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How Do Prescription Opioid Users Differ From Users of Heroin or Other Drugs in Psychopathology: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Wu, Li-Tzy ScD; Woody, George E. MD; Yang, Chongming PhD; Blazer, Dan G. MD, PhD

Journal of Addiction Medicine: March 2011 - Volume 5 - Issue 1 - p 28-35
doi: 10.1097/ADM.0b013e3181e0364e
Original Research

Objectives: To study substance use and psychiatric disorders among prescription opioid users, heroin users, and nonopioid drug users in a national sample of adults.

Methods: Analyses of data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093).

Results: Four groups were identified among 9140 illicit or nonprescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and nonopioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (SUDs; cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) when compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders when compared with other opioid-only users. Nonopioid drug users had reduced odds of all SUDs and other mental disorders (mood, anxiety, pathologic gambling, and personality) when compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year nonopioid drug users.

Conclusions: All opioid users had higher rates of SUDs than nonopioid drug users, and these rates were particularly increased among heroin-other opioid users. The findings suggest the need to distinguish between these 4 groups in research and treatment as they may have different natural histories and treatment needs.

From the Department of Psychiatry and Behavioral Sciences (L.-T.W., D.G.B.), School of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Psychiatry (G.E.W.), School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA; and Social Science Research Institute (C.Y.), Duke University, Durham, NC.

Received for publication January 20, 2010; accepted March 29, 2010.

Send correspondence and reprint requests to Li-Tzy Wu, ScD, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Box 3419, Durham, NC 27710. e-mail:

Supported by research grants from the US National Institute on Drug Abuse of the National Institutes of Health: DA019623 (to L.-T.W.), DA019901 (to L.-T.W.), DA027503 (to L.-T.W.), DA026652 (to W.W. Eaton), DA017009 (to G.E.W.), DA013043 (to G.E.W.), and HSN271200522071C (to D.G.B.).

The sponsoring agency had no further role in the study design and analysis, the writing of the report, or the decision to submit the article for publication.

George E. Woody is a member of the RADARS(r) System Scientific Advisory Board whose job is to assess abuse, misuse and diversion of prescription medications. Denver Health and Hospitals Authority is a non-profit public hospital that administers the RADARS(r) System, and its costs are supported by contracts with pharmaceutical companies. The other authors have no conflicts of interest to disclose.

© 2011 American Society of Addiction Medicine