Opioid abuse and depression in adolescents: Results from the National Survey on Drug Use and Health

• We investigated the relationship between depression and opioid abuse in adolescents.
• Major depression is strongly associated with opioid abuse in adolescents.
• When comorbid, major depression usually precedes opioid abuse.
• Programs to decrease opioid abuse should consider the prominent role of depression.

ObjectiveTo investigate the association of major depressive episode (MDE) with nonmedical prescription opioid use (NMPOU) and opioid abuse/dependence among adolescents aged 12 to 17.MethodsWe analyzed 5 years of data from the National Survey on Drug Use and Health (NSDUH). We used logistic regressions to study the relationship between MDE and NMPOU among all adolescents, as well as the relationship of MDE with opioid abuse/dependence among adolescents with NMPOU. Other covariates included: sociodemographics, alcohol abuse/dependence, nonopioid drug abuse/dependence, delinquency, school performance, religious services attendance, and family support/supervision.ResultsIn the sample of all adolescents, 6% reported past year NMPOU, and 8% reported past year MDE. When NMPOU and MDE were comorbid, MDE usually preceded the NMPOU. In the sample of adolescents with NMPOU, 15% reported past year opioid abuse/dependence, and 20% reported past year MDE. In adjusted logistic regression, MDE was associated with both NMPOU (OR = 1.51, p < 0.001) among all adolescents and opioid abuse/dependence (OR = 2.18, p < 0.001) among adolescents with NMPOU.ConclusionMDE occurs commonly in adolescents and is associated with NMPOU and opioid abuse/dependence. In terms of population attributable risk, which is a function of both the prevalence and the strength of the association, MDE is an important risk factor for NMPOU among adolescents and opioid abuse/dependence among adolescents with NMPOU. Preventive and clinical programs to decrease NMPOU and opioid abuse/dependence among adolescents should consider the prominent role of depression.