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Teenagers who reported nonmedical prescription opioid use during high school were significantly more likely to later use heroin, according to findings from a prospective cohort study published in JAMA Pediatrics.

“The opioid epidemic has overwhelmed many communities in the United States, and teenagers are a particularly vulnerable group who also are at risk,” lead author Lorraine Kelley-Quon, MD, MSHS, assistant professor in the division of pediatric surgery at Children's Hospital Los Angeles, told Infectious Diseases in Children. “Prescription opioids are pharmacologically similar to heroin, making the association notable and unique.”

Kelley-Quon and colleagues conducted a longitudinal cohort survey in eight urban and two suburban Los Angeles high schools that were chosen because of their diverse demographic characteristics. The researchers followed 3,298 adolescents from ninth grade in 2013 through 12th grade in 2017. The adolescents, who had never used heroin at baseline, participated in eight waves of semi-annual surveys — each wave representing a semester in high school — to assess nonmedical prescription opioid use, heroin use and social and environmental factors. 

Current nonmedical prescription opioid use has a 13.1% estimated cumulative probability of subsequent heroin use initiation.

The cohort included 1,775 teen girls (53.9%), 1,563 (48.3%) Hispanic students, 548 (17%) Asian students, 155 (4.8%) African American students, 529 (16.4) non-Hispanic white students and 220 (6.8%) multiracial students.

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