Abstract
As addiction treatment becomes difficult due to social distancing measures, it is important to understand the risk factors of inappropriate opioid use. Past studies have evaluated the risk factors of opioid use disorder (OUD) and overdose, but few focused on the risk factors for inappropriate opioid use that can lead to an OUD. This study aims to perform a secondary analysis on the publicly available database of the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) to identify the risk factors for inappropriate and appropriate opioid use among participants. We used multinomial logistic regression analysis to examine which factors are associated with opioid use. We also examined effect modification by gender and education. There were 1237 participants, 57% were female and the median age was 39 (IQR 29–54) years. Younger age, male, not physically active at all in the past 30 days, former smoker, cocaine and/or heroin use in past 12 months, and diagnosis of depression/anxiety were significantly associated with inappropriate opioid use, compared to no opioid use. Further, we observed an elevation in inappropriate opioid use among females who were Non-Hispanic Black and Hispanic, and that the association between no physical activity and inappropriate opioid use was stronger among those with lower education level. Overall, important risk factors associated with opioid use were found that can inform our approaches to mitigate the opioid epidemic.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of Data and Material
The NYC HANES 2013 to 2014 dataset is made publicly available. http://nychanes.org/data/
Code Availability
The code for the current study is available by emailing the corresponding author on reasonable request.
Abbreviations
- OUD:
-
opioid use disorder
- DUQ:
-
Drug Use Questionnaire
References
Butanis, B. John Hopkins Medicine (2018, April 30). What Are Opioids? https://www.hopkinsmedicine.org/opioids/what-are-opioids.html
Cauley, C. E., Anderson, G., Haynes, A. B., Menendez, M., Bateman, B. T., & Ladha, K. (2017). Predictors of in-hospital postoperative opioid overdose after major elective operations: A nationally representative cohort study. Annals of Surgery, 265(4), 702–708. https://doi.org/10.1097/SLA.
Centers for Disease Control and Prevention. (2020, March 19). Understanding the Epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html
Clarke, H., Soneji, N., Ko, D. T., Yun, L., & Wijeysundera, D. N. (2014). Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study. BMJ (Clinical research ed.), 348, g1251. https://doi.org/10.1136/bmj.g1251.
Cragg, A., Hau, J. P., Woo, S. A., Kitchen, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2019). Risk factors for misuse of prescribed opioids: A systematic review and meta-analysis. Annals of Emergency Medicine, 74(5), 634–646.
Degenhardt, L., & Hall, W. (2001). The relationship between tobacco use, substance-use disorders and mental health: Results from the National Survey of mental health and well-being. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 3(3), 225–234. https://doi.org/10.1080/14622200110050457.
Ehrentraut, J. H., Kern, K. D., Long, S. A., An, A. Q., Faughnan, L. G., & Anghelescu, D. L. (2014). Opioid misuse behaviors in adolescents and young adults in a hematology/oncology setting. Journal of Pediatric Psychology, 39(10), 1149–1160. https://doi.org/10.1093/jpepsy/.
Feingold, D., Brill, S., Goor-Aryeh, I., Delayahu, Y., & Lev-Ran, S. (2017). Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana. Journal of Affective Disorders, 218, 1–7. https://doi.org/10.1016/j.jad.2017.04.026.
Forrester, J. E., Tucker, K. L., & Gorbach, S. L. (2005). The effect of drug abuse on body mass index in Hispanics with and without HIV infection. Public Health Nutrition, 8(1), 61–68. https://doi.org/10.1079/phn2005667.
Foy, R., Leaman, B., McCrorie, C., Petty, D., House, A., Bennett, M., Carder, P., Faulkner, S., Glidewell, L., & West, R. (2016). Prescribed opioids in primary care: Cross-sectional and longitudinal analyses of influence of patient and practice characteristics. BMJ Open, 6(5), e010276. https://doi.org/10.1136/bmjopen-2015-010276.
Hargan, E. D. (2017). Determination that a public health emergency exists. Department of Health and Human Services.
Hjsted, J., Ekholm, O., Kurita, G. P., Juel, K., & Sjgren, P. (2013). Addictive behaviors related to opioid use for chronic pain: A population-based study. Pain, 154(12), 2677–2683. https://doi.org/10.1016/j.pain.2013.07.046.
Hudson, T. J., Edlund, M. J., Steffick, D. E., Tripathi, S. P., & Sullivan, M. D. (2008). Epidemiology of regular prescribed opioid use: Results from a national, population-based survey. Journal of Pain and Symptom Management, 36(3), 280–288.
Iheanacho, T., Stefanovics, E., & Rosenheck, R. (2018). Opioid use disorder and homelessness in the veterans health administration: The challenge of multimorbidity. Journal of Opioid Management, 14(3), 171–182. https://doi.org/10.5055/jom.2018.0447.
Jakobsson, U. (2008). Tobacco use in relation to chronic pain: Results from a Swedish population survey. Pain medicine (Malden, Mass.), 9(8), 1091–1097. https://doi.org/10.1111/j.1526-4637.2008.00473.x.
Jamison, R. N., Butler, S. F., Budman, S. H., Edwards, R. R., & Wasan, A. D. (2010). Gender differences in risk factors for aberrant prescription opioid use. The Journal of Pain, 11(4), 312–320. https://doi.org/10.1016/j.jpain.2009.07.016.
