Trends in non-medical prescription opioid and heroin co-use and medication assisted treatment utilization 公开
Mital, Sasha (Spring 2018)
Published
Abstract
Introduction: The rate of opioid-related overdoses more than quadrupled in the United States from 1999 to 2016. In response to the opioid epidemic, interventions emphasized reducing opioid availability rather than expanding access to medication-assisted treatment (MAT), the most effective treatment for problem opioid use. Evidence demonstrates that non-medical prescription opioid (NMPO)-only users transitioned to heroin and subsequent co-use of both opioids, which is associated with increased risk of morbidity and overdose. To better understand and inform a response to this phenomenon, this dissertation aims to 1) quantify and describe trends in co-use, 2) explore multilevel factors related to transition, and 3) examine corresponding trends in MAT enrollment and factors related to MAT completion.
Methods: We used data from the 2003-2014 National Surveys on Drug Use and Health and the 2004-2015 Treatment Episodes Datasets. Informed by trend theory, we examined trends in opioid use overall and in co-use by demographics, substance use behaviors, and mental health characteristics. We also explored the multilevel relationships between transition and access to healthcare, NMPO source, perceived opioid availability, and perceived risk of use according to the socioecological model. Guided by Andersen’s Behavioral Model of Health Services, we assessed trends in MAT admissions and correlates of treatment completion by opioid use type including access to health care and demographics.
Results: While the prevalence of all opioid use decreased, co-use increased substantially. The highest prevalence of co-use was among those who lacked health insurance, were unemployed, had psychological distress, and used illicit non-opioids in the past year. These characteristics were also associated with increased risk of transition, along with earlier age of NMPO initiation, an illicit NMPO source relative to a familial source, and a lower perceived risk of trying heroin. The frequency of MAT admissions increased over time but the proportion of those enrolled for co-use remained stable. Treatment completion was less likely among co-users relative to heroin-only users. Referral source was the strongest predictor of treatment completion for co-use, while the relationship between immediate admission and treatment completion was strongest for heroin-only use, indicating differences by opioid use type.
Conclusions: Findings highlight the importance of subgroup-specific efforts to investigate and address recent shifts in opioid use and lack of treatment. Taken together, they underscore the need for targeted prevention and response interventions reaching those at risk of transition, co-users, and subgroups with disproportionately low MAT admission and completion rates.
Table of Contents
Table of Contents
Chapter 1: Introduction 1
1. The link between non-medical prescription opioid and heroin use 1
2. Highly dynamic patterns of opioid use 3
3. Research gaps and current research 10
4. References 17
Chapter 2: Trends in non-medical prescription opioids and heroin co-use among adults, 2003-2014 33
1. Background 34
2. Methods 37
3. Results 39
4. Discussion 42
5. Tables and Figures 46
Table 1. Current demographic, substance use and mental health characteristics of adult opioid users, by opioid use type—NSDUH 2013-2014 46
Figure 1. Prevalence trends of opioid use, overall and by opioid use type among all opioid users, adjusted for sex, age, race, rurality and employment status—NSDUH 2003-2014 47
Table 2. Stratified trends in prevalence of co-use—NSDUH, 2003-2014 48
Figure 2. Change in prevalence of co-use from 2003-2004 to 2013-2014, stratified trends compared to overall trend 49
6. References 52
Chapter 3: Factors related to transition from non-medical prescription opioid use to heroin initiation and co-use of both opioids among adults, 2012-2014 58
1. Background 59
2. Methods 63
3. Results 67
4. Discussion 68
5. Tables 75
Table 1. Descriptive statistics of current (past year) NMPO users—NSDUH 2012-2014, N=7,045 76
Table 2. Factors associated with transition in multivariable regression—NSDUH 2012-2014, N=7,045 77
6. References 78
Chapter 4: Use of outpatient medication-assisted treatment by opioid use type: trends in admissions (2004-2015) and factors related to treatment completion 86
1. Background 88
2. Methods 92
3. Results 97
4. Discussion 100
5. Tables and Figures 107
Figure 1. MAT admissions overall and by problem opioid use type─2004-2015, TEDS-A 107
Table 1. Problem opioid use type, demographic, and access to healthcare characteristics among MAT admissions—2004-2015, TEDS-A 108
Table 2. Demographic and access to health care characteristics among MAT admissions, and differences by opiate use type—TEDS-A, 2015, N=44,086 109
Table 3. Association of opioid use type and demographics with successful MAT completion—2013 TEDS-D, N=13,883 110
Table 4. Association between access to healthcare and successful MAT completion, stratified by opioid use type—2013 TEDS-D, N=13,883 111
6. References 112
Chapter 5: Summary and conclusions 124
1. Rationale for research 124
2. Summary of aims and main findings 125
3. Practical implications 127
4. Strengths, limitations and implications for future research 130
5. Overall contributions of the research 132
6. References 133
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