Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses. Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days. Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantly associated with riskier opioid misuse trajectories. Conclusion. Young adults who reported more debilitating experiences as children and adolescents misused opioids longer and engaged in higher risk alternate modes of administering opioids. Data on decisions both to use and to alter a drug’s form can be combined to describe patterns of misuse over time and predict important risk behaviors. 1. Introduction Over the past decade, prescription drug misuse has increased significantly in the U.S. [1, 2] and is most prevalent among young adults 18 to 25 years of age [2, 3]. Prescription opioids, such as hydrocodone and oxycodone, are the most frequently misused class of prescription drug among young adults [2]. Prescription opioids are a particularly important public health concern since opioid misuse is associated with a range of negative health outcomes, including injection drug use [4], drug dependence [2, 5], and fatal overdose [6, 7]. Prescription opioid trajectories among young adults begin with initiation into misuse [8] and include various patterns of misuse over a period of years [9, 10]. Features of opioid use trajectories, including duration of misuse and mode of administration, have been linked to negative outcomes among young adults. Individuals who initiate opioid misuse earlier in their lives or have misused opioids for several years have a greater likelihood of developing a substance abuse disorder [11, 12]. Misusing opioids for a period of years has been linked to transitioning to heroin among young injection drug users (IDUs) [8]. Among adults, a longer duration
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