TY - JOUR
T1 - Non-medical use of prescription opioids is associated with heroin initiation among US veterans
T2 - a prospective cohort study
AU - Banerjee, Geetanjoli
AU - Edelman, E. Jennifer
AU - Barry, Declan T.
AU - Becker, William C.
AU - Cerdá, Magdalena
AU - Crystal, Stephen
AU - Gaither, Julie R.
AU - Gordon, Adam J.
AU - Gordon, Kirsha S.
AU - Kerns, Robert D.
AU - Martins, Silvia S.
AU - Fiellin, David A.
AU - Marshall, Brandon D.L.
N1 - Funding Information:
This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA: U10-AA013566, U01-AA020795, U01-AA020790, U24-AA020794, U10-AA013566, and P01-AA019072), the National Institute of Allergy and Infectious Diseases (P30-AI042853), and in kind by the US Department of Veterans Affairs. J.R.G. is supported by the National Institute on Drug Abuse (F31-DA035567). E.J.E. is a Yale?Drug Abuse, Addiction, and HIV research scholar (K12-DA033312). B.D.L.M. is supported by the National Institute on Drug Abuse (R03-DA037770). S.S.M. is supported by the National Institute on Drug Abuse (R01-DA037866). S.C. is supported by AHRQ awards 1U19HS021112 and R18-HS023258. R.D.K. is supported by a Center of Innovation grant from the Health Services Research and Development Service of the Department of Veterans Affairs (CIN 13-047). The sponsors had no role in the study design; the collection, analysis and interpretation of data; the writing of the report; and in the decision to submit the article for publication. We would like to acknowledge the veterans who participate in the Veterans Aging Cohort Study (VACS) and the study coordinators and staff at each VACS site and at the West Haven Coordinating Center. We would also like to thank Melissa Skanderson for her assistance and support during data acquisition. The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
Publisher Copyright:
© 2016 Society for the Study of Addiction.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - AIMS: To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.DESIGN: Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.SETTING: Veterans Health Administration (VHA) infectious disease and primary care clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh and Washington, DC.PARTICIPANTS: A total of 3396 HIV-infected and uninfected patients enrolled into the Veterans Aging Cohort Study who reported no life-time NMUPO or heroin use, had no opioid use disorder diagnoses at baseline and who were followed between 2002 and 2012.MEASUREMENTS: The primary outcome measure was self-reported incident heroin use and the primary exposure of interest was new-onset NMUPO. Our final model was adjusted for socio-demographics, pain interference, prior diagnoses of post-traumatic stress disorder and/or depression and self-reported other substance use.FINDINGS: Using a multivariable Cox regression model, we found that non-medical use of prescription opioids NMUPO was associated positively and independently with heroin initiation [adjusted hazard ratio (AHR) = 5.43, 95% confidence interval (CI) = 4.01, 7.35].CONCLUSIONS: New-onset non-medical use of prescription opioids (NMUPO) is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States who reported no previous history of NMUPO or illicit opioid use.
AB - AIMS: To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.DESIGN: Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.SETTING: Veterans Health Administration (VHA) infectious disease and primary care clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh and Washington, DC.PARTICIPANTS: A total of 3396 HIV-infected and uninfected patients enrolled into the Veterans Aging Cohort Study who reported no life-time NMUPO or heroin use, had no opioid use disorder diagnoses at baseline and who were followed between 2002 and 2012.MEASUREMENTS: The primary outcome measure was self-reported incident heroin use and the primary exposure of interest was new-onset NMUPO. Our final model was adjusted for socio-demographics, pain interference, prior diagnoses of post-traumatic stress disorder and/or depression and self-reported other substance use.FINDINGS: Using a multivariable Cox regression model, we found that non-medical use of prescription opioids NMUPO was associated positively and independently with heroin initiation [adjusted hazard ratio (AHR) = 5.43, 95% confidence interval (CI) = 4.01, 7.35].CONCLUSIONS: New-onset non-medical use of prescription opioids (NMUPO) is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States who reported no previous history of NMUPO or illicit opioid use.
KW - Heroin
KW - longitudinal study
KW - non-medical prescription drug use
KW - opioid-related disorders
KW - polysubstance use
KW - veterans
UR - http://www.scopus.com/inward/record.url?scp=84990235097&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84990235097&partnerID=8YFLogxK
U2 - 10.1111/add.13491
DO - 10.1111/add.13491
M3 - Article
C2 - 27552496
AN - SCOPUS:84990235097
VL - 111
SP - 2021
EP - 2031
JO - Addiction
JF - Addiction
SN - 0965-2140
IS - 11
ER -