Non-medical use of prescription opioids is associated with heroin initiation among US veterans

a prospective cohort study

Geetanjoli Banerjee, E. Jennifer Edelman, Declan T. Barry, William C. Becker, Magdalena Cerda, Stephen Crystal, Julie R. Gaither, Adam J. Gordon, Kirsha S. Gordon, Robert D. Kerns, Silvia S. Martins, David A. Fiellin, Brandon D.L. Marshall

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2021-2031
Number of pages11
JournalAddiction (Abingdon, England)
Volume111
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Heroin
Veterans
Opioid Analgesics
Prescriptions
Cohort Studies
Prospective Studies
HIV
Proportional Hazards Models
Veterans Health
Baltimore
United States Department of Veterans Affairs
Los Angeles
Post-Traumatic Stress Disorders
Observational Studies
Communicable Diseases
Primary Health Care
Research Design
Demography
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Heroin
  • longitudinal study
  • non-medical prescription drug use
  • opioid-related disorders
  • polysubstance use
  • veterans

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Non-medical use of prescription opioids is associated with heroin initiation among US veterans : a prospective cohort study. / Banerjee, Geetanjoli; Edelman, E. Jennifer; Barry, Declan T.; Becker, William C.; Cerda, Magdalena; Crystal, Stephen; Gaither, Julie R.; Gordon, Adam J.; Gordon, Kirsha S.; Kerns, Robert D.; Martins, Silvia S.; Fiellin, David A.; Marshall, Brandon D.L.

In: Addiction (Abingdon, England), Vol. 111, No. 11, 01.11.2016, p. 2021-2031.

Research output: Contribution to journalArticle

Banerjee, G, Edelman, EJ, Barry, DT, Becker, WC, Cerda, M, Crystal, S, Gaither, JR, Gordon, AJ, Gordon, KS, Kerns, RD, Martins, SS, Fiellin, DA & Marshall, BDL 2016, 'Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study', Addiction (Abingdon, England), vol. 111, no. 11, pp. 2021-2031. https://doi.org/10.1111/add.13491
Banerjee, Geetanjoli ; Edelman, E. Jennifer ; Barry, Declan T. ; Becker, William C. ; Cerda, Magdalena ; Crystal, Stephen ; Gaither, Julie R. ; Gordon, Adam J. ; Gordon, Kirsha S. ; Kerns, Robert D. ; Martins, Silvia S. ; Fiellin, David A. ; Marshall, Brandon D.L. / Non-medical use of prescription opioids is associated with heroin initiation among US veterans : a prospective cohort study. In: Addiction (Abingdon, England). 2016 ; Vol. 111, No. 11. pp. 2021-2031.
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abstract = "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){\"i}¿½={\"i}¿½5.43, 95{\%} confidence interval (CI){\"i}¿½={\"i}¿½4.01, 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.",
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author = "Geetanjoli Banerjee and Edelman, {E. Jennifer} and Barry, {Declan T.} and Becker, {William C.} and Magdalena Cerda and Stephen Crystal and Gaither, {Julie R.} and Gordon, {Adam J.} and Gordon, {Kirsha S.} and Kerns, {Robert D.} and Martins, {Silvia S.} and Fiellin, {David A.} and Marshall, {Brandon D.L.}",
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T2 - a prospective cohort study

AU - Banerjee, Geetanjoli

AU - Edelman, E. Jennifer

AU - Barry, Declan T.

AU - Becker, William C.

AU - Cerda, 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.

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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.

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