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Addict Behav. 2015 Dec;51:106-12. doi: 10.1016/j.addbeh.2015.07.013. Epub 2015 Jul 26.

Comparing characteristics of prescription painkiller misusers and heroin users in the United States.

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Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612, United States. Electronic address:
Department of Agricultural Economics, Sociology, and Education, Population Research Institute, The Pennsylvania State University.



Prescription painkiller misuse (PPM) is a major U.S. public health concern. However, as prescribing practices have tightened and prescription painkillers have become less accessible, many users have turned to heroin as a substitute. This trend suggests the face of heroin users has likely changed over the past several years. Understanding the demographic, socioeconomic, psychosocial, and substance use characteristics of different groups of opiate users is important for properly tailoring interventions.


This study used data from the 2010-2013 National Survey on Drug Use and Health to examine differences in characteristics of U.S. adults in three mutually exclusive categories of past-year opiate use: heroin-only (H-O, N=179), prescription painkiller-only (PP-O, N=9,516), and heroin and prescription painkiller (H-PP, N=506).


Socioeconomic disadvantage, older age, disconnection from social institutions, criminal justice involvement, and easy access to heroin were associated with greater odds of being in the H-O group. HH-P users were more likely to be young white males with poor physical and mental health who also misuse other prescription medications and began such misuse as adolescents. PP-O users were the most economically stable, most connected to social institutions, least likely to have criminal justice involvement, and had the least access to heroin.


Results suggest the socio-demographic characteristics of heroin users versus PP misusers vary widely, and the conditions leading to heroin use versus PPM versus both may be different. Ultimately, a one-size-fits-all approach to opiate prevention and treatment is likely to fail. Interventions must account for the unique needs of different user groups.


Heroin; Opiates; Prescription painkiller misuse; Prevention; Treatment

[Indexed for MEDLINE]
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