Abstract
BackgroundFew studies have comprehensively and contextually examined the relationship of variables associated with opioid use. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse and use disorder in the United States by identifying the most salient predictors.MethodsA multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N = 85,580; weighted N = 248,008,986). The outcome of opioid misuse and/or use disorder was based on reported prescription pain reliever and/or heroin use dependence, abuse, or misuse. Biopsychosocial predictors of opioid misuse and use disorder in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators. Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives).ResultsThe comprehensive model found that criminality (adjusted odds ratio [AOR] = 2.58, 95% confidence interval [CI] = 1.98–3.37, p < 0.001), self-reported health (i.e., excellent compared to fair/poor [AOR = 3.71, 95% CI = 2.19–6.29, p < 0.001], good [AOR = 3.43, 95% CI = 2.20–5.34, p < 0.001], and very good [AOR = 2.75, 95% CI = 1.90–3.98, p < 0.001]), no private health insurance (AOR = 2.12, 95% CI = 1.55–2.89, p < 0.001), serious psychological distress (AOR = 2.12, 95% CI = 1.55–2.89, p < 0.001), suicidality (AOR = 1.58, 95% CI = 1.17–2.14, p = 0.004), and other substance dependence or abuse were significant predictors of opioid misuse and/or use disorder. Substances associated were nicotine (AOR = 3.01, 95% CI = 2.30–3.93, p < 0.001), alcohol (AOR = 1.40, 95% CI = 1.02–1.92, p = 0.038), marijuana (AOR = 2.24, 95% CI = 1.40–3.58, p = 0.001), cocaine (AOR = 3.92, 95% CI = 2.14–7.17, p < 0.001), methamphetamine (AOR = 3.32, 95% CI = 1.96–5.64, p < 0.001), tranquilizers (AOR = 16.72, 95% CI = 9.75–28.65, p < 0.001), and stimulants (AOR = 2.45, 95% CI = 1.03–5.87, p = 0.044).ConclusionsBiopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse and use disorder than sociodemographic characteristics.
Highlights
Few studies have comprehensively and contextually examined the relationship of variables associated with opioid use
Substances associated were nicotine (AOR = 3.01, 95% confidence interval (CI) = 2.30–3.93, p < 0.001), alcohol (AOR = 1.40, 95% CI = 1.02–1.92, p = 0.038), marijuana (AOR = 2.24, 95% CI = 1.40–3.58, p = 0.001), cocaine (AOR = 3.92, 95% CI = 2.14–7.17, p < 0.001), methamphetamine (AOR = 3.32, 95% CI = 1.96–5.64, p < 0.001), tranquilizers (AOR = 16.72, 95% CI = 9.75–28.65, p < 0.001), and stimulants (AOR = 2.45, 95% CI = 1.03–5.87, p = 0.044)
In response to this need, we comprehensively examined the relationship of opioid misuse and/or use disorder and biopsychosocial characteristics using four domains: (1) sociodemographic factors; (2) socioecological factors; (3) health factors; and (4) other substance dependence or abuse
Summary
Few studies have comprehensively and contextually examined the relationship of variables associated with opioid use. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse and use disorder in the United States by identifying the most salient predictors. Opioid related deaths increased 345% between 2001 to 2016 [4]. Between July 2016 and September 2017 deaths due to illicit opioid overdose increased by 30%, leading to an emergency declaration in 45 states [4]. Projections indicate that if current prevention and intervention strategies do not change by 2025, the rate of misuse and overdose death will rise by 61% [5]. Increasing the availability of naloxone—a medication that reverses the effects of an overdose—is projected to reduce opioid-related deaths by approximately 4% according to the most recent projections [6]. Supply-side prevention strategies are estimated to have minimal impact, preventing only 3.0 to 5.3% of overdose deaths [6]
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