Youth with a history of childhood depression and/or tobacco use are at a greater risk of using opioids by the age of 30 than those without such a history, according to a study published today in JAMA Pediatrics.
“Childhood tobacco use and chronic depression may be associated with impaired reward system functioning, which may increase young adults’ vulnerability to opioid-associated euphoria,” wrote Lily Shanahan, Ph.D., of the University of Zurich and colleagues. “Known evidence-based prevention strategies [for smoking and depression] could save lives, especially because mental health and substance use disorders are associated with opioid overdoses among the young.”
Shanahan and colleagues used data from the Great Smoky Mountains Study, a longitudinal study that enrolled over 1,400 children aged 9 to 13 years from 11 rural counties in western North Carolina in 1993 and periodically assessed them until age 30. The researchers specifically focused their analysis on data collected from 1,252 non-Black participants, including 342 American Indians, who had not used any opioids upon enrollment. (The sample of Black children was too small for inclusion in the study, the authors noted.) By age 30, 24.2% of the participants had used nonheroin opioids, 8.8% had used nonheroin opioids at least once a week, and 6.6% had used heroin.
The researchers identified several factors in childhood (defined as age 16 and younger) that increased the likelihood of future opioid use, including being male, using tobacco, using cannabis, and having depression. After adjusting for other variables, childhood tobacco use and depression had the strongest associations for future opioid use.
The risks were greatest in participants who had chronic depression (at least two years of symptoms) or dysthymia (persistent low mood). For example, participants with childhood dysthymia were 5.43 times as likely to have used nonheroin opioids, 8.89 times as likely to have used nonheroin opioids weekly, and 8.16 times as likely to have used heroin by age 30 as those without a history of childhood dysthymia.
“One possible reason childhood chronic depression increases the risk of later opioid use is self-medication,” Shanahan and colleagues wrote. “Opioids may offer a problematic antidote to depression-related difficulties detecting and experiencing reward or pleasure, debilitating low moods, and low self-esteem. Children with chronic depression may also later take opioids to alleviate the physical symptoms and pain that often accompany depression.”
To read more about this topic, see the Psychiatric News article “Opioid Prescribing in Rural Areas Far Outpaces Urban, CDC Finds.”
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