Rising drug overdose rates are a major social problem, but understanding of trends in the use of high-risk drugs is limited. The increasingly addictive potential of high-risk drugs, broader social changes, and the importance of peers and social contexts in shaping use may create conditions in which some cohorts have elevated use further into adulthood than others.

We use an age-period-cohort model that defines cohort effects as the differential influences of social events for individuals of different ages. We analyze data from the 1979–2018 National Survey on Drug Use and Health to study past-year (mis)use of prescription analgesics, heroin, cocaine, and methamphetamine.

Pre-1990 cohorts had either consistently lower than average odds or decreasing odds of use as they aged. The 1990s cohorts had higher than average odds of use, which increased as they aged. Early-2000s cohorts had increasing odds of use with age, despite low odds in adolescence.

High-risk drug use appears to be an important cohort differentiating mechanism, with implications for policy and theories of deviance and stratification. The typical focus on period trends obscures the elevated odds of high-risk drug use in certain cohorts, whose members are entering the ages when overdose is most likely and consequences become most pronounced.