Differences in onset and abuse/dependence episodes between prescription opioids and heroin: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.
Substance abuse and rehabilitation 05/2011; 2011(2):77-88. DOI: 10.2147/SAR.S18969
Source: PubMed


To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO) and heroin use disorders in a national sample of adults, and to explore differences by gender and substance abuse treatment status.

Analyses of data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093).

Of all respondents, 5% (n = 1815) reported a history of nonmedical PO use (NMPOU) and 0.3% (n = 150) a history of heroin use. Abuse was more prevalent than dependence among NMPOUs (PO abuse, 29%; dependence, 7%) and heroin users (heroin abuse, 63%; dependence, 28%). Heroin users reported a short mean interval from first use to onset of abuse (1.5 years) or dependence (2.0 years), and a lengthy mean duration for the longest episode of abuse (66 months) or dependence (59 months); the corresponding mean estimates for PO abuse and dependence among NMPOUs were 2.6 and 2.9 years, respectively, and 31 and 49 months, respectively. The mean number of years from first use to remission from the most recent episode was 6.9 years for PO abuse and 8.1 years for dependence; the mean number of years from first heroin use to remission from the most recent episode was 8.5 years for heroin abuse and 9.7 years for dependence. Most individuals with PO or heroin use disorders were remitted from the most recent episode. Treated individuals, whether their problem was heroin or POs, tended to have a longer mean duration of an episode than untreated individuals.

Periodic remissions from opioid or heroin abuse or dependence episodes occur commonly but take a long time. Timely and effective use of treatment services are needed to mitigate the many adverse consequences from opioid/heroin abuse and dependence.

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Available from: Li-Tzy Wu, Oct 01, 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 aims: Injecting 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 methods: A 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. Results: Pharmaceutical 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.
    Drug and Alcohol Review 10/2014; 34(1). DOI:10.1111/dar.12208 · 1.55 Impact Factor
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    • "With the large sample of alcohol users available, it became possible to examine conditional prevalences of alcohol use disorders (probability of having a disorder-given use) to identify subgroups with elevated odds of having SUDs. Blazer and Wu (2011) 22 reported conditional prevalences of alcohol use disorders (7.4%) and subthreshold dependence (12.5%) among 5548 past-year alcohol users aged 50–64 as well as conditional prevalences of alcohol use disorders (3.4%) and subthreshold dependence (12.1%) among 3478 past-year alcohol users aged 65þ. "
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    ABSTRACT: Globally, adults aged 65 years or older will increase from 516 million in 2009 to an estimated 1.53 billion in 2050. Due to substance use at earlier ages that may continue into later life, and ageing-related changes in medical conditions, older substance users are at risk for substance-related consequences. MEDLINE and PsychInfo databases were searched using keywords: alcohol use disorder, drug use disorder, drug misuse, substance use disorder, prescription drug abuse, and substance abuse. Using the related-articles link, additional articles were screened for inclusion. This review focused on original studies published between 2005 and 2013 to reflect recent trends in substance use disorders. Studies on psychiatric comorbidity were also reviewed to inform treatment needs for older adults with a substance use disorder. Among community non-institutionalized adults aged 50+ years, about 60% used alcohol, 3% used illicit drugs and 1-2% used nonmedical prescription drugs in the past year. Among adults aged 50+, about 5% of men and 1.4% of women had a past-year alcohol use disorder. Among alcohol users, about one in 14 users aged 50-64 had a past-year alcohol use disorder vs one in 30 elder users aged 65+. Among drug users aged 50+, approximately 10-12% had a drug use disorder. Similar to depressive and anxiety disorders, substance use disorders were among the common psychiatric disorders among older adults. Older drug users in methadone maintenance treatment exhibited multiple psychiatric or medical conditions. There have been increases in treatment admissions for illicit and prescription drug problems in the United States. Substance use in late life requires surveillance and research, including tracking substance use in the racial/ethnic populations and developing effective care models to address comorbid medical and mental health problems.
    International Journal of Epidemiology 10/2013; 43(2). DOI:10.1093/ije/dyt173 · 9.18 Impact Factor
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    • "Drug users sentenced to a compulsory detoxification center are typically detained for up to 2 years. However, drug addiction, particularly heroin addiction, is a chronic condition with a high rate of relapse [4,5]. In China, more than 90% of heroin users relapse after being released from detoxification centers [6-9]. "
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    BMC Public Health 08/2013; 13(1):747. DOI:10.1186/1471-2458-13-747 · 2.26 Impact Factor
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