Changes in US Lifetime Heroin Use and Heroin Use Disorder

Martins, Sílvia S.; Sarvet, Aaron L.; Santaella-Tenorio, Julián; Saha, Tulshi D.; Grant, Bridget F.; Hasin, Deborah S.

doi:10.1001/jamapsychiatry.2017.0113

Cited by 177 publications

(127 citation statements)

References 60 publications

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“…While judicious opioid prescribing may be associated with better outcomes among the opioid-naive, the same may not be true for those with a history of opioid dependence and/or addiction, particularly if reduced access to prescription opioid analgesics leads to substitution with riskier illicit opioids such as heroin and fentanyl [25,28,30,42]. While there is a general consensus that increased opioid prescribing initiated the recent epidemic of opioid addiction and overdose, focusing solely on opioid prescribing patterns is unlikely to stem the tide of opioidrelated harm [5,14,26,27,29,43]. Consistent with this idea, even among the opioid-naive individuals in this study, fentanyl was present at autopsy among nearly half of those who died of an opioid overdose, while approximately a quarter had alcohol, cocaine and/or marijuana as coingestants at the time of death.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing consensus that prescribing of opioid analgesics initiated an epidemic of addiction and overdose in the United States [1][2][3][4][5][6]. In response, there have been multiple initiatives to limit opioid prescribing [7][8][9][10][11][12], which could reduce the burden of opioid use disorder (OUD) and its associated harms by avoiding initial exposure to prescription opioids among individuals receiving treatment for pain [13][14][15] or by promoting safer treatment regimens for those who do start opioid analgesics [16,17], thus mitigating OUD and overdose risk.…”

Section: Introductionmentioning

confidence: 99%

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Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

et al. 2019

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Aims To examine how the risks of incident opioid use disorder (OUD), non‐fatal and fatal overdose have changed over time among opioid‐naive individuals receiving an initial opioid prescription. Design Retrospective, longitudinal study using the Massachusetts Chapter 55 data set, which linked multiple administrative data sets to study the opioid epidemic. We identified the cumulative incidence of OUD, non‐fatal and fatal overdose among the opioid‐naive initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years to 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. Setting Massachusetts, USA. Participants Massachusetts residents aged ≥ 11 years in 2011–15 who were opioid‐naive (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n = 2 154 426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. Measurements Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and non‐fatal overdose were identified from claims in the All Payer Claims Database (APCD) and hospital encounters in the acute hospital case mix files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. Findings Among opioid‐naive individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1‐year OUD rate was 1.18% in 2011, 1.11% in 2012, 1.26% in 2013 and 0.94% in 2014. Longer therapy duration was associated with higher risk of OUD [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 2.19–2.29 for duration of 3 or more months], non‐fatal (HR = 1.67, 95% CI = 1.53–1.82) and fatal opioid overdose (HR = 2.24, 95% CI = 1.91–2.61). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR = 1.14, 95% CI = 1.12–1.17), non‐fatal (HR = 1.20, 95% CI = 1.10–1.30) and fatal overdose (HR = 1.86, 95% CI = 1.61–2.16). Conclusions Among opioid‐naive individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of opioid use disorder and opioid overdose.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

et al. 2019

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“…Population surveys reveal that heroin use increased evenly across the four Census Regions suggesting that the increase in the population at risk has been even (Jones et al, 2015; Martins et al, 2017). However, the divergence in HOD hospitalization rates across geographic locations, supported by these results, suggest that some areas are experiencing increases in risk from heroin use, not just an increase in the number of heroin users.…”

Section: Discussionmentioning

confidence: 99%

“…Between the 2002 and 2013 past year heroin use has increased from 1.6 per 1000 persons to 2.6 per 1000 (Jones, Logan, Gladden, & Bohm, 2015; Martins, Sarvet, & Santaella-Tenorio, 2017). While the increase in Heroin Use Disorder has been spread evenly across the 4 census regions, it has been concentrated in white non-Hispanic males under the age of 44 (Martins et al, 2017). …”

Section: Introductionmentioning

confidence: 99%

US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations

Unick

Ciccarone

2017

International Journal of Drug Policy

109

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Background US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opiate opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opiate overdose (POD) and heroin overdose (HOD) hospitalizations. Methods Data come from the National Inpatient Sample (NIS) for the years 2000 through 2014. POD and HOD hospitalizations were abstracted from ICD-9 codes. Rates of POD and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in POD and HOD rates. Results POD hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not POD trends across the four regions between 2000 and 2014. Between 2012 and 2014 POD rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both POD and HOD rates show different demographic patterns across the nine census divisions. Conclusion Comparing POD and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These Mepidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics require innovative public health research and interventions which need to consider local and regional contexts.

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“…Likely contributing to this disparity is that prevalence of heroin use disorders is growing among white populations. Although heroin use has risen across most demographic groups, it has increased most sharply among non-Hispanic whites (Jones et al, 2015b) and evidence suggests that many whites that initiate heroin use previously misused prescription opioids (Martins et al, 2015; Martins et al, 2017). Providers who serve populations not historically affected by opioid use may lack training about OUD, and stigma in addition to regulatory and insurance obstacles may further bar integrating medication into existent treatment settings (Heinrich and Cummings, 2014).…”

Section: Discussionmentioning

confidence: 99%

Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample

Krawczyk

Feder

Fingerhood

et al. 2017

Drug and Alcohol Dependence

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Background Opioid Agonist Treatment (OAT) is the standard of care for the treatment of opioid use disorders. However, most people in treatment do not receive OAT. This study evaluated whether there are racial and/or ethnic differences in OAT receipt among adults entering specialty treatment for opioid use disorders in publicly-funded treatment programs across the U.S. Methods Using data from the national Treatment Episode Data Base, odds of OAT receipt were compared among black, Hispanic and white clients. Mediation analyses were used to explore whether any racial/ethnic differences in OAT receipt were explained by variation in clinical need or by other treatment, sociodemographic, or geographic characteristics. Interaction terms were used to assess whether this association was modified by primary opioid type. Results Only 28.7% of clients received OAT. Odds of OAT receipt were significantly higher odds among blacks (OR: 2.27(2.14–2.41)) and Hispanics (OR: 1.98(1.88–2.09)), compared to whites. Differences in clinical need accounted for a substantial portion of this difference (76.79% and 49.74%, respectively). Differences persisted after accounting for other potential explanatory variables (adjusted OR: 1.37 (1.24–1.52); 1.21(1.11–1.32)), but were only evident for primary heroin users (adjusted OR: 1.50 (1.34- 1.69); 1.29 (1.17–1.42)) and not other opioid users. Conclusions OAT receipt in treatment programs is low overall and particularly lacking among white heroin users. Differences in OAT receipt cannot be fully explained by differences in clinical need. More research is needed to understand and address barriers that underpin these differences so more patients with opioid use disorder can access evidenced-based treatment.

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Changes in US Lifetime Heroin Use and Heroin Use Disorder

Cited by 177 publications

References 60 publications

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations

Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample

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