Differences in onset and abuse/dependence episodes between prescription opioids and heroin: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Abstract

OBJECTIVES: To examine patterns of onset and abuse/dependence episodes of prescription opioid (PO) and heroin use disorders in a national sample of adults, and to explore differences by gender and substance abuse treatment status. METHODS: Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). RESULTS: Of all respondents, 5% (n = 1815) reported a history of nonmedical PO use (NMPOU) and 0.3% (n = 150) a history of heroin use. Abuse was more prevalent than dependence among NMPOUs (PO abuse, 29%; dependence, 7%) and heroin users (heroin abuse, 63%; dependence, 28%). Heroin users reported a short mean interval from first use to onset of abuse (1.5 years) or dependence (2.0 years), and a lengthy mean duration for the longest episode of abuse (66 months) or dependence (59 months); the corresponding mean estimates for PO abuse and dependence among NMPOUs were 2.6 and 2.9 years, respectively, and 31 and 49 months, respectively. The mean number of years from first use to remission from the most recent episode was 6.9 years for PO abuse and 8.1 years for dependence; the mean number of years from first heroin use to remission from the most recent episode was 8.5 years for heroin abuse and 9.7 years for dependence. Most individuals with PO or heroin use disorders were remitted from the most recent episode. Treated individuals, whether their problem was heroin or POs, tended to have a longer mean duration of an episode than untreated individuals. CONCLUSION: Periodic remissions from opioid or heroin abuse or dependence episodes occur commonly but take a long time. Timely and effective use of treatment services are needed to mitigate the many adverse consequences from opioid/heroin abuse and dependence.

Figure 1

Lifetime prevalence of prescription opioid use disorders and remission^a from the most recent episode among lifetime nonmedical prescription opioid users; lifetime prevalence of heroin use disorders and remission^a from the most recent episode among lifetime heroin users: 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions: by gender and lifetime substance abuse treatment status. Lines extending from bars indicate 95% confidence intervals of the estimates. Note: ^aRemission does not necessarily indicate sustained remission.

Figure 2

Patterns of courses of prescription opioid use disorders among lifetime nonmedical prescription opioid users; patterns of courses of heroin use disorders among lifetime heroin users: 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions. Figures in the parenthesis are 95% confidence intervals of the mean. Notes: ^aRemission does not necessarily indicate sustained remission. *P<0.05.

Figure 3

Proportions of onset of prescription opioid abuse or dependence by year after the first nonmedical use of prescription opioids among individuals with the corresponding opioid use disorder; proportions of onset of heroin abuse or dependence by year after first heroin use among individuals with the corresponding heroin use disorder.

Figure 4

Total number of prescription opioid abuse or dependence episodes (1–4+) and the duration of the longest episode (1–12 to 61+ months) among individuals with the corresponding opioid use disorder; total number of heroin abuse or dependence episodes (1–4+) and the duration of the longest episode (1–12 to 61+ months) among individuals with the corresponding heroin use disorder.

Figure 5

Proportions of remission^a from the most recent prescription opioid abuse or dependence episode by year after the first nonmedical use of prescription opioids among individuals remitted from the corresponding disorder; proportions of remission^a from the most recent heroin abuse or dependence episode by year after the first heroin use among individuals remitted from the corresponding disorder. Note: ^aRemission does not necessarily indicate sustained remission.