Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics

Abstract

Objectives The purpose of this study was to compare demographic, clinical, and survival characteristics of drug-using safety-net primary care patients who used or did not use opioids, and to examine treatment implications of our findings. Methods The sample consisted of 868 adults who reported illicit drug use in the 90 days prior to study enrollment, 396 (45.6%) of whom were opioid users. Results Multiple measures indicated that, as a group, opioid users were less physically and psychiatrically healthy than drug users who did not endorse using opioids, and were heavy users of medical services (e.g., emergency departments, inpatient hospitals, outpatient medical) at considerable public expense. After adjusting for age, they were 2.61 (CI, 1.48-4.61) times more likely to die in the 1 to 5 years after study enrollment and more likely to die from accidental poisoning than non-opioid users. Subgroup analyses suggested patients using any non-prescribed opioids had more serious drug problems including more intravenous drug use and greater HIV risk than patients using opioids only as prescribed. Conclusions Use of opioids adds a dimension of severity over and above illicit drug use as it presents in the primary care setting. Opioid users may benefit from psychiatric and addiction care integrated into their primary care setting, naloxone overdose prevention kits, and prevention efforts such as clean needle exchanges. Addiction or primary care providers are in a key position to facilitate change among such patients, especially the third or more opioid users having a goal of abstinence from drugs.

Drug Use Severity, Mortality, and Cause of Death in Primary Care Patients With Substance Use Disorders

“…Individuals in the low-or medium-severity groups had a higher percent of deaths due to cancer or cardiovascular diseases, yet also died of conditions related to substance use disorders, including alcohol use disorders. While these findings were not particularly unexpected, they tell a tragic story of premature death and potentially avoidable deaths due to accidents among individuals with problem drug use (Colton & Manderscheid, 2006;Dembling et al, 1999;Maynard & Boyko, 2006;Ries et al, 2015). Participants in the trial used a variety of drugs including marijuana, prescription opiates, methadone, heroin, and stimulants as well as alcohol and nicotine.…”

Association between process measures and mortality in individuals with opioid use disorders

“…OUDs are frequently co-morbid with medical problems (Centers for Disease Control and Prevention, 2012; Degenhardt et al, 2011; Degenhardt et al, 2014b; Ries et al, 2015), putting individuals at risk for polypharmacy (Dublin et al, 2011; Saunders et al, 2010; Woolcott et al, 2009) and poor care for their medical conditions. The few studies examining the link between utilization and mortality suggest that more service use could increase the receipt of preventive health services as well the early identification and management of new or worsening physical health problems (Druss et al, 2001; Meyer et al, 2014; Paddock et al, in press; Ronan and Herzig, 2016; Watkins et al, 2016).…”

“Health Is on the Back Burner:” Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs

“…21 Despite the benefits of primary care, PWID have low primary care utilization 27,28 and frequently access emergency medical services for conditions that could be addressed in primary care settings. 29,30 Emergency departments have developed innovative protocols to address the unmet needs of PWID accessing emergency services. 31,32 However, emergency departments are not designed or resourced for delivering preventive services, providing long-term management of SUD and other chronic conditions, or addressing social needs.…”