How Do Prescription Opioid Users Differ From Users of Heroin or Other Drugs in Psychopathology: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
Journal of Addiction Medicine (Impact Factor: 1.71). 03/2011; 5(1):28-35. DOI: 10.1097/ADM.0b013e3181e0364e
Source: PubMed

ABSTRACT To study substance use and psychiatric disorders among prescription opioid users, heroin users, and non-opioid drug users in a national sample of adults.
Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093).
Four groups were identified among 9140 illicit or non-prescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and non-opioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) as compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders as compared with other opioid-only users. Non-opioid drug users had reduced odds of all substance use disorders and other mental disorders (mood, anxiety, pathological gambling, and personality) as compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year non-opioid drug users.
All opioid use groups had higher rates of substance use disorders than non-opioid drug users, and these rates were particularly elevated among heroin-other opioid users. Findings suggest the need to distinguish between these four groups in research and treatment as they may have different natural histories and treatment needs.

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Available from: Li-Tzy Wu, Aug 26, 2015
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    • "Recent studies have indicated that pharmaceutical opioid users are different from heroin users with regard to socioeconomic characteristics, comorbid substance use, family history of substance use and mental illness [10] [11] [12] [13]. Primary heroin users are found to have a severe pattern of drug use, lower social stability and higher level of treatment use compared with pharmaceutical opioid users. "
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    ABSTRACT: Introduction and AimsInjecting pharmaceutical opioids for non-medical purposes is a major concern globally. Though pharmaceutical opioids injection is reported in India, the exact proportion of people who inject drugs (PWID) using pharmaceutical opioids is unknown. The objectives of this study were to describe the various types of drugs that are injected by people in India and to analyse the differences between the commonly injected drugs. Design and MethodsA cross-sectional, multicentric study covering 22 harm-reduction sites from different regions of the country was conducted. First 50 subjects, chosen randomly from a list of PWIDs accessing services from each site and fulfilling study criteria, were interviewed using a structured questionnaire. Data from 902 male subjects are presented here. ResultsPharmaceutical opioid injectors (POI) accounted for 65% of PWIDs (buprenorphine: 30.8%, pentazocine: 21.8% and dextropropoxyphene: 11.9%). Heroin, injected by 34.3%, was prevalent in most states surveyed. Buprenorphine and pentazocine were not injected in the north-east region, whereas dextropropoxyphene was injected in the north-east alone. Univariate and multivariate logistic regression showed that, compared with heroin injectors, the POI group was more likely to consume alcohol and pharmaceutical opioids orally, inject frequently, share needle/syringes and develop injection-site complications. Among individual POIs, buprenorphine injectors had significantly higher proportion of subjects injecting frequently, sharing needle/syringes and developing local complications. Irrespective of the opioid type, majority of subjects were opioid dependent. Discussion and Conclusions Pharmaceutical opioids are the most common drugs injected in India currently and have greater injection-related risks and complications. Significant differences exist between different pharmaceutical opioids, which would be important considerations for interventions. [Ambekar A, Rao R, Mishra AK, Agrawal A. Type of opioids injected: Does it matter? A multicentric cross-sectional study of people who inject drugs. Drug Alcohol Rev 2015;34:97-104]
    Drug and Alcohol Review 10/2014; 34(1). DOI:10.1111/dar.12208 · 1.55 Impact Factor
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    • "Since 1999, intentional overdose deaths related to PO have quadrupled and now account for more overdose deaths than heroin and cocaine combined [5]. Young non-medical users of POs are often unaware of the risks associated with their use [6], tending to view prescribed drugs as safer, less stigmatised and less subject to legal penalties than illicit street drugs [7] [8]. Although most non-medical PO use begins with oral ingestion, recent research indicates that a significant minority may transition to the use of heroin and/or administration of opioids by injection, typically within 2–3 years of initiating use [9]. "
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    ABSTRACT: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use. These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions. [Dertadian G, Maher L. From oxycodone to heroin: Two cases of transitioning opioid use in young Australians. Drug Alcohol Rev 2013].
    Drug and Alcohol Review 11/2013; 33(1). DOI:10.1111/dar.12093 · 1.55 Impact Factor
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    • "We use the term " prescription " to refer to the type of opioid, which may not necessarily have been obtained with a prescription . These opioid-type groups are similar to empirically identified opioid users described in past studies of methadone maintenance (Brands et al., 2004; Wu, Woody, Yang, & Blazer, 2011). Although Brands and colleagues (2004) described four groups, the current data did not allow us to determine the temporal precedence of heroin or prescription opioid misuse, so a single mixed use category was used. "
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    ABSTRACT: Prescription opioid use has grown rapidly, but few studies examined whether users have similar treatment responses as heroin users. Participants were 1,648 opioid users in Florida Access to Recovery (2004-2007). Participants engaged in methadone or buprenorphine maintenance had better retention than those in nonmaintenance treatment. Heroin only users (HO) had better engagement in nonmaintenance treatments and had worse retention than prescription opioid only users (PO). In methadone maintenance, PO were more likely to report opioid abstinence during treatment than heroin and prescription opioid users (H&P). Future research should focus on understanding and improving the treatment experience of opioid use subgroups.
    Substance Use &amp Misuse 06/2013; 48(8). DOI:10.3109/10826084.2013.800112 · 1.23 Impact Factor
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