Increased use of heroin as an initiating opioid of abuse: Further considerations and policy implications

Cicero, Theodore J.; Kasper, Zachary A.; Ellis, Matthew S.

doi:10.1016/j.addbeh.2018.05.030

Cited by 48 publications

(31 citation statements)

References 17 publications

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“…Most patients with OUD use heroin and/or fentanyl, 3 , 4 , 5 , 6 but 50% to 90% of patients with OUD were exposed to a prescription opioid first. 7 , 8 The prevalence estimate of OUD in the US in 2018 is 2 million individuals, 9 similar to the previous year’s prevalence estimates. 10 However, OUD is likely underdiagnosed within the health system setting.…”

Section: Introductionsupporting

confidence: 59%

Assessment of Probable Opioid Use Disorder Using Electronic Health Record Documentation

et al. 2020

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Key Points Question Are medication monitoring programs within a hospital associated with more accurate identification of patients with opioid use disorder through the use of proxy Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-5) criteria for opioid use disorder extracted from electronic health records? Findings This cross-sectional study demonstrated that DSM-5 criteria for opioid use disorder can be extracted through review of electronic health records and that patients who are part of a drug monitoring program had a higher mean prevalence of opiod use disorder and a higher mean number of psychiatric comorbidities associated with opioid use disorder. Meaning Proxy measures that rely on multiple sources of data, including prescription drug history and notes in the electronic health record, may help identify patients with opioid use disorder who have not received a diagnosis.

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Section: Introductionsupporting

confidence: 59%

Assessment of Probable Opioid Use Disorder Using Electronic Health Record Documentation

et al. 2020

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“…Providers must be vigilant about the direction that OUDs are progressing in the upcoming years. As more users of opioids are turning away from prescription opioids to heroin and fentanyl over the past 3 years, 10 this led to an increase of lethal overdoses. A critical contributing factor to the lethality of opioid overdoses include the emergence of synthetic opioids in the United States.…”

Section: Resultsmentioning

confidence: 99%

“…9 Thus, prescription opioids were more regulated and less available, but another wave of opioid misuse began with heroin abuse increasing from 2014 to 2017. 10 Continued opioid use is driven through a neurobiological process in which patients have a binge/ intoxication stage, withdrawal stage, and a preoccupation/ anticipation stage. 11 When used chronically, such as to treat chronic pain, tolerance will develop.…”

Section: Introductionmentioning

confidence: 99%

Keeping Up with Clinical Advances: Opioid Use Disorder

2019

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Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.

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“…In the US alone, 11 million people reported past-year opioid misuse in 2016 (Substance Abuse and Mental Health Services Administration, 2017); however, this estimate is conservative as it does not include homeless or incarcerated individuals with disproportionately higher levels of opioid use. In addition, the rate of first-time heroin users rose in parallel with non-medical use of prescription opioids from 2002 to 2011 (United Nations Office on Drugs and Crime, 2019), a reflection that suggests individuals with past-year prescription opioid misuse are 19 times more likely to initiate heroin use than those without such a history (Muhuri et al, 2013;Cicero et al, 2018). Studies have investigated polydrug use among heroin and prescription opioid misusers and found higher frequencies of opioid use in people that also use cocaine (>33%) or methamphetamine (>20%) (Wang et al, 2017;Hedegaard et al, 2018), but reduced prevelance for primary opioid use in those that have secondary alcohol or cannabis use (Wang et al, 2017; but see Cicero et al, 2020).…”

Section: Opioidsmentioning

confidence: 99%

One Is Not Enough: Understanding and Modeling Polysubstance Use

et al. 2020

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Substance use disorder (SUD) is a chronic, relapsing disease with a highly multifaceted pathology that includes (but is not limited to) sensitivity to drug-associated cues, negative affect, and motivation to maintain drug consumption. SUDs are highly prevalent, with 35 million people meeting criteria for SUD. While drug use and addiction are highly studied, most investigations of SUDs examine drug use in isolation, rather than in the more prevalent context of comorbid substance histories. Indeed, 11.3% of individuals diagnosed with a SUD have concurrent alcohol and illicit drug use disorders. Furthermore, having a SUD with one substance increases susceptibility to developing dependence on additional substances. For example, the increased risk of developing heroin dependence is twofold for alcohol misusers, threefold for cannabis users, 15fold for cocaine users, and 40-fold for prescription misusers. Given the prevalence and risk associated with polysubstance use and current public health crises, examining these disorders through the lens of co-use is essential for translatability and improved treatment efficacy. The escalating economic and social costs and continued rise in drug use has spurred interest in developing preclinical models that effectively model this phenomenon. Here, we review the current state of the field in understanding the behavioral and neural circuitry in the context of co-use with common pairings of alcohol, nicotine, cannabis, and other addictive substances. Moreover, we outline key considerations when developing polysubstance models, including challenges to developing preclinical models to provide insights and improve treatment outcomes.

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Increased use of heroin as an initiating opioid of abuse: Further considerations and policy implications

Cited by 48 publications

References 17 publications

Assessment of Probable Opioid Use Disorder Using Electronic Health Record Documentation

Assessment of Probable Opioid Use Disorder Using Electronic Health Record Documentation

Keeping Up with Clinical Advances: Opioid Use Disorder

One Is Not Enough: Understanding and Modeling Polysubstance Use

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