Predictors of Transition to Heroin Use among Initially Non-Opioid Dependent Illicit Pharmaceutical Opioid Users: A Natural History Study
BACKGROUND:
Increases
in illicit pharmaceutical opioid (PO) use have been associated with risk for
transition to heroin use. We identify predictors of transition to heroin use
among young, illicit PO users with no history of opioid dependence or heroin
use at baseline.
METHODS:
Respondent-driven
sampling recruited 383 participants; 362 returned for at least one biannual
structured interview over 36 months. Cox regression was used to test for
associations between lagged predictors and hazard of transition to heroin use.
Potential predictors were based on those suggested in the literature. We also
computed population attributable risk (PAR) and the rate of heroin transition.
RESULTS:
Over 36
months, 27 (7.5%) participants initiated heroin use; all were white, and the
rate of heroin initiation was 2.8% per year (95% CI=1.9%-4.1%). Mean length of
PO at first reported heroin use was 6.2 years (SD=1.9). Lifetime PO dependence
(AHR=2.39, 95% CI=1.07-5.48; PAR=32%, 95% CI=-2% to 64%), early age of PO
initiation (AHR=3.08, 95%; CI=1.26-7.47; PAR=30%, 95% CI=2%-59%), using illicit
POs to get high but not to self-medicate a health problem (AHR=4.83, 95%
CI=2.11-11.0; PAR=38%, 95% CI=12%-65%), and ever using PO non-orally most often
(AHR=6.57, 95% CI=2.81-17.2; PAR=63%, 95% CI=31%-86%) were significant
predictors.
CONCLUSION:
This
is one of the first prospective studies to test observations from previous
cross-sectional and retrospective research on the relationship between illicit
PO use and heroin initiation among young, initially non-opioid dependent PO
users. The results provide insights into targets for the design of urgently
needed prevention interventions.
- 1Center for Interventions, Treatment, and Addiction Research, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3171 Research Park Bld, Suite 124, Kettering, OH 45420, USA. Electronic address: robert.carlson@wright.edu.
- 2Center for Global Health, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3123 Research Boulevard, Department of Psychiatry, 627 Edwin C. Moses Blvd., Dayton, OH 45417, USA.
- 3Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
- 4Center for Interventions, Treatment, and Addiction Research, Department of Community Health, Boonshoft School of Medicine, Wright State University, 3171 Research Park Bld, Suite 124, Kettering, OH 45420, USA.
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