OBJECTIVE We assessed overdose mortality by opioid types involved as well as interrelationships between nonmedical use of prescription opioids (NUPO) and heroin and injection drug use (IDU) among adolescents. METHOD We examined 2010 and 2016 overdose data by drug type for decedents in the United States ages 15-19 years from the Multiple Cause of Death Files. We also analyzed data from the 2017 National Youth Risk Behavior Survey, a nationally representative survey of high school students. We assessed lifetime NUPO and calculated heroin use and IDU by frequency of lifetime NUPO. Adjusted prevalence ratios (aPRs) were generated, and linear contrast analysis determined dose-response relationships between frequency of lifetime NUPO and the two outcomes. RESULTS The percentage of deaths involving prescription opioids that also involved illicit opioids such as heroin or fentanyl was 5.5% in 2010 and 25.0% in 2016. We observed a positive dose-response relationship with frequency of lifetime NUPO; aPRs were highest for 20 or more times of NUPO and heroin use (aPR = 49.49, 95% CI [33.39, 73.34]) and IDU (aPR = 44.37, 95% CI [23.16, 84.99]). However, aPRs for heroin and IDU were high even among those reporting just one or two occasions of NUPO (aPRs = 9.25, 95% CI [5.90, 14.49] and 6.63, 95% CI [3.99, 11.02], respectively). CONCLUSIONS Adolescent prescription opioid overdose deaths now frequently involve illicit opioids. Heroin use and IDU are higher among students reporting even a few instances of NUPO, indicating that students with any NUPO are an important risk group. Clinical, community, and school-based efforts can address NUPO, noting these associations.

中文翻译：

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阿片类药物的非医学使用，海洛因的使用，注射毒品的使用以及美国青少年的过量死亡率

目的我们评估了青少年所用阿片类药物的过量使用死亡率，以及非医学处方阿片类药物（NUPO）和海洛因与注射毒品使用（IDU）之间的相互关系。方法我们检查了美国多死亡原因档案中15-19岁美国死者按药物类型划分的2010年和2016年用药过量数据。我们还分析了2017年全国青少年风险行为调查（National Youth Risk Behavior Survey）的数据，该调查是一项针对全国的高中生调查。我们评估了终身NUPO，并根据终身NUPO的频率计算了海洛因的使用量和IDU。调整后的患病率（aPRs）产生，线性对比分析确定终生NUPO频率与两个结果之间的剂量反应关系。结果2010年和2016年，涉及处方阿片类药物以及海洛因或芬太尼等非法阿片类药物的死亡百分率是5.5％，2016年是25.0％。在20倍以上的NUPO和海洛因使用中，aPR最高（aPR = 49.49，95％CI [33.39，73.34]）和IDU（aPR = 44.37，95％CI [23.16，84.99]）。然而，即使仅报告一两次NUPO的海洛因和IDU的aPR也很高（aPRs分别为9.25、95％CI [5.90、14.49]和6.63、95％CI [3.99、11.02]）。结论青少年处方阿片类药物过量死亡现在经常涉及非法阿片类药物。在报告了NUPO实例很少的学生中，海洛因的使用率和IDU较高，表明使用NUPO的学生是重要的危险人群。临床，社区，