Local changes in opioid-dispensing rates have a direct effect on individuals’ misuse and dependence on prescription opioids, but they do not affect the odds of heroin misuse or dependence, according to a study published today in AJP in Advance.
The results suggest that changes to prescribing patterns may have helped curb the prescription opioid crisis, wrote Mike Vuolo, Ph.D., of Ohio State University and Brian C. Kelly, Ph.D., of Purdue University. However, they continued, “trends in heroin use may be an ancillary component of the opioid crisis rather than directly attributable to patterns of opioid prescribing.”
Vuolo and Kelly analyzed 2006-2016 data from the National Survey on Drug Use and Health, which surveys about 70,000 individuals aged 12 and older annually, as well as CDC data on county-level opioid dispensing. They specifically focused on whether county-level dispensing rates affected respondents’ substance use, frequency of use, and prescription opioid or heroin dependence.
Among the 748,800 respondents, 4.6% reported past-year prescription opioid misuse, and 0.5% reported dependence. Only 0.3% of respondents reported past-year heroin use, 0.2% of whom reported heroin dependence. Average county-level opioid dispensing rates rose from 80.5 per 100 people in 2006 to 96.1 per 100 people in 2012 before the rates began to steadily decline.
The odds of prescription opioid misuse, increased frequency of misuse, and dependence were 7.2%, 3.5%, and 10.4% higher, respectively, for each unit increase in the county-level opioid dispensing rate per 100 people. Similarly, each unit decrease in the county-level opioid dispensing rate was associated with decreases in all three outcomes. There was, however, no significant association between the county-level opioid dispensing rate and the three heroin outcomes.
“Given that many heroin users have transitioned from prescription opioid misuse, there has been a reasonable fear that well-meaning attempts to curb opioid prescriptions could result in additional opioid misusers making this transition,” the authors wrote. “However, we found no evidence that this occurred at the population level, such that efforts should continue to reduce opioid prescription to levels required for patient care without fears that reductions may drive up heroin use.”
For related information, see the Psychiatric News article “Psychiatrists Can Play Vital Role in Stemming Opioid Crisis.”
(Image: iStock/Charday Penn)
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