Socioeconomic status, fundamental cause theory, and prescription opioid use behaviors: a theoretical examination

Abstract

I applied Phelan et al.'s fundamental cause theory (FCT) framework to examine the association between socioeconomic status (SES) and prescription opioid use behaviors among a nationally representative sample of US adults. I also explored the mediating roles of health status and the deployment of flexible resources. Consistent with FCT, the results showed that higher SES was associated with significantly lower odds of prescription opioid use behaviors. Two flexible resources—health care access and social support—and various indicators of poor health helped explain this relationship. Inconsistent with FCT, knowledge of heroin use as being a “great risk” was not a mediator of the SES-prescription opioid use behaviors association. Based on these findings, efforts to reduce SES disparities in prescription opioid use behaviors should emphasize reducing SES disparities overall as well as in health and access to important health-enhancing resources. Limitations of this study are discussed.

Acknowledgements

The author gives special thanks to Jason Ford, Khary Rigg, Melanie Sberna-Hinojosa, Fernando Rivera, and Brian Kelly for their comments on earlier versions of this manuscript.

Notes

1 Prescription opioid use behaviors refers to (i) prescription opioid use without misuse/use disorder, (ii) prescription opioid misuse without use disorder, and (iii) prescription opioid use disorder (Lauer et al. 2018)

2 The misuse of a prescription drug refers to the (a) use of a medication without a prescription of your own; (b) use in greater amounts, more often, or longer than you were told to take them; or (c) use in any other way not authorized by a doctor (Center for Behavioral Health Statistics and Quality 2017).

3 According to the DSM-V criteria on substance use disorders, POUD occurs when an individual is either abusing or dependent on a prescription opioid (Han et al. 2018). Dependence occurs when one experiences three or more of the following six symptoms: (1) spending a great deal of time over a period of a month obtaining or using a substance; (2) being unable to keep set limits on substance use or used more often than intended; (3) needing to use the substance more than before to achieve the desired effects or noticing that using the same amount has less effect than before; (4) being unable to cut down or stop using the substance every time one tries or wants to; (5) continuing to use the substance even though it causes emotional, nervous, mental health, or physical problems; or (6) reducing or giving up participation in important activities (Center for Behavioral Health Statistics and Quality 2017). Abuse occurs when individuals experience one of the following four symptoms: (1) use to the extent that it begins to interfere with major obligations at work, school, or home; (2) use leading to being placed in dangerous situations; (3) use causing trouble with the law; or (4) use causing trouble with friends or family and continued use despite these problems.

4 A period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth” (National Institute of Mental Health 2019).

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Harvey L. Nicholson

Harvey L. Nicholson Jr. is currently an Assistant Professor of Sociology at the University of Florida in the Department of Sociology and Criminology & Law. His research interest involves numerous areas, including, but not limited to, medical sociology, population health, race, ethnicity, social stratification, and politics. He has published in various scholarly outlets such as Sociology of Race and Ethnicity, Journal of Racial and Ethnic Health Disparities, and Drug and Alcohol Dependence.