Nonmedical use of prescription opioids (NMUPO) is an ongoing public health challenge, as NMUPO is associated with psychopathology, other drug use and fatal overdose. These concomitant risks are greatest in those with opioid use disorder (OUD), but the development of NMUPO-related use disorder is poorly understood. The primary aim of this study was to establish factors associated with the development of and time to OUD among persons engaged in NMUPO.
Data were from Wave 1 of the National Epidemiologic Study on Alcohol and Related Conditions, with 1,755 participants endorsing lifetime NMUPO. Analyses used sequential design-based logistic regression for DSM-IV opioid dependence correlates, followed by Cox regression of proportional hazards for correlates (e.g., sociodemographics, age of NMUPO initiation and psychopathology) of time to dependence in those who developed DSM-IV dependence.
Earlier age of NMUPO initiation increased OUD odds (AOR= 0.95, 95%CI= 0.94–0.96) but slowed OUD development (AHR= 1.05, 95%CI= 1.04–1.06) in those who developed OUD (n= 118), after controlling for sociodemographics, psychopathology and ages of other drug use initiation. Psychopathology and earlier other drug use initiation were associated with higher OUD odds, but only having an alcohol use disorder was associated with shorter time to OUD.
Earlier NMUPO initiation is associated with increased odds of OUD, though those with early initiation had a slower progression to OUD. Programs that prevent early NMUPO initiation, which might lower rates of OUD, and/or identify the later initiators at highest risk for rapid OUD development could have great public health benefits.