Underage Drinking, Alcohol Dependence, and Young People Starting to Use Prescription Pain Relievers Extra-Medically: A Zero-Inflated Poisson Regression Model

摘要

Among young people who start using prescription pain relievers (PPRs) for feeling-states such as "to get high" or otherwise beyond boundaries intended by prescribers, the most recent epidemiological incidence estimates show 2%-9% with rapid-onset opioid dependence. In this work, we study recently active underage alcohol dependence as a susceptibility marker and estimate alcohol dependence-associated PPR rates of use, once use starts. In recent U.S. epidemiological samples, we identified 16,125 community-dwelling 12-to-20-year-olds with standardized assessments of both problem drinking and newly incident extra-medical PPR use. We applied zero-inflated Poisson (ZIP) regressions to estimate (a) alcohol dependence associations with susceptibility-to-persist after the very first occasion of extra-medical PPR use, and (b) the rate of PPR use, conditional on persistence. Underage drinkers with alcohol dependence were more susceptible to persistence in their extra-medical PPR use (p .001). In addition, given susceptibility-to-persistence, there was an alcohol dependence-associated excess rate of extra-medical PPR use (risk ratio = 1.3; 95% confidence interval = 1.1, 1.6). Using ZIP regressions, we can see that underage alcohol dependence signals membership in a susceptible-to-persistence class of extra-medical PPR users and excess rates of extra-medical use. Underage drinking can be an indicator of greater vulnerability to start and persist in extra-medical use of PPR, particularly if presenting clinical features of alcohol dependence already are seen at or near time of first onset of such PPR use. For alcohol dependence-affected adolescent patients, nondrug pain management plans deserve consideration, with special surveillance if analgesic drugs are prescribed. Implications for genetic susceptibility research are discussed.