Non‐medical use of prescription opioids is associated with heroin initiation among US veterans

Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference

“…Department of Veterans Affairs, 2018). Despite such efforts, some veterans who had been prescribed POs for pain have transitioned to black-market PO or heroin use, which present additional OD risks, particularly when laced with fentanyl-class substances (Banerjee et al, 2016;Jasuja et al, 2018;Ruan et al, 2017). For some veterans, PO misuse or the use of illicit opioids can be a form of self-medication to deal with acute and chronic pain or psychological problems; however, this form of pain self-management can result in heightened OD risk due to opioids' diminishing analgesic efficacy over time and the related potential for self-initiated dosage increases (Krebs et al, 2018).…”

Reply to Ruan et al. (2017): Non‐medical use of prescription opioids is associated with heroin initiation among US veterans

“…Detection and management of substance misuse in patients prone to behave violently is critical for maintaining the safety of patients, staff members and the public at large. The most commonly used specimen type in UK mental health settings is urine [1]. This was, until recently, the case at the State Hospital, the high-security psychiatric hospital for Scotland and Northern Ireland.…”

“…We thank Ruan and colleagues for their letter and appreciate their comments regarding our recent study [1], which demonstrated an independent association between non-medical use of prescription opioids (NMUPO) and heroin initiation among US veterans [2].…”