Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

William C. Becker

Abstract

Recent changes to the US opioid overdose epidemic have been driven by the spread of illicitly-manufactured opioids and complex patterns of multi-substance use. This study provides updated analyses of opioid use epidemiology among US adults, which are needed to guide new research and interventions. We conducted a cross- sectional study of data from the National Survey on Drug Use and Health, 2021-22. Using nationally-representative estimates weighted to 255,053,169 adults, multivariable logistic regression models determined odds of mutually exclusive past-year opioid use categories (non-medical use of pharmaceutical opioids [NMUPO], heroin use, or both) across demographic, socioeconomic, and clinical variables. Prevalence of NMUPO among US adults was 3.0%, heroin use 0.2%, and both 0.2%. Demographic characteristics associated with non-medical opioid use included middle age groups (e.g., 35-49 years old relative to 18-25 years old, NMUPO: aOR 1.61, 95% CI 1.26-2.07) and LGB sexual orientation relative to heterosexual orientation (e.g., NMUPO: aOR 1.33, 95% CI 1.09-1.64). Among socioeconomic variables, the strongest associations were with lower educational attainment (e.g., completing high school relative to completing college, both: aOR 3.84, 95% CI 1.53-9.68). Clinical variables strongly associated with opioid use included non-medical sedative/tranquilizer use (e.g., NMUPO: aOR 7.48, 95% CI 5.86- 9.56), non-medical stimulant use (e.g., both: aOR 32.42, 95% CI 17.11-61.42), lower self-rated health (e.g., “poor” health relative to “excellent” health, NMUPO: aOR 1.98, 95% CI 1.34-2.91), and severe mental illness (e.g., both: aOR 3.78, 95% CI 2.05-6.96). Future research and public health efforts should account for heterogeneity in opioid use patterns across US adults, including strong associations with non-opioid substance use.

Comments

This is an Open Access Thesis.

Open Access

This Article is Open Access

Share

COinS