Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study

Abstract

Aims To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among U.S. veterans receiving medical care. Design Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-positive and an age/race/site matched control group of HIV-negative veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use. Setting Veterans Health Administration (VHA) infectious disease and primary care clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Participants A total of 3,396 HIV-infected and uninfected patients enrolled in the Veterans Aging Cohort Study who reported no lifetime NMUPO or heroin use, had no opioid use disorder diagnoses at baseline, and who were followed between 2002 and 2012. Measurements The primary outcome measure was self-reported incident heroin use and the primary exposure of interest was new onset NMUPO. Our final model was adjusted for sociodemographics, pain interference, prior diagnoses of post-traumatic stress disorder and/or depression, and self-reported other substance use. Findings Using a multivariable Cox regression model, we found that NMUPO was positively and independently associated with heroin initiation (adjusted hazard ratio [AHR] = 5.43, 95%CL: 4.01, 7.35). Conclusions New onset non-medical use of prescription opioids (NMUPO) is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States who reported no previous history of NMUPO or illicit opioid use.

Examining Fatal Opioid Overdoses in Marion County, Indiana

“…Specifically, our findings are consistent with a growing body of research suggesting that while increased regulation of prescription opiates can reduce the likelihood of these substances to be present in overdoses, [29][30][31] it also results in nonmedical prescription opiate users-those using prescription opiates, without a prescription, for the purposes of experiencing or feeling the effects of the drug-turning to illicit opioids. [32][33][34][35] …”

“…[33][34][35] The dramatic increase in prescription opiates during the 1990s and 2000s is well documented and is generally attributed to greater social acceptance, diversification in what these drugs are used for, and marketing activities of pharmaceutical companies. 36,37 Our Table 3 shows the decline in prescriptions for codeine and oxymorphone is evident as of 2012 whereas the decline in prescriptions for all other opioids is not present until 2013.…”

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

“…We read with interest the article by Banerjee and colleagues [1], entitled 'Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study', published in Addiction. The authors aimed to estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans.…”

“…They found that non-medical use of prescription opioids (NMUPO) was associated positively and independently with heroin initiation. Banerjee et al conclude that new-onset NMUPO is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States [1].…”

“…The number of people who used heroin peaked to 914 000 in 2014 versus 373 000 in 2007, a 145% increase [4]. Further, mortality related to heroin overdose has more than quintupled, from 1842 in 2000 to 10 574 deaths in 2014 [2], which is 2317 more than cited in Banerjee et al's [1] report.…”