Prescription opioid misuse and mental health among young injection drug users

Abstract

Background: Prescription opioid (PO) misuse is a significant concern in the United States. Objectives: This study describes the prevalence and timing of PO misuse, diagnoses of opiate abuse and dependence, and their associations with psychiatric disorders in a sample of young people who inject drugs (PWID). Methods: Participants were 570 young (18–25 years) PWID, primarily heroin users, recruited through outreach and respondent-driven sampling. Trained interviewers administered a semi-structured psychiatric interview. Diagnoses of substance use and mental disorders were based on DSM-IV diagnostic criteria. Results: Estimated rates of lifetime PO abuse and dependence were 19% and 17%, respectively. Past year PO misuse was significantly associated with anti-social personality disorder (ASPD, OR = 2.15, 95% CI 1.43–3.24), past year substance-induced major depression (SIMD, OR = 1.81, 95% CI 1.16–2.83), and prior post-traumatic stress disorder (PTSD, OR = 2.45, 95% CI 1.31–4.60). Among male PO users, PTSD was a significant predictor of PO abuse (prior, OR = 7.62, 95% CI 2.16–26.88; past year, OR = 21.67 95% CI 2.46–190.75), and dependence (prior, OR = 4.82, 95% CI 1.48–15.67; past year, OR = 9.65, 95% CI 1.75–53.32). Conclusion: Among young PWID, PTSD is a significant risk factor for PO misuse for both men and women, and men with PTSD are in addition at increased risk for PO abuse and dependence. These findings have implications for harm reduction and substance abuse prevention efforts.