Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco

Abstract

Background: Current data suggest that opioid misuse or opioid use disorder (OUD) may be over represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. Methods: Data were derived from a sample of 2,000 adult (aged ≥18) primary care patients across 5 distinct clinics. Among past-year tobacco users (n=882), we assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use. Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership. Results: Past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14.0% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78.0%), a tobacco-cannabis use group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics. Conclusions: Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users.

A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey

“…Other substance dependence or abuse has been associated with opioid misuse based on varying risk factors. [13,28,33,47,50] In this study, we speci cally found that nicotine, [28,29] alcohol, [28,30] cocaine, [50] methamphetamine, [32] tranquilizers, [34,35,51] other illicit stimulants [20], and marijuana [28] have a positive relationship with opioid misuse and use disorder. The stimulant effect from nicotine, cocaine, methamphetamine, and other illicit stimulants have been stipulated to mitigate the depressive effects of opioids and may increase the "high" effect.…”

“…The role of other substance dependence, abuse, and/or misuse, whether legal, illicit, or prescribed, has also been linked to opioid misuse and/or use disorder. Concurrent substance use such as nicotine and tobacco dependence [28,29], alcohol [30], sedatives [31], methamphetamines [32], tranquilizers [33][34][35], other analgesics [36], and marijuana [37] have been positively associated with opioid misuse and use disorder [37,38]. Marijuana may be context dependent as it has a mixed relationship with opioid use, misuse, and use disorder.…”

A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey

“…Other substance dependence or abuse has been associated with opioid misuse based on various risk factors. [11,25,30,45,52] In this study, we found that nicotine [25,26], alcohol [25,27], cocaine [52], methamphetamine [29], tranquilizers [31,32,53], other illicit stimulants [15], and marijuana [25] have a positive relationship with opioid misuse and use disorder. The stimulant effect from nicotine, cocaine, methamphetamine, and other illicit stimulants may mitigate the depressive effects of opioids and may increase the "high" effect.…”

“…Concurrent substance use such as nicotine and tobacco dependence [25,26], alcohol [27], sedatives [28], methamphetamines [29], tranquilizers [30][31][32], other analgesics [33], and marijuana [34] have been positively associated with opioid misuse and use disorder [34,35]. Marijuana's association may be context dependent, as it has a mixed relationship with opioid use, misuse, and use disorder.…”

Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model

“…Other substance dependence or abuse has been associated with opioid misuse based on varying risk factors. 19, 25−28 In this study, we specifically found that nicotine, 25,29 marijuana, 25 cocaine, 28 methamphetamine, 30 tranquilizers, 31−33 and stimulants 34 increase the probability toward opioid misuse. Although the present study revealed an increased association of opioid misuse with marijuana compared to non-marijuana users, the relationship in the literature has been mixed.…”