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Polydrug Use Among People Who Use Opioids, National Survey on Drug Use and Health 2002 to 2017

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Polydrug Use Among People Who Use Opioids, National Survey on Drug Use and Health 2002 to 2017 University of Louisville ThinkIR: The University of Louisville's Institutional Repository Electronic Theses and Dissertations 5-2019 Polydrug use among people who use opioids, national survey on drug use and health 2002 to 2017. Diana Kuo Stojda University of Louisville Follow this and additional works at: https://ir.library.louisville.edu/etd Part of the Epidemiology Commons Recommended Citation Stojda, Diana Kuo, "Polydrug use among people who use opioids, national survey on drug use and health 2002 to 2017." (2019). Electronic Theses and Dissertations. Paper 3208. https://doi.org/10.18297/etd/3208 This Doctoral Dissertation is brought to you for free and open access by ThinkIR: The nivU ersity of Louisville's Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of ThinkIR: The nivU ersity of Louisville's Institutional Repository. This title appears here courtesy of the author, who has retained all other copyrights. For more information, please contact [email protected]. POLYDRUG USE AMONG PEOPLE WHO USE OPIOIDS, NATIONAL SURVEY ON DRUG USE AND HEALTH 2002 to 2017 By Diana Kuo Stojda BS, The University of North Carolina – Chapel Hill, 2012 MPH, Boston University, 2007 BS, University of Connecticut, 2005 BA, University of Connecticut, 2005 A Dissertation Submitted to the Faculty of the School of Public Health and Information Sciences of the University of Louisville in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Public Health Sciences Department of Epidemiology and Population Health University of Louisville Louisville, Kentucky May 2019 Copyright 2019 by Diana K. Stojda All rights reserved POLYDRUG USE AMONG PEOPLE WHO USE OPIOIDS, NATIONAL SURVEY ON DRUG USE AND HEALTH 2002 to 2017 By Diana Kuo Stojda BS, The University of North Carolina – Chapel Hill, 2012 MPH, Boston University, 2007 BS, University of Connecticut, 2005 BA, University of Connecticut, 2005 A Dissertation Approved on April 15, 2019 by the following Dissertation Committee Richard N. Baumgartner, Ph.D. Martin T. Hall, Ph.D., MSSW Nicholas Peiper, Ph.D., MPH Kira C. Taylor, Ph.D., MS Anne Baber Wallis, Ph.D., MHS ii ACKNOWLEDGMENTS “No one is useless in this world who lightens the burdens of another.” - Charles Dickens Those who know me well, know that I’ve been a student longer than I’ve been a working professional. The journey to obtaining my doctorate was a long and crazy one, with emotional ups and downs, but the one aspect of this journey that has helped me hold on to my sanity was the support of my family, friends, school colleagues, and everyone else who contributed in some way for me to realize my dream of lightening the burdens of others. To my parents, I thank you for supporting me emotionally (and financially!) in my academic pursuits; to my loving husband, Piotr, for putting up with the long distance and time apart; to my closest childhood friends, Christine Ku and Maria Shi, for their emotional comfort during times of deep stress; to all faculty and staff at the School of Public Health and Information Sciences who I have gotten to know throughout my time here; and to my partners in crime at UofL, Chisom Odoh and Colette Davis, for their friendship and emotional support while trying to finish the doctoral program. And finally, to my fantastic dissertation committee members: Drs. Richard Baumgartner, Martin Hall, Nicholas Peiper, Kira Taylor, and Anne Wallis, thank you all for giving me your time, energy, and expertise in making this dissertation a reality. iii ABSTRACT POLYDRUG USE AMONG PEOPLE WHO USE OPIOIDS, NATIONAL SURVEY ON DRUG USE AND HEALTH 2002 to 2017 Diana K. Stojda April 15, 2019 Introduction: Mortality due to overdose has been increasing since 2010 in the U.S., with an increase in the reported use of heroin and co-use of heroin and prescription opioids. Trends and correlates of polydrug use need to be analyzed to propose policies to reduce overdose risk. The overall objective of this study is to characterize high-risk polydrug groups among people who use opioids (PWUO) to understand the patterns of co-used substances and overdose risk factors. Methods: Publicly available data from the 2002-2017 National Survey on Drug Use and Health were analyzed to obtain weighted prevalence rates and trends for PWUO groups, core substance use among each group, as well as polydrug latent classes. Trend analyses consisted of Rao-Scott Chi-square (χ2) tests and joinpoint regression modeling. Multinomial logistic regression was used to determine associations between latent class membership and correlates such as sociodemographic factors, past year opioid use disorder (OUD) and residential transience. Results: Overall prevalence of all individuals who reported the use of either a prescription pain reliever (PPR) or heroin in the past month has declined since 2006, however, the prevalence of the combination opioid use group has been increasing since iv 2002. Multiple substance use by the past month combination opioid use group was substantially greater than those who exclusively used PPR or heroin in the past month, a finding that aligns with past research. Although it was hypothesized the combination opioid class would be characterized as having the highest risk of past year OUD, this was not the case; the Class with the highest adjusted odds of having past year OUD had the highest probability of reporting the past month use of heroin, marijuana, and other illicit substances [aOR (95% CI): 11.03 (6.46, 18.82)]. Conclusion: The increasing prevalence of polydrug use populations among people who use opioids, particularly those who have reported heroin use, underscores the need for prompt action from local, state, and federal stakeholders to pursue more aggressive action to stem the opioid crisis. Policies should conform to a unified public health framework, (e.g., Cascade of Care) and address both individual- and population-level strategies. v TABLE OF CONTENTS Page ACKNOWLEDGMENTS ................................................................................................. iii ABSTRACT ....................................................................................................................... iv LIST OF TABLES ............................................................................................................. ix LIST OF FIGURES ........................................................................................................... xi CHAPTER I: INTRODUCTION AND STUDY OVERVIEW Historical Overview of Opioid Use in the United States ...............................................1 Changing Trends of Prescription Opioid Misuse and Heroin Use in the United States, 2008 to 2014 .......................................................................................................4 Defining Polydrug Use ..................................................................................................5 Rationale and Significance of Study ..............................................................................6 Objective and Specific Aims .........................................................................................8 Hypotheses Testing for Aim 3 .....................................................................................10 Overview of the Present Study ....................................................................................11 CHAPTER II: LITERATURE REVIEW Introduction ..................................................................................................................13 Opioid Literature from 1970 to 1990 ...........................................................................13 Opioid Literature after 1990 ........................................................................................15 vi Epidemiology of People Who Use Opioids .................................................................16 Literature on Polydrug use in PWUO ..........................................................................23 Drug, Set, and Setting Conceptual Framework ............................................................27 Drug Factors: Commonly Co-used Substances in PWUO ..........................................28 Set Factors: Individual Level Characteristics Associated with Opioid Misuse ...........40 Setting Factors: Environmental Characteristics Associated with Opioid Misuse ........46 What This Study Contributes .......................................................................................48 CHAPTER III: RESEARCH DESIGN AND METHODOLOGY Introduction ..................................................................................................................50 National Survey of Drug Use and Health (2002-2017) ...............................................50 The Current Study: Polydrug Use in PWUO, 2002-2017............................................57 Data Analysis Methods ................................................................................................70 CHAPTER IV: RESULTS Aim 1 Results ...............................................................................................................83 Aim 2 Results .............................................................................................................121 Aim 3 Results .............................................................................................................131 CHAPTER V: DISCUSSION Longitudinal Prevalence of People Who Use Opioids and Their
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