Risk Factors for Prescription Opioid Misuse Include Suicide Ideation, Past Substance Abuse Disorders

Several key factors were identified as being associated with prescription opioid misuse, including certain age demographics, suicide ideation, tobacco use, and other substance use disorders, according to study data published in the Journal of Clinical Psychiatry.

Researchers extracted data from 51,200 adults (≥18 years old) who participated in the 2015 National Survey on Drug Use and Health, which collected nationally representative data on opioid misuse and abuse. Study analyses incorporated sociodemographic factors including self-reported physical health, history of suicide ideation, and information on past substance abuse. Logistic regression models were used to assess the associations between these variables.

Individuals aged 18 to 29 years and 30 to 49 years were at increased risk for opioid use disorders in the fully adjusted model, and men were more likely than woman to develop an opioid use disorder. Individuals with self-rated “good” and “fair/good” health were also more likely to report an opioid use disorder compared with patients who reported “very good” or “excellent” health. Opioid use disorders were also associated with lower high school education levels, Hispanic ethnicity, and being uninsured. Clinical factors associated with prescription opioid use disorder were suicide ideation (adjusted odds ratio [AOR] 2.4; 95% CI, 1.58-3.71), past-month nicotine dependence (AOR 3.6; 95% CI, 1.73-7.40), past-year alcohol use disorder (AOR 3.0; 95% CI, 1.11-8.18), lifetime cocaine use (AOR 1.8; 95% CI, 1.02-3.24), past-year cocaine use disorder (AOR 8.3; 95% CI, 3.05-22.64), and past-year heroin use or use disorder (AOR 17.6; 95% CI, 8.55-36.10). Stimulant misuse or use disorder (AOR 4.6; 95% CI, 3.00-7.05) and prescription sedative/tranquilizer misuse or use disorder (AOR 17.0; 95% CI, 11.39-25.34) were also predictive of opioid misuse. The majority of patients (63.4%) reported pain relief as their primary motivation for prescription opioid use whereas others listed “[getting] high” (11.6%), and relaxation (10.9%). Reporting pain as a motivation for prescription opioid use was associated with suicide ideation, cannabis and heroin use or use disorders, cocaine use disorder, and other psychotropic misuse or use disorders.

These data underscore the impact of comorbid health conditions on opioid misuse disorders, and support the use of screening for co-occurring health conditions for patients who misuse prescription opioids. Recognizing the comorbidity of opioid misuse with suicide ideation and other substance use disorders may guide clinicians in properly treating individuals with opioid use disorders.

Disclosures: Dr Compton reports ownership of stock in General Electric, 3M, and Pfizer unrelated to the submitted work. Dr Blanco reports ownership of stock in General Electric, Sanofi, and Eli Lilly. Dr Han and Dr Jones have no conflicts to disclose.

Reference

Han B, Compton WM, Blanco C, Jones CM. Correlates of prescription opioid use, misuse, use disorders, and motivations for misuse among US adults. J Clin Psychiatry. 2018;79:17m11973.