Trajectories of Medical Prescription Opioid Use in Middle Adulthood and Substance Use Disorder Symptoms

OBJECTIVE: Major changes in opioid prescribing have created a need to understand long-term patterns of medical prescription opioid use and its associations with substance-related consequences. This study aimed to identify trajectories of medical use of prescription opioids during middle adulthood (ages 35-60) and examine associations of such trajectories with nonmedical prescription opioid use and substance use disorder symptoms. METHODS: Twenty-seven cohorts of 31,094 adults were followed longitudinally via self-administered surveys during midlife. Latent profile analysis was used to create trajectory profiles based on frequency of medical prescription opioid use between ages 35 and 60. RESULTS: An estimated 37.3% of adults reported at least one episode of medical prescription opioid use during midlife, and four trajectories were identified: infrequent use (27.1% of all adults); multiple peaks at ages 35, 45, and 60 (3.7%); multiple peaks at ages 40 and 55 (2.9%); and frequent use at all ages (3.7%). The prevalence and adjusted odds ratio (AOR) of experiencing multiple substance use disorder symptoms were significantly higher among adults with frequent use at all ages (60.5%, AOR=2.1); multiple peaks at ages 35, 45, and 60 (51.1%, AOR=1.7); multiple peaks at ages 40 and 55 (48.9%, AOR=1.5); and infrequent use (41.1%, AOR=1.4), relative to a population control group. CONCLUSIONS: Most adults with frequent long-term medical use of prescription opioids reported multiple substance use disorder symptoms. Screening for nonmedical use and substance use disorders before prescribing opioids and ongoing monitoring for substance use disorders are critical, particularly among adults requiring frequent or long-term recurrent medical use of prescription opioids.