Opioid misuse increased dramatically throughout the United States from 1999-2017, fueling the current opioid epidemic. The recent rise in the availability of highly potent synthetic opioids, such as fentanyl, has also been a key driver in the opioid epidemic. Opioid misuse—defined as using opioids in a manner or dose other than what is prescribed, using someone else’s prescription, or using opioids to experience euphoria—has declined slightly in the past few years but continues to be a major cause of morbidity and mortality for patients of all ages.

Opioid misuse in young adults has been linked to higher risks for secondary substance abuse, long-term opioid use disorder, and opioid overdoses. Recent estimates have shown that more than 50% of patients who misuse opioids obtained them from friends or relatives, whereas about 25% obtained these medications from the healthcare system. “Rates of prescription opioid misuse rise during adolescence and peak in young adulthood,” says Jason Nagata, MD, MSc. “Young adulthood has been seen as a particularly high-risk period for opioid exposure, often coming from a healthcare setting.”

Assessing the Impact of Healthcare Exposure on Future Opioid Misuse

Several studies have established outpatient opioid prescribing as a risk factor for opioid misuse in adolescents and young adults, but data are lacking on whether healthcare exposure alone in young adults is a risk factor for opioid misuse, according to Dr. Nagata. For a study published in the American Journal of Preventive Medicine, Dr. Nagata and colleagues analyzed the impact of exposure to a healthcare setting in young adulthood on future opioid misuse. “The goal of our study was to examine the association be tween healthcare exposure in young adulthood and future opioid misuse,” Dr. Nagata says.

Using data from the National Longitudinal Study of Adolescent to Adult Health (2001-2018), the investigators looked at healthcare exposures, such as inpatient hospitalization and visits to a clinic, ED, mental health facility, or dentist. Opioid misuse was defined as using prescription painkillers without a doctor’s permission and was measured 17 years after exposure. A total of 8,225 young adults met inclusion criteria for the study.

Healthcare Exposure to Opioids in Young Adulthoods Raises Risks Later in Life

Almost one in seven adults with no opioid misuse at baseline reported new misuse over the 17-year follow-up period. Early exposure to the healthcare system appeared to be a risk factor for opioid misuse later in life. Populations with a higher incidence of adult-onset opioid misuse included patients who were White, male, and/ or depressed as well as those who reported previous substance use and people with less than a high school education at follow-up. Non college graduates were at the highest risk for misuse.

“Our study found that young adults exposed to inpatient hospitalizations, EDs, or mental health facilities had an increased risk for opioid misuse later in adulthood,” says Dr. Nagata (Figure). The study also found that two healthcare exposures were associated with increased odds for future opioid misuse. Of note, engaging in routine preventive healthcare behaviors at a doctor’s visit in the past 2 years was not associated with opioid misuse.

Beware of Potential for Opioid Misuse in At-Risk Young Adults

“Healthcare professionals and parents of young adults should be aware that their children who visit the doctor outside of routine care may have a greater risk for future opioid misuse,” Dr. Nagata says. “Primary care physicians should screen for illicit drug use, including non-medical use of prescription pills, especially in young adults. Physicians should also follow responsible prescribing practices to prevent opioid misuse while providing adequate and safe pain control.”

Since physicians and hospital systems encounter young adults every day, screening and intervention efforts should be reinforced throughout adolescence and adulthood. “Future research should investigate the role of opioid prescription sources, such as EDs, postoperative care units, or primary care settings, on the potential for long-term opioid misuse,” says Dr. Nagata.