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: 1.76). 03/2011; 5(1):28-35. DOI: 10.1097/ADM.0b013e3181e0364e
Source: PubMed


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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    • "Other limitations include potential for selection biases and impression management, and subjectivity inherent in the use of qualitative methods. Buprenorphine and methadone programs may serve different populations (Wu et al. 2011) and the alcohol assessments (AUDIT vs. DSM-IV) and care providers (i.e., physicians vs. counselors) differed. Nonetheless, comparing these settings provided insights into areas where agonist treatment can be strengthened and streamlined with respect to the provision of SBIRT for alcohol use disorders. "
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    ABSTRACT: Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.
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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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    • "Moreover, accurate estimates of the numbers of NMPDUs in treatment facilities are not available due to a lack of data characterizing specific prescription medication use and a lack of studies that include both private and public treatment facilities [11]. Health and social risk profiles of treatment seeking NMPDUs are needed, as these individuals are likely to differ from other substance users in terms of specific characteristics that could impact treatment services needs, such as underlying medical conditions and demographics [10,12-14]. "
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