Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study
Year: 2016
Type: article
Study design: Observational Study
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.
Source: Addiction
DOI: 10.1111/add.13491
Institutions: Brown University, Yale University, APT Foundation, VA Connecticut Healthcare System, University of California, Davis, Rutgers, The State University of New Jersey, University of Pittsburgh, Mental Illness Research, Education and Clinical Centers, VA Pittsburgh Healthcare System, Columbia University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Veterans Affairs, Yale University, Health Services Research and Development, National Institutes of Health, Agency for Healthcare Research and Quality, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences
Awards: G1158786059, G1362894327, Chronic Opioid Therapy and Patient Safety in HIV Infected and Uninfected Veterans, G1770212026, G2882883290, 2/6 COMpAAAS U01: Observation Study, G3673658808, CENTER FOR EDUCATION AND RESEARCH ON MENTAL HEALTH THERAPEUTICS, 3/6 COMpAAAS U01: Intervention Study, Alcohol Associated Outcomes Among HIV+/- Aging Veterans, Addressing alcohol misuse in HIV prevention and care: The Brown University Alcohol Research Center on HIV (ARCH), State medical marijuana laws and NSDUH marijuana use and consequences since 2004, G5646444599, SMINET: APPLYING EVIDENCE TO IMPROVE CARE AND OUTCOMES IN SEVERE MENTAL ILLNESS, G5993464628, 1/6 COMpAAAS U24: Coordinating Center, Minority Populations Resource Core, Exploring transitions to injecting among young adult non-medical opioid users, G6606233791, G7661508111, Alcohol Associated Outcomes Among HIV+/-Aging Veterans, G8256625706, G8549008097, Providence/Boston Center for AIDS Research (CFAR), Yale-Drug use, Addiction, and HIV prevention Research Scholars (Yale-DAHRS), Yale Clinical and Translational Science Award
OpenAlex ID: W2512079066