Young adults' opioid use trajectories: From nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose

Guarino, Honoria; Mateu‐Gelabert, Pedro; Teubl, Jennifer; Goodbody, Elizabeth

doi:10.1016/j.addbeh.2018.04.017

Cited by 83 publications

(83 citation statements)

References 27 publications

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“…The models also controlled for potential confounders with either established or hypothesized relationships with both changes in prescribed OPR dose and use of heroin or non-prescribed OPRs. [29][30][31][32][33][34][35] Potential confounders that were essentially fixed (e.g., demographics) were included as baseline covariates that remained static over the study period whereas potential confounders that changed over time were included as lagged covariates that could change over the study period. Specifically, each model controlled for continuous patient age; race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other/mixed race); gender (male, female, transgender or other); education (less than high school, high school graduate, some college less than Bachelor's, Bachelor's degree or higher); any heroin or non-prescribed OPR use prior to baseline (defined as the first quarter included in the analysis); mean OPR dose during the first year of follow-up (i.e., the year prior to baseline); and OPR dose change in the quarter prior to the cohort-defining quarter, the initial OPR dose that was used to define the dose change in the cohort-defining quarter.…”

Section: Discussionmentioning

confidence: 99%

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

et al. 2020

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Background After decades of increased opioid pain reliever prescribing, providers are rapidly reducing prescribing. We hypothesized that reduced access to prescribed opioid pain relievers among patients previously reliant upon opioid pain relievers would result in increased illicit opioid use. Methods and findings We conducted a retrospective cohort study among 602 publicly insured primary care patients who had been prescribed opioids for chronic non-cancer pain for at least three consecutive months in San Francisco, recruited through convenience sampling. We conducted a historical reconstruction interview and medical chart abstraction focused on illicit substance use and opioid pain reliever prescriptions, respectively, from 2012 through the interview date in 2017-2018. We used a nested-cohort design, in which patients were classified, based on opioid pain reliever dose change, into a series of nested cohorts starting with each follow-up quarter. Using continuation-ratio models, we estimated associations between opioid prescription discontinuation or 30% increase or decrease in dose, relative to no change, and subsequent frequency of heroin and non-prescribed opioid pain reliever use, separately. Models controlled for demographics, clinical and behavioral characteristics, and past use of heroin or non-prescribed opioid pain relievers. A total of 56,372 and 56,484 participant-quarter observations were included from the 597 and 598 participants available for analyses of heroin and non-prescribed opioid pain reliever outcomes, respectively. Participants discontinued from prescribed opioids were more likely to use heroin (Adjusted Odds Ratio (AOR) = 1.57, 95% CI: 1.25-1.97) and non-prescribed opioid pain relievers (AOR = 1.75, 1.45-2.11) more frequently in subsequent quarters compared to participants with unchanged opioid prescriptions. Participants whose opioid pain reliever dose increased were more likely to use heroin more frequently (AOR = 1.67, 1.32-2.12). Results held throughout sensitivity analyses. The main limitations were the observational nature of results and limited generalizability beyond safety-net settings.

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Section: Discussionmentioning

confidence: 99%

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

et al. 2020

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“…However, the restricted prescription opioid supply was likely only one contributing factor to the rise in heroin overdose deaths. At the same time as prescription opioid became less available, heroin prices decreased and heroin purity and supply increased (42,46,47). After 2013, the introduction of fentanyl into the illegal drug market, and the adulteration of heroin with fentanyl contributed greatly to the rise in heroin overdose deaths.…”

Section: Restriction Of the Prescription Opioid Supply And The Rise Omentioning

confidence: 99%

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

Friedman

Krawczyk

Perlman

et al. 2020

Front. Public Health

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The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.

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“…Unlike in past decades, this higher purity means, among other things, that intoxication can be achieved with insufflation and smoking, thereby facilitating heroin initiation and use in a more acceptable way (i.e., without injection being necessary as the initial route of administration) . Nevertheless, the majority of individuals using heroin eventually transition to injection use, raising their risk for overdose and infectious disease transmission . The relatively lower price of heroin (and now fentanyl, as described below) compared with prescription opioids may also have contributed to the transition from prescription opioids to heroin and other illicit opioids .…”

Section: Vector Factorsmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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The roots of the remarkably lethal U.S. opioid crisis are complex and inextricably entangled with healthcare, especially in its treatment of another serious health problem: pain. Failures of the healthcare system—including lack of both training in pain management and caution in using an addictive class of medications—precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host–agent–environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the “vector” to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host–agent–vector–environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical‐related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.

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Young adults' opioid use trajectories: From nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose

Abstract: Findings may help inform the optimal timing for delivery of primary, secondary and tertiary prevention efforts targeting young opioid users.

Cited by 83 publications

References 27 publications

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

Epidemiology of the U.S. opioid crisis: the importance of the vector

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