Understanding risk and protective factors associated with opioid misuse among at-risk adolescents and young adults in the emergency department.

Abstract

Opioid misuse/opioid use disorder prevention strategies tailored for risk and protective factors are needed among adolescents and young adults (AYAs). We describe baseline risk/protective factors related to opioid misuse among at-risk AYAs who attended Emergency Departments (EDs) enrolled in a randomized controlled trial. People who recently visited an ED (ages 16-30) and self-reported 1) past-year prescription opioid use+a risk factor for misuse (i.e., drug use, binge drinking, depression symptoms, suicide risk) or 2) heroin or prescription opioid misuse at screening were enrolled. Measures assessed background characteristics and risk/protective factors. Analyses compared participants based on whether they reported opioid misuse or were at-risk for misuse. We enrolled 1155 people (27.5 % male); 79.5 % reported opioid use+risk factor and 20.5 % reported opioid misuse. In unadjusted analyses, relative to those with opioid use+risk factor, those with opioid misuse were significantly more likely to report: male sex, Black/African American race, receiving public assistance, food insecurity, stronger opioid use motives, greater substance use, a prior suicide attempt, violence involvement, and greater impulsivity. They also reported lower social support, prosocial activities, and self-efficacy to avoid substances. In adjusted analyses, those with opioid misuse were significantly more likely to be male, have greater alcohol and other substance use, and report violence, with lower self-efficacy and social support. Social determinants of health, other substance use, social support, self-efficacy, etc., were key factors differentiating AYAs who have misused opioids from those at-risk for future misuse. Prevention and early interventions may be improved via tailoring for these risk/protective factors.