Jiang, X., Orton, M., Feng, R., Hossain, E., Malhotra, N. R., Zager, E. L., & Liu, R. (2017). Chronic opioid usage in surgical patients in a large academic center. Annals of Surgery, 265(4), 722–727. https://doi.org/10.1097/SLA.0000000000001780.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S. L., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184.
Klimas, J., Gorfinkel, L., Fairbairn, N., Amato, L., Ahamad, K., Nolan, S., Simel, D. L., & Wood, E. (2019). Strategies to identify patient risks of prescription opioid addiction when initiating opioids for pain: A systematic review. JAMA Network Open, 2(5), e193365. https://doi.org/10.1001/jamanetworkopen.2019.3365.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266. https://doi.org/10.1097/00006842-200203000-00008.
Lord, S., Downs, G., Furtaw, P., Chaudhuri, A., Silverstein, A., Gammaitoni, A., & Budman, S. (2009). Nonmedical use of prescription opioids and stimulants among student pharmacists. Journal of the American Pharmacists Association : JAPhA, 49(4), 519–528. https://doi.org/10.1331/JAPhA.2009.08027.
National Institute on Drug Abuse. (2021a). Opioid Overdose Crisis. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis Accessed 12 Jul 2021.
National Institute on Drug Abuse. (2021b). Prescription Opioids. https://www.drugabuse.gov/publications/drugfacts/prescription-opioids. Accessed 12 Jul 2021.
National Institutes of Health U.S. (n.d.). Library of Medicine Opioid addiction NIH. https://ghr.nlm.nih.gov/condition/opioid-addiction. Accessed 12 Jul 2021.
National Safety Council. (n.d.). Implications of Substance Use Disorders for Employers. https://www.nsc.org/work-safety/safety-topics/drugs-at-work/substances. Accessed 12 Jul 2021.
Niesters, M., Dahan, A., Kest, B., Zacny, J., Stijnen, T., Aarts, L., & Sarton, E. (2010). Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies. Pain, 151(1), 61–68. https://doi.org/10.1016/j.pain.2010.06.012.
Plesner, K., Jensen, H. I., & Højsted, J. (2016). Smoking history, nicotine dependence and opioid use in patients with chronic non-malignant pain. Acta Anaesthesiologica Scandinavica, 60(7), 988–994. https://doi.org/10.1111/aas.12741.
SAS Institute Inc. (2014). SAS® university edition: Installation guide for windows.
Smith, P. H., Mazure, C. M., & McKee, S. A. (2014). Smoking and mental illness in the U.S. population. Tobacco Control, 23(e2), e147–e153. https://doi.org/10.1136/tobaccocontrol-2013-051466.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20–07–01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data.
Sullivan, M. D., Edlund, M. J., Steffick, D., & Unützer, J. (2005). Regular use of prescribed opioids: Association with common psychiatric disorders. Pain, 119(1–3), 95–103. https://doi.org/10.1016/j.pain.2005.09.020.
Thiese, M. S., Ronna, B., & Ott, U. (2016). P value interpretations and considerations. Journal of thoracic disease, 8(9), E928–E931. https://doi.org/10.21037/jtd.2016.08.16.
Thorpe, L. E., Greene, C., Freeman, A., Snell, E., Rodriguez-Lopez, J. S., Frankel, M., Punsalang Jr., A., Chernov, C., Lurie, E., Friedman, M., Koppaka, R., & Perlman, S. E. (2015). Rationale, design and respondent characteristics of the 2013-2014 new York City health and nutrition examination survey (NYC HANES 2013-2014). Preventive Medicine Reports, 2, 580–585. https://doi.org/10.1016/j.pmedr.2015.06.019.
U.S. Department of Health and Human Services. (2019, September 4). What is the U.S. Opioid Epidemic? https://www.hhs.gov/opioids/about-the-epidemic/index.html
Wasan, A. D., Butler, S. F., Budman, S. H., Benoit, C., Fernandez, K., & Jamison, R. N. (2007). Psychiatric history and psychologic adjustment as risk factors for aberrant drug-related behavior among patients with chronic pain. The Clinical Journal of Pain, 23(4), 307–315. https://doi.org/10.1097/AJP.0b013e3180330dc5.
Wilson, G., Bryan, J., Cranston, K., Kitzes, J., Nederbragt, L., & Teal, T. K. (2017). Good enough practices in scientific computing. PLoS Computational Biology, 13(6), e1005510. https://doi.org/10.1371/journal.pcbi.1005510.
World Health Organization. (1988). WHO-disability assessment schedule II. Geneva: World Health Organization.
Acknowledgments
The authors would like to thank The City University of New York (CUNY) School of Public Health and the New York City (NYC) Health Department. This study was made possible by their publicly available data provided from the NYC HANES 2013-2014 survey.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval
Not applicable.
Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Joseph, S.A., Chiu, YH.M. & Tracy, K. Risk factors for inappropriate opioid use among New York City residents. Curr Psychol 42, 7649–7658 (2023). https://doi.org/10.1007/s12144-021-02070-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-021-02070-2