Examining Prevalence of Nonmedical Prescription Opioid Use by Race and Ethnicity from 2015-2018 among a National Sample Open Access

Abstract

Prescription opioids (POs) continue to account for almost a quarter of all drug overdose (OD) deaths. For over a decade, White rural Americans have disproportionately experienced opioid OD. However, Black and Latino Americans in urban and suburban areas have recently experienced alarming increases in opioid OD compared to White populations. Recent data are needed to understand shifts in PO use among Black and Latino populations. Using 2015-2018 National Survey on Drug Use and Health data, we examined the current socio-demographic, mental health and substance use correlates of non-medical prescription opioid (NMPO) use by race and ethnicity. Data cleaning and analysis was performed in SAS version 9.4. Preliminary results of this nationally representative sample (n=154,350) suggest that NMPO remains significantly higher among White (4.46%) compared to Black (3.75%) and Latino (4.13%) populations. Significant correlates of NMPO between racial and within racial groups included lower education, unemployment, never being married, lacking health insurance, depression, psychological distress, and the use of other licit and illicit substances including alcohol. Urbanicity was only significantly higher among White urban (4.54%; p=0.02) compared to White rural residents (4.04%), suggesting an important shift in our prior epidemiology. These preliminary results suggest that the opioid crisis may be evolving and has grown to impact Blacks and Hispanics to a greater degree than previously understood. Understanding current differences in NMPO use across racial and ethnic groups is critical to thwarting further spread of this epidemic.

Table of Contents

INTRODUCTION - 1

Effects of Opioids on the Body - 1

Economic Impact of Prescription Opioid Abuse - 2

Overall Trends in Opioid Deaths and Use - 3

Trends in Opioid Overdose Deaths By Sex, Age, and Geography - 4

Trends in Opioid Overdose Deaths By Race and Ethnicity - 5

Related Factors Influencing Black Experiences of the Opioid Epidemic - 9

The History of Opioids In America - 10

America’s First Opioid Epidemic - 10

Study Purpose -15

II. LITERATURE REVIEW - 16

Methodology - 16

NMPO Use Differences Based on Race and Ethnicity - 18

Sex Specific Differences in NMPO Use - 21

Age Specific Patterns in NMPO Use and Disorder - 24

NMPO Use and Related Mental Health Trends - 26

Educational Achievement and NMPO Use - 27

Employment Status and NMPO Use - 30

Geographic Differences in NMPO Use Trends - 31

NMPO Use and Smoking - 33

Conclusion - 34

III. METHODS - 35

Data Source and Study Design - 35

Recruitment and sample - 36

Data collection and survey instrument - 37

Description of variables - 38

Statistical Analysis - 40

IV. JOURNAL MANUSCRIPT - 41

V. RESULTS AND CONCLUSIONS - 61

Descriptive Results - 61

Bivariate Results - 62

Regression Results - 64

Discussion - 64

Limitations - 66

Strengths - 68

Next Steps and Public Health Impact - 68

REFERENCES - 70

TABLE 1: DEMOGRAPHICS OF SAMPLE POPULATION OVERALL AND BY RACE/ETHNICITY (N=154,350) - 76

TABLE 2: NMPO USE OF SAMPLE POPULATION OVERALL AND BY RACE/ETHNICITY (N= 154,350) - 77

TABLE 3 MODELS: PREDICTED PROBABILITIES OF NMPO USE BY YEAR AND RACE/ETHNICITY - 79

TABLE 1 SUPPLEMENTARY: OTHER DEMOGRAPHICS OF SAMPLE POPULATION OVERALL AND BY RACE/ETHNICITY (N=154,350) - 80

TABLE 2 SUPPLEMENTARY: OTHER NMPO USE OF SAMPLE POPULATION OVERALL AND BY RACE/ETHNICITY (N= 154,350) - 81

APPENDIX A: SAS CODE FOR DATA IMPORTING - 83

APPENDIX B: SAS CODE FOR ANALYSIS - 85

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	national opioid ethnicity trend race epidemic
Committee Chair / Thesis Advisor	Crawford, Natalie, Emory University
Committee Members	Livingston, Melvin, Emory University

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