hulley
mesh_terms: D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D011307:Drug Prescriptions; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D013223:Statistics as Topic; D014481:United States
chemical_list: D009294:Narcotics