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Painkiller misuse increases risk for heroin initiation in veterans

Non-medical prescription opioid use significantly increased risk for heroin initiation among veterans with and without HIV, according to recent findings.

“This study quantifies the issue of starting painkiller misuse and heroin use in a specific, high-risk population — veterans around the U.S.,” study researcher Brandon Marshall, PhD, of Brown University School of Public Health, said in a press release. “Of the 500 participants who initiated heroin, 77% reported prior or concurrent non-medical prescription painkiller use.”

Brandon Marshall

To assess the influence of non-medical use of prescription opioids on heroin initiation among U.S. veterans receiving medical care, researchers analyzed data from a prospective, multi-site observational study of veterans with and without HIV infection (n = 3,396). Study participants reported no lifetime non-medical prescription opioid use or heroin use, had no diagnosed opioid use disorder at baseline and were followed from 2002 to 2012.

Overall, 14.7% of participants initiated heroin use during the 10-year study period.

Heroin initiation was significantly associated with being black, male, aged 43 to 49 years, less educated and having lower income (P < .001 for all).

Past-year marijuana, cocaine, stimulant and alcohol abuse were significantly associated with heroin initiation (P < .05 for all).

Previous non-medical prescription opioid use was reported among 77% of participants who initiated heroin (P < .001).

The crude incidence rate for heroin initiation among all study participants was 2.6 per 100 person-years, compared with 4.82 per 100 person-years among those who reported non-medical prescription opioid use and 1.02 per 100 person-years among non-users (P < .001).

Among participants who reported new-onset non-medical prescription opioid use, 27.3% initiated heroin by the end of the study period.

Participants with previous PTSD or depression diagnoses were significantly more likely to initiate heroin than those without these diagnoses, according to researchers.

In multivariable Cox regression analysis, non-medical prescription opioid use remained positively and significantly associated with heroin initiation (adjusted HR = 5.43; 95% CI, 4.01-7.35).

Receipt of short-term opioid prescription from the Veterans Health Administration increased risk for heroin initiation by 65% (aHR = 1.65; 95% CI, 1.43-1.94), according to fully adjusted analysis.

“This paper shows that, as a general clinical practice, particularly for this population which does experience a lot of chronic pain and other risks for substance use including PTSD, screening for non-medical painkiller use, whether you are prescribing an opioid or not, may be effective to prevent even more harmful transitions to heroin or other drugs,” Marshall said in the release. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.