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Addiction. 2016 Nov;111(11):2021-2031. doi: 10.1111/add.13491. Epub 2016 Aug 23.

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

Author information

1
Department of Epidemiology, Brown School of Public Health, Providence, RI, USA.
2
Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
3
Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA.
4
Yale University School of Medicine, New Haven, CT, USA.
5
APT Foundation Pain Treatment Services, New Haven, CT, USA.
6
Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA, Connecticut Healthcare System, West Haven, CT, USA.
7
Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.
8
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
9
Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA.
10
Center for Health Equity Research and Promotion (CHERP) & Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA.
11
VA Connecticut Healthcare System, West Haven, CT, USA.
12
Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA.
13
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
14
Department of Epidemiology, Brown School of Public Health, Providence, RI, USA. brandon_marshall@brown.edu.

Abstract

AIMS:

To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.

DESIGN:

Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected 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 3396 HIV-infected and uninfected patients enrolled into the Veterans Aging Cohort Study who reported no life-time 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 socio-demographics, 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 non-medical use of prescription opioids NMUPO was associated positively and independently with heroin initiation [adjusted hazard ratio (AHR) = 5.43, 95% confidence interval (CI) = 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.

KEYWORDS:

Heroin; longitudinal study; non-medical prescription drug use; opioid-related disorders; polysubstance use; veterans

PMID:
27552496
PMCID:
PMC5056813
DOI:
10.1111/add.13491
[Indexed for MEDLINE]
Free PMC Article

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