Perceived risk of heroin use among nonmedical prescription opioid users

Abstract

Aims The prevalence of heroin use among nonmedical prescription opioid (NMPO) users has increased in recent years. Identifying characteristics associated with heroin use in this population can help inform efforts to prevent heroin initiation and maintenance. The aim of this study was to evaluate differences in perceived risk of heroin among NMPO users with and without histories of heroin use, and to examine temporal trends in perceived risk of heroin among this population. Methods Data are from the 2002–2013 National Survey on Drug Use and Health, and included all past-year NMPO users (N=49,045). Participants reported perceived risk of trying heroin once or twice and regular heroin use. Responses were coded dichotomously (great risk vs. other risk) and logistic regression analyses were used to evaluate the association between lifetime heroin use and perceived risk of heroin, and to determine temporal changes in perceived risk. Results Results indicated a significant association between lifetime heroin use and lower likelihood of reporting great risk of trying heroin (OR = 0.38, 95% CI: 0.33, 0.44, p < .001), and of regular use of heroin (OR = 0.39, 95% CI: 0.32, 0.48, p < .001). There was a significant, yet modest, trend toward decreasing perception of great risk from 2002–2013. Conclusions Findings from this analysis of nationally representative data indicate that NMPO users with a history of heroin use perceive heroin to be less risky. Perception of risk has decreased from 2002–2013 in this population, consistent with increasing rates of heroin initiation.

Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States

“…61 Major depressive disorder was assoc iated w ith SUDs, particularly drug disorders, as found previously for cannabis, 40,62 nonmedical prescription opioids, 5,57,63 and drug use disorders. 41 With increasingly positive attitudes toward substance use [64][65][66] and increasing rates of adult SUDs and associated problems, 24,41,42,67-69 MDD comorbidity with SUDs remains a substantial public health 24,70 and economic 16 burden. Evidence suggests that efforts to selfmanage depression with cannabis are increasing [71][72][73][74][75] (also Aaron L. Sarvet, MPH, written communication, January 2, 2018) despite lack of evidence that cannabinoids are effective for this purpose 76,77 ; prospectively, cannabis worsens the course of depressive disorders.…”

Prescription painkiller misuse and the perceived risk of harm from using heroin

“…The responses were on a 4-point scale, labelled as "great risk," "moderate risk," "slight risk," and "no risk." We dichotomized responses into "great risk" and "less than great risk," similarly to other studies of perceived risk using NSDUH (Lipari et al, 2017;Pacek et al, 2015;Votaw et al, 2017).…”

“…Cross-sectional studies have shown that individuals who use a particular substance may perceive that behavior as lower risk, compared to individuals who do not (Chomynova et al, 2009;Lipari et al, 2017;Pacek et al, 2015). One such study of people who used prescription pain relievers showed that those who had previously used heroin were much less likely to feel heroin use as being very risky, compared to those who had not used heroin (Votaw et al, 2017). Longitudinal studies have also explored this link, showing that the perceived harmfulness of a substance may be inversely associated with subsequent use.…”

Complexities in understanding and addressing the serious public health issues related to the nonmedical use of prescription drugs

“…Dramatic increases in overdoses from prescription opioids and the transition to heroin use among nonmedical users of prescription opioids has certainly captured the attention of community leaders across the nation. In this issue, Votaw et al (2016) analyzed multiple years of data from the National Survey of Drug Use and Health (NSDUH) and showed a significant association between low perceived risk of regular heroin use and using heroin among nonmedical prescription opioid users. In an analysis of injection drug users, Al-Tayyib et al (2016) found that 32% reported being hooked on prescription opioids prior to initiating injection drug use.…”