TY - JOUR
T1 - Polysubstance use trends and variability among individuals with opioid use disorder in rural versus urban settings
AU - Ellis, Matthew S.
AU - Kasper, Zachary A.
AU - Cicero, Theodore J.
N1 - Funding Information:
All authors are employees of Washington University in St Louis, which receives research funding from Denver Health and Hospital Authority . T. J. C. serves as a paid consultant on the Scientific Advisory Board of the RADARS System. M. S. E. serves as a paid consultant on the Scientific Advisory Group for the National Drug Early Warning System (NDEWS). None of the authors have a direct financial, commercial, or other relationship with any of the subscribers of the RADARS System. This work was supported by private funds from Washington University in St Louis and the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System , an independent nonprofit postmarketing surveillance system that is supported by subscription fees from pharmaceutical manufacturers and other institutions that use these data for pharmacovigilance activities and to meet regulatory obligations. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado.
Funding Information:
All authors are employees of Washington University in St Louis, which receives research funding from Denver Health and Hospital Authority. T. J. C. serves as a paid consultant on the Scientific Advisory Board of the RADARS System. M. S. E. serves as a paid consultant on the Scientific Advisory Group for the National Drug Early Warning System (NDEWS). None of the authors have a direct financial, commercial, or other relationship with any of the subscribers of the RADARS System. This work was supported by private funds from Washington University in St Louis and the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, an independent nonprofit postmarketing surveillance system that is supported by subscription fees from pharmaceutical manufacturers and other institutions that use these data for pharmacovigilance activities and to meet regulatory obligations. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Rural areas of the United States have been disproportionately impacted by the opioid epidemic, exacerbated by COVID-19-related economic upheavals. While polysubstance use is an important determinant of overdose risk, variability in polysubstance use as a result of numerous factors (e.g., access, preference) has yet to be described, particularly among rural persons with opioid use disorder (PWOUD). Survey data on past-month use of prescription and illicit opioids and 12 non-opioid psychoactive drug classes were analyzed from a national sample of rural (n = 3872) and urban (n = 8153) residents entering treatment for OUD from 2012 to 2019. Trend analyses for opioid and stimulant use were compared between rural and urban PWOUD. Latent class analyses assessed substance use trends through identified typologies of rural/urban PWOUD, which then underwent comparative analyses. By 2019, prescription opioid use remained greater in rural versus urban PWOUD, and methamphetamine use showed greater growth in rural, compared to urban areas. Latent class analyses identified variability in polysubstance use, with five identical subgroups in rural/urban PWOD: high polysubstance, polyprescription, prescription opioid-focused, prescription opioid-focused with polysubstance use, and illicit opioid-focused. Polyprescription was highest in rural areas, with illicit opioid-focused use highest in urban areas. Demographic characteristics, co-morbid conditions and healthcare coverage were all associated with between-group differences. There is significant variability in polysubstance use that may identify specific prevention and treatment needs for subpopulations of OUD patients: interventions focused on reducing opioid prescriptions, early engagement with mental health resources, wider distribution of naloxone, and screening/treatment plans that take into account the use of multiple substances.
AB - Rural areas of the United States have been disproportionately impacted by the opioid epidemic, exacerbated by COVID-19-related economic upheavals. While polysubstance use is an important determinant of overdose risk, variability in polysubstance use as a result of numerous factors (e.g., access, preference) has yet to be described, particularly among rural persons with opioid use disorder (PWOUD). Survey data on past-month use of prescription and illicit opioids and 12 non-opioid psychoactive drug classes were analyzed from a national sample of rural (n = 3872) and urban (n = 8153) residents entering treatment for OUD from 2012 to 2019. Trend analyses for opioid and stimulant use were compared between rural and urban PWOUD. Latent class analyses assessed substance use trends through identified typologies of rural/urban PWOUD, which then underwent comparative analyses. By 2019, prescription opioid use remained greater in rural versus urban PWOUD, and methamphetamine use showed greater growth in rural, compared to urban areas. Latent class analyses identified variability in polysubstance use, with five identical subgroups in rural/urban PWOD: high polysubstance, polyprescription, prescription opioid-focused, prescription opioid-focused with polysubstance use, and illicit opioid-focused. Polyprescription was highest in rural areas, with illicit opioid-focused use highest in urban areas. Demographic characteristics, co-morbid conditions and healthcare coverage were all associated with between-group differences. There is significant variability in polysubstance use that may identify specific prevention and treatment needs for subpopulations of OUD patients: interventions focused on reducing opioid prescriptions, early engagement with mental health resources, wider distribution of naloxone, and screening/treatment plans that take into account the use of multiple substances.
KW - Opioid use disorder
KW - Polysubstance use
KW - Rural
UR - http://www.scopus.com/inward/record.url?scp=85112058995&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2021.106729
DO - 10.1016/j.ypmed.2021.106729
M3 - Article
C2 - 34293380
AN - SCOPUS:85112058995
SN - 0091-7435
VL - 152
JO - Preventive Medicine
JF - Preventive Medicine
M1 - 106729
ER -