Severe mental health distress among young adult prescription opioid abusers

Background: To examine predictors of severe mental health distress among young adults in Miami's nightclub culture. Data are drawn from a natural history study of drug use and health and social consequences among adults ages 18 to 39 (N=512). Methods: Baseline interviews include well-tested measures of mental health and drug use. Multivariate models were developed to predict severe mental distress. Results: Median age was 23; 35% were female, 52% Hispanic, 23% White, and 21% Black. Heavy use of specific substances was defined as the top quartile of quantity used monthly (e.g., 100+ drinks, 15+ opioid pills, 120+ lines of cocaine). Heavy opioid users were more likely to also be heavy users of cocaine, MDMA and prescription sedatives. In multivariate logistic regression, female gender (p=.042), greater victimization history (p<.000), heavy opioid abuse (p=.004), and lower social support (p<.000) predicted severe overall mental health distress. The same factors also separately predicted severe depression, anxiety and traumatic stress, except that gender was unrelated to anxiety. Conclusions: Young adults in Miami's club scene report high levels of drug use, prior victimization and mental health distress. Heavy abuse of prescription opioids is especially prevalent among those with severe mental health problems. Such abuse is likely related to attempts at self-medication as well as to moderate the effects of illicit stimulants popular in the club scene. Interventions are needed to reach young adults in need of mental health care, as well as to increase their awareness of the risks of prescription opioid abuse.