Within 1 year of their first opioid prescription, 2 trajectories of low and high risk for opioid persistence were identified among youth and young adults. These findings were published in JAMA Network Open.

Researchers at the University of Pittsburgh analyzed enrollment and claims data collected between 2007 and 2016 from Pennsylvania Medicaid enrollees. Patients (N=189,477) aged 10 to 21 years who received a first prescription for an opioid were assessed during the next 12 months for instances of psychiatric conditio ns and evidence of opioid overuse.

Patients received their first prescription at a median age of 16.9 (interquartile range [IQR], 14.6-18.8) years, 56.8% were women or girls, and 59.6% were White. This patient population had relatively high rates of mental illnesses, such as attention-deficit/hyperactivity disorder (14%), depression (13%), and anxiety (6%).

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The median length of opioid prescriptions was 4.0 (IQR, 3.0-5.0) days and the mean daily dosage was 57.7 (standard deviation [SD], 31.59) morphine milligram equivalents. A quarter (25.1%) filled at least 1 refill.

A 2-trajectory model was the most parsimonious fit for these data. Group 1 (3.1%) had a high-risk trajectory and group 2 (96.9%), a low risk. Within 12 months, 30.0% of group 1 and 10.1% of group 2 received a diagnosis of opioid use disorder (P <.001).

Individuals in group 1 were more likely to have cancer (adjusted odds ratio [aOR], 2.07; 95% CI, 1.60-2.68), depression (aOR, 1.35; 95% CI, 1.16-1.59), anxiety (aOR, 1.28; 95% CI, 1.02-1.60), and older ages (aOR, 1.19; 95% CI, 1.15-1.232). Patients who received their prescription from the dentist (aOR, 0.28; 95% CI, 0.22-0.35) or were Black (aOR, 0.62; 95% CI, 0.52-0.75) were less likely to have a high-risk trajectory.

These findings may not be generalizable because those patients covered by Medicaid in Pennsylvania tend to be from a lower socioeconomic status, and this group has been hard-hit by the opioid epidemic in the US.

The study authors determined from these data there were 2 trajectories of opioid use after a first prescription among youth and young adults. Clinicians should screen patients for comorbidities, such as depression and anxiety, before dispensing opioids.


Wilson JD, Abebe KZ, Kraemer K, et al. Trajectories of opioid use following first opioid prescription in opioid-naive youths and young adults. JAMA Netw Open. 2021;4(4):e214552. doi:10.1001/jamanetworkopen.2021.4552

This article originally appeared on Clinical Pain Advisor