Prescription Opioids and Veterans' Heroin Use

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Non-medical use of prescription opioid medications is a significant risk factor for heroin use among United States veterans.
Non-medical use of prescription opioid medications is a significant risk factor for heroin use among United States veterans.

Consistent with earlier research, newly published data indicate that, even without any previous history of non-medical use of prescription opioids or other illicit drugs, new-onset non-medical use of prescription opioid medications is a significant risk factor for heroin use among United States veterans. The authors of this longitudinal, 10-year study are affiliated with the University of California-Davis, Brown School of Public Health, Yale University, University of Pittsburgh, and Columbia University, and the results were reported in Addiction, a journal published by the Society for the Study of Addiction.

“People who engage in [non-medical use of prescription opioid medications] may be at a higher risk for transitioning to heroin use, in part because heroin has become more accessible and less expensive than prescription opioid[s] in many US settings,” the authors wrote in their publication.

It is well documented that opioid-related disorders are an emerging public health concern globally and in the United States, and that the non-medical use of prescription opioids is currently the fastest growing drug problem in the United States. The number of overdose deaths from prescription opioids has tripled between 2001 and 2014.

Numerous reports indicate that use or abuse of prescription opioid medications is increasingly common in a general adult population, and that non-medical use of prescription opioids may open the door to heroin abuse. According to available data, the rate of heroin initiation is almost 20 times greater among those who reported prior use of prescription opioid medications compared with individuals who did not report previous non-medical use of opioids.

Chronic pain is a significant problem among United States veterans, and since opioids are associated with a serious long-term risk of addiction, the initiation of opioid medication treatment places the population of veterans at a particularly high risk for opioid medication-related use and abuse.

In the current study, researchers examined the association between new-onset non-medical use of prescription opioids and heroin initiation among 3 396 veterans [mean age=49.7 (SD=10.6)] who enrolled into the Veterans Aging Cohort Study. Approximately 45% of the study participants were HIV-infected. At the initial observation, almost 4% of participants reported a past-year opioid medication prescription.

Data indicate that almost 15% (n=500) of all participants initiated heroin use during the 10-year study period. Certain demographic characteristics were associated significantly with heroin initiation: being black, male, 43-49 years of age, lower academic attainment, and lower income. The use of illicit drugs including marijuana and cocaine, as well as the use of alcohol, during the past year were all associated significantly with initiation of heroin use.

Out of 500 participants who initiated heroin use during the study period, more than 75% reported previous or current non-medical use of prescription opioid medications. In the sample of participants who reported new-onset non-medical use of prescription opioids, more than 27% started using heroin by the end of the 10-year study period. “Receipt of a short-term opioid prescription from the Veterans Health Administration increased the hazard of heroin initiation by 65% (adjusted HR=1.65, 95% CI=1.43-1.94),” the authors reported.

Reference

Banerjee G, Edelman EJ, Barry DT, et al. Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study. Addiction. 2016. doi: 10.1111/add.13491. [Epub ahead of print]

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