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Observational Study
. 2016 Nov;111(11):2021-2031.
doi: 10.1111/add.13491. Epub 2016 Aug 23.

Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study

Geetanjoli Banerjee  1 , E Jennifer Edelman  2   3 , Declan T Barry  4   5 , William C Becker  6 , Magdalena Cerdá  7 , Stephen Crystal  8 , Julie R Gaither  3   9 , Adam J Gordon  10 , Kirsha S Gordon  11 , Robert D Kerns  6   12 , Silvia S Martins  13 , David A Fiellin  2   3 , Brandon D L Marshall  14
Affiliations
Observational Study

Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study

Geetanjoli Banerjee et al. Addiction. 2016 Nov.

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.

Keywords: Heroin; longitudinal study; non-medical prescription drug use; opioid-related disorders; polysubstance use; veterans.

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Figure 1
Figure 1
Flow chart of eligible VACS participants, 2002-2012
Figure 2
Figure 2
Relationship between prior/concurrent NMUPO and first-time initiation of heroin among VACS participants (2002-2012)
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