title: Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors.
abstract: BACKGROUND
  Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use.
  
  
  METHODS
  Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009-2013, Weighted N=67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined.
  
  
  RESULTS
  12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use.
  
  
  CONCLUSIONS
  Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.
authors.affiliation: New York University Langone Medical Center, Department of Population Health, New York, NY, USA; Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA; Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA. Electronic address: joseph.palamar@nyumc.org.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Palamar
authors.affiliation: New York University Langone Medical Center, Department of Population Health, New York, NY, USA; College of Global Public Health, New York University, New York, NY, USA.
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Shearston
authors.affiliation: New York University Langone Medical Center, Department of Population Health, New York, NY, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Dawson
authors.affiliation: Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA; National Development and Research Institutes, New York, NY, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mateu-Gelabert
authors.affiliation: Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA; Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA; College of Global Public Health, New York University, New York, NY, USA.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Ompad
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D003932:Heroin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D012574:Schools / Q000639:trends*; D013334:Students / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin
keywords: Adolescents; Analgesics; Heroin; Nonmedical drug use; Opioids