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.

Keywords:

• comorbidity
• heroin use disorders
• natural recovery
• opioid use disorders
• prescription opioid abuse
• self-change

Acknowledgments

This work was made possible by research grants from the US National Institute on Drug Abuse of the National Institutes of Health (DA019623, DA027503, and DA019901 to L-T Wu; DA017009 and DA013043 to GE Woody). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. NESARC was sponsored and conducted by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, with supplemental support from the National Institute on Drug Abuse. We thank Amanda McMillan for her editorial assistance.

Disclosure

GE Woody is a member of the Research on Adverse Drug Events and Reports (RADARS) postmarketing study external advisory group, whose job is to assess abuse of prescription medications. Denver Health administers RADARS, and nine pharmaceutical companies currently support its work. The other authors have no conflicts of interest to disclose. P Mannelli has received support from the following: AstraZeneca, Bristol-Myers Squibb, Cephalon, Inc., Forest, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, King Pharmaceutical, Lundbeck, McNeil Consumer and Specialty, Merck, Organon, Orphan Medical, Pfizer, Reckitt Benckiser and Titan.