Using latent class analysis (LCA) to analyze patterns of drug use in a population of illegal opioid users

Monga, Neerav; Rehm, Jürgen; Fischer, Benedikt; Brissette, Suzanne; Bruneau, Julie; el‐Guebaly, Nady; Noël, Lina; Tyndall, Mark W.; Wild, C.; Leri, Francesco; Fallu, Jean-Sébastien; Bahl, Saira

doi:10.1016/j.drugalcdep.2006.08.029

Cited by 110 publications

(109 citation statements)

References 46 publications

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“…Overdoses with cocaine and heroin in combination, cocaine-only and cocaine, heroin and alcohol combinations are often experienced by drug users, yet their epidemiology is not well understood [29,31]. Areas that have historically reported high abuse of cocaine and other stimulants such as the US eastern seaboard [32], California [33] and Canada [34][35][36] may find muted effects of naloxone training programs on the prevalence of fatal drug overdose in their community. Curricula to recognize and respond to non-opioid overdose, especially cocaine intoxication, should be incorporated into naloxone trainings.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

2008

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Aims-This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose-response in the United States.Design and participants-Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62).Setting-US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico.Measurements-Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics.Findings-Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t 60 = 3.76, P < 0.001) and instances where naloxone was indicated (t 59 = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). Conclusions-Resultssuggest that naloxone training programs in the United States improve participants' ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality.

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Section: Discussionmentioning

confidence: 99%

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

2008

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“…The Fischer et al 12 OPICAN study found that the overall prevalence of pain was 15.2%. The Monga et al 45 latent class analysis of the OPICAN data indicated that the group predominantly including POA users had more self-reported pain, compared with predominant users of heroin, crack, or other drugs. The Rosenblum et al 54 study of people entering MMTs for opioid abuse across the United States found that chronic pain was positively associated with POA abuse, and that chronic pain increased the odds of using POAs as the primary drug of abuse, compared with no chronic pain.…”

Section: Nmpou and Painmentioning

confidence: 99%

“…Latent class analysis of the cohort found that respondents involving NMPOU had the highest proportion of people with depression, compared with users of other drugs. 45 The Havens et al 46 US survey of untreated stimulant users indicated that POA misuse was associated with higher depression and anxiety scores.…”

Section: Nmpou and Mental Health Problemsmentioning

confidence: 99%

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

et al. 2011

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Objective: In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. Method:A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.Results: Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. Conclusions:The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.Can J Psychiatry. 2011;56(8):495-502. Clinical Implications• Mental health and (or) pain comorbidities are highly coprevalent in people engaging in NMPOU.• When observing NMPOU in patients, undiagnosed or untreated mental health and (or) pain must be examined as a possible cause.• People in need of medical POA care for pain should be screened for mental health problems. Limitations• A systematic review and meta-analysis is needed to further validate and add statistical precision findings.• NMPOU was inconsistently defined and operationalized across different studies.• Most studies were cross-sectional, thus directionality of the association cannot be determined.

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“…Several in-depth analyses revealed further interesting dynamics related to drug use within the study cohort. First, a latent class analysis suggested that OPICAN cohort participants could be divided into 3 distinctly different drug-user groups characterized primarily by heroin and cocaine injection use, other opioid and benzodiazpenine use, and noninjected other opioid and crack use (109). Second, a specific examination of those who also used crack, compared with those who did not also use crack, revealed that the former were significantly more likely to be characterized by key indicators of social and health risks or harms, including unstable housing, criminal activity, health problems, and injection risks (110).…”

Section: Drug Usementioning

confidence: 99%

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

2006

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Clinical Implications • Illicit opioid use to a large extent manifests via the illicit use of prescription opioids and typically includes polysubstance use. • Physical and (or) mental health comorbidities are highly prevalent in illicit opioid user populations. • Morbidity and (or) mortality risks are often associated with social marginalization. Limitations • Little is known about the patterns and consequences of illicit opioid use in general populations. • Owing to the marginalized and illegal status of illicit opioid users, information is available only from selective populations with limited potential for generalizability of data. • The OPICAN study specifically builds largely on self-report and may be subject to bias. Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

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Using latent class analysis (LCA) to analyze patterns of drug use in a population of illegal opioid users

Cited by 110 publications

References 46 publications

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

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