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      Age of initiation, psychopathology, and other substance use are associated with time to use disorder diagnosis in persons using opioids nonmedically

      1 , 2
      Substance Abuse
      Informa UK Limited

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4717802e123">Background:</h5> <p id="P3">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. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4717802e128">Methods:</h5> <p id="P4">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. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4717802e133">Results:</h5> <p id="P5">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. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d4717802e138">Conclusions:</h5> <p id="P6">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. </p> </div>

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          Most cited references37

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          Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

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            Loss to follow-up in cohort studies: how much is too much?

            Loss to follow-up is problematic in most cohort studies and often leads to bias. Although guidelines suggest acceptable follow-up rates, the authors are unaware of studies that test the validity of these recommendations. The objective of this study was to determine whether the recommended follow-up thresholds of 60-80% are associated with biased effects in cohort studies. A simulation study was conducted using 1000 computer replications of a cohort of 500 observations. The logistic regression model included a binary exposure and three confounders. Varied correlation structures of the data represented various levels of confounding. Differing levels of loss to follow-up were generated through three mechanisms: missing completely at random (MCAR), missing at random (MAR) and missing not at random (MNAR). The authors found no important bias with levels of loss that varied from 5 to 60% when loss to follow-up was related to MCAR or MAR mechanisms. However, when observations were lost to follow-up based on a MNAR mechanism, the authors found seriously biased estimates of the odds ratios with low levels of loss to follow-up. Loss to follow-up in cohort studies rarely occurs randomly. Therefore, when planning a cohort study, one should assume that loss to follow-up is MNAR and attempt to achieve the maximum follow-up rate possible.
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              Age at drinking onset and alcohol dependence: age at onset, duration, and severity.

              To examine whether starting to drink at an early age is associated with developing alcohol dependence at a younger age and chronic relapsing dependence, controlling for respondent demographics, smoking and illicit drug use, childhood antisocial behavior and depression, and family alcoholism history. Cross-sectional survey. Nationwide face-to-face survey with a multistage probability sample. A total of 43,093 adults were surveyed in 2001-2002. Based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, lifetime alcohol dependence, dependence within 10 years of starting drinking, multiple episodes, an alcohol dependence episode in the past year, episodes exceeding 1 year, and meeting 6 or 7 dependence criteria. Relative to respondents who began drinking at 21 years or older, those who began drinking before age 14 years were more likely to experience alcohol dependence ever and within 10 years of first drinking (adjusted hazard ratios and 95% confidence intervals [CIs], 1.78 [1.51-2.11] and 1.69 [1.38-2.07], respectively). They also more often experienced past-year dependence and multiple dependence episodes (adjusted odds ratios, 1.93 [95% CI, 1.40-2.64] and 3.09 [95% CI, 2.19-4.35], respectively). Among alcohol-dependent persons, the odds were 2.62 (95% CI, 1.79-3.84) for having at least 1 episode exceeding 1 year and 2.89 (95% CI, 1.97-4.23) for meeting 6 or 7 dependence diagnostic criteria. There is a need to screen and counsel adolescents about alcohol use and to implement policies and programs that delay alcohol consumption.
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                Author and article information

                Journal
                Substance Abuse
                Substance Abuse
                Informa UK Limited
                0889-7077
                1547-0164
                July 12 2017
                October 02 2017
                July 19 2017
                October 02 2017
                : 38
                : 4
                : 407-413
                Affiliations
                [1 ] Department of Psychology, Texas State University, San Marcos, Texas, USA
                [2 ] Center for Administrative Records Research and Applications, U.S. Census Bureau, Suitland, Maryland, USA
                Article
                10.1080/08897077.2017.1356791
                6130196
                28723266
                4497d35a-8c30-4919-8482-e17f413ac3c4
                © 2017
                History

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