Opioid use disorders, like most mental disorders, have complex origins. Determining modifiable risk factors is particularly crucial in informing early intervention efforts. Findings from three large studies that included participants who were 18 years or younger shed light on these risk factors.

An Alberta study examined the link between mental disorders and the later development of opioid use disorder in nearly 2,000 young people aged 18 to 25 years. Researchers identified young adults with opioid use disorder in provincial health administrative databases. Individuals were then matched based on age and sex with more than 7,000 individuals without this diagnosis. Researchers found that alcohol use, anxiety and depressive disorders predicted the development of opioid use disorder. Alcohol use disorder was particularly potent, increasing risk more than sixfold, while anxiety and depressive disorders each more than doubled the risk.

A US study involved nearly 77,000 youth aged 14 to 18 years who were enrolled in a Colorado health maintenance organization. Researchers first identified 108 youth who had opioid use disorder and then identified preceding risk variables. Having a substance use disorder or using substances resulted in about five times higher likelihood of being diagnosed with opioid use disorder. And having other mental health diagnoses (i.e., anxiety, adjustment, conduct, depressive and/or eating disorders) resulted in four times higher likelihood.

The third study was a survey of more than 41,000 youth who were representative of American 12- to 17-year-olds — and highlighted similar risks. Past-year substance use and depression were both risk factors for developing prescription opioid use disorder. Specifically, the odds of developing this disorder increased by 522% for “illicit” drug use; 176% for cannabis use; 102% for alcohol use; and 237% for depression.

Taken together, the findings of these three studies demonstrate that mental health conditions confer considerable extra risk for young people regarding opioid misuse.

For more information, see Vol. 18, No. 3 of the Children’s Mental Health Research Quarterly.