A research letter published in JAMA Network Open suggests immigrants are at increased risk of using opioids as they spend more time in the United States.

Brian D. Sites, MD, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and Matthew A. Davis, MPH, PhD, from the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, conducted a cross-sectional study to examine the association of immigration status and prescription opioid use among first-generation immigrants, using data from the Medical Expenditure Panel Survey.

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The authors identified 13,635 adult immigrants and categorized immigrants as new (<5 years), semi-established (5 to <15 years), and long-standing (≥15 years). Individuals in these categories were then compared with native-born Americans to determine how opioid use varied across immigration status, race/ethnicity, and family income level. The researchers used logistic regression to examine the correlation between length of time spent in the United States and the odds of prescription opioid use.

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Nonimmigrants used prescription opioids at significantly higher rates than all first-generation immigrants (16.1% vs 7.8%, adjusted odds ratio [OR], 1.35; 95% CI, 1.09-1.67; P =.005). In addition, there was a positive association between time spent in the United States and the likelihood of prescription opioid use (P for trend <.001). The adjusted rate of opioid use increased nearly 4-fold (adjusted OR, 4.18; 95% CI, 1.76-9.96), going from 4.7% among new immigrants to 14.8% among those who had been in this country for 15 years or more. This relationship shows a comparable pattern to the opioid use of nonimmigrants, who have a 5-fold higher rate than new immigrants (adjusted OR, 5.17; 95% CI, 2.19-12.22).

“[W]e suspect that time-sensitive cultural factors may have influenced the dynamic between health care practitioners and immigrant patients as they contemplated the decision to initiate opioid therapy,” the authors conclude, adding that acknowledgement of cultural factors that influence opioid use in the United States may help policy efforts to curb reliance on opioids for pain relief.


Sites BD, Davis MA. Association of length of time spent in the United States with opioid use among first-generation immigrants. JAMA Network Open. 2019;2(10):e1913979.