Demographic,Socioeconomic,and Clinical Variables Associated With Nonmedical Pharmaceutical Opioid Use and Heroin Use Among US Adults in 2021 to 2022

Abstract

Background:

Recent changes to the US opioid overdose epidemic have been driven by the spread of illicitly manufactured opioids and complex patterns of multisubstance use. Updated analyses of opioid use epidemiology among US adults are needed to guide new research and interventions.

Methods:

Cross-sectional study of 2021 to 2022 National Survey on Drug Use and Health. Using nationally representative estimates weighted to 255 053 169 adults, multivariable logistic regression models determined odds of mutually exclusive past-year opioid use categories (nonmedical use of pharmaceutical opioids [NMUPO], heroin use, or both) across demographic, socioeconomic, and clinical variables.

Results:

Prevalence of NMUPO among US adults was 3.0%, heroin use 0.2%, and both 0.2%. Demographic characteristics associated with nonmedical opioid use included middle age groups (e.g., 35-49 years old relative to 18-25 years old, NMUPO: adjusted odds ratio [aOR] 1.61, 95% CI 1.26-2.07) and LGB sexual orientation relative to heterosexual orientation (e.g., NMUPO: aOR 1.33, 95% CI 1.09-1.64). Among socioeconomic variables, the strongest associations were with lower educational attainment (e.g., completing high school relative to completing college, both: aOR 3.84, 95% CI 1.53-9.68). Clinical variables strongly associated with opioid use included nonmedical sedative/tranquilizer use (e.g., NMUPO: aOR 7.48, 95% CI 5.86-9.56), nonmedical stimulant use (e.g., both: aOR 32.42, 95% CI 17.11-61.42), lower self-rated health (e.g., “poor” health relative to “excellent” health, NMUPO: aOR 1.98, 95% CI 1.34-2.91), and severe mental illness (e.g., both: aOR 3.78, 95% CI 2.05-6.96).

Conclusions:

Future research and public health efforts should account for heterogeneity in opioid use patterns across US adults, including strong associations with nonopioid substance use.