title: Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment.
abstract: BACKGROUND
  As a population, non-medical prescription opioid users are not well-defined. We aimed to derive and describe typologies of prescription opioid use and nonmedical use using latent class analysis in an adult population being assessed for substance abuse treatment.
  
  
  METHODS
  Latent class analysis was applied to data from 26,314 unique respondents, aged 18-70, self-reporting past month use of a prescription opioid out of a total of 138,928 cases (18.9%) collected by the Addiction Severity Index-Multimedia Version (ASI-MV®), a national database for near real-time prescription opioid abuse surveillance. Data were obtained from November 2005 through December 2009. Substance abuse treatment, criminal justice, and public assistance programs in the United States submitted data to the ASI-MV database (n = 538). Six indicators of the latent classes derived from responses to the ASI-MV, a version of the ASI modified to collect prescription opioid abuse and chronic pain experience. The latent class analysis included respondent home ZIP code random effects to account for nesting of respondents within ZIP code.
  
  
  RESULTS
  A four-class adjusted latent class model fit best and defined clinically interpretable and relevant subgroups: Use as prescribed, Prescribed misusers, Medically healthy abusers, and Illicit users. Classes varied on key variables, including race/ethnicity, gender, concurrent substance abuse, duration of prescription opioid abuse, mental health problems, and ASI composite scores. Three of the four classes (81% of respondents) exhibited high potential risk for fatal opioid overdose; 18.4% exhibited risk factors for blood-borne infections.
  
  
  CONCLUSIONS
  Multiple and distinct profiles of prescription opioid use were detected, suggesting a range of use typologies at differing risk for adverse events. Results may help clinicians and policy makers better focus overdose and blood-borne infection prevention efforts and intervention strategies for prescription opioid abuse reduction.
authors.affiliation: Brown Medical School, Providence, Rhode Island, United States of America. traci.c.green@gmail.com
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Ryan
authors.initials: R
authors.lastname: Black
authors.forename: Jill M
authors.initials: JM
authors.lastname: Grimes Serrano
authors.forename: Simon H
authors.initials: SH
authors.lastname: Budman
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D003625:Data Collection; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D055553:Prescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
references.citation: Subst Use Misuse. 2004 Jan;39(1):1-23
references.pmid: 15002942
references.citation: Pharmacoepidemiol Drug Saf. 2008 Dec;17(12):1142-54
references.pmid: 18932173
references.citation: J Pain Palliat Care Pharmacother. 2006;20(2):5-13
references.pmid: 16702131
references.citation: Drug Alcohol Depend. 2007 Apr 17;88(1):1-8
references.pmid: 17049753
references.citation: J Subst Abuse Treat. 1989;6(2):133-41
references.pmid: 2746712
references.citation: Eur Addict Res. 2000 Sep;6(3):154-9
references.pmid: 11060480
references.citation: Addiction. 2008 Jun;103(6):979-89
references.pmid: 18422830
references.citation: Drug Alcohol Depend. 2010 Nov 1;112(1-2):69-80
references.pmid: 20580168
references.citation: J Am Coll Health. 2005 May-Jun;53(6):253-62
references.pmid: 15900989
references.citation: Am J Addict. 2007 May-Jun;16(3):166-73
references.pmid: 17612819
references.citation: Addict Behav. 2003 Aug;28(6):1175-82
references.pmid: 12834660
references.citation: Drug Alcohol Depend. 2009 Jun 1;102(1-3):63-70
references.pmid: 19278795
references.citation: Pain. 2011 Mar;152(3):488-497
references.pmid: 21185119
references.citation: Am J Public Health. 2009 May;99(5):788-91
references.pmid: 19363214
references.citation: J Adolesc Health. 2007 Jan;40(1):76-83
references.pmid: 17185209
references.citation: Addiction. 2001 Aug;96(8):1113-25
references.pmid: 11487418
references.citation: Drug Alcohol Depend. 2011 May 1;115(1-2):107-12
references.pmid: 21126831
references.citation: J Nerv Ment Dis. 1980 Jan;168(1):26-33
references.pmid: 7351540
references.citation: J Pain Symptom Manage. 2000 Jan;19(1):53-62
references.pmid: 10687327
references.citation: AIDS. 1987 May;1(1):39-44
references.pmid: 3122788
references.citation: J Acquir Immune Defic Syndr. 2003 Jun 1;33(2):259-66
references.pmid: 12794564
references.citation: J Subst Abuse. 2001;13(1-2):89-102
references.pmid: 11547627
references.citation: Am J Health Syst Pharm. 2005 Dec 15;62(24):2604-8
references.pmid: 16333058
references.citation: J Clin Psychiatry. 2006 Jul;67(7):1062-73
references.pmid: 16889449
references.citation: J Addict Dis. 2004;23(1):29-38
references.pmid: 15077838
references.citation: Drug Alcohol Depend. 2005 Jan 7;77(1):37-47
references.pmid: 15607840
references.citation: J Opioid Manag. 2008 Mar-Apr;4(2):63-71
references.pmid: 18557162
references.citation: JAMA. 2008 Dec 10;300(22):2613-20
references.pmid: 19066381
references.citation: AIDS. 2005 Jun 10;19(9):935-42
references.pmid: 15905674
references.citation: Am J Geriatr Pharmacother. 2006 Dec;4(4):380-94
references.pmid: 17296542
references.citation: Addiction. 2007 May;102(5):778-85
references.pmid: 17506155
references.citation: Subst Use Misuse. 2006;41(8):1111-24
references.pmid: 16798679
references.citation: J Drug Educ. 2002;32(4):261-70
references.pmid: 12556132
references.citation: J Addict Dis. 2008;27(1):1-11
references.pmid: 18551883
references.citation: Addict Behav. 2010 Nov;35(11):1001-7
references.pmid: 20598809
references.citation: J Subst Abuse Treat. 2005 Apr;28(3):225-30
references.pmid: 15857722
references.citation: Pain. 2004 Nov;112(1-2):65-75
references.pmid: 15494186
references.citation: Pharmacoepidemiol Drug Saf. 2006 Sep;15(9):618-27
references.pmid: 16862602
references.citation: Natl Vital Stat Rep. 2011 Mar;59(4):1-51
references.pmid: 25073815
references.citation: Addict Behav. 2007 Mar;32(3):562-75
references.pmid: 16843611
references.citation: J Pain. 2008 Apr;9(4):360-72
references.pmid: 18203666
references.citation: Drug Alcohol Depend. 2008 Jan 1;92(1-3):267-76
references.pmid: 17913395
references.citation: Drug Alcohol Depend. 2004 Nov 11;76(2):213-5
references.pmid: 15488345
references.citation: Drug Alcohol Depend. 2009 Jul 1;103(1-2):65-73
references.pmid: 19409735
references.citation: Am J Psychiatry. 2007 Nov;164(11):1750-6
references.pmid: 17974941
references.citation: Addiction. 2003 Dec;98 Suppl 2:21-9
references.pmid: 14984239
references.citation: J Am Pharm Assoc (2003). 2009 Jul-Aug;49(4):519-28
references.pmid: 19589764
references.citation: Addiction. 2008 Jan;103(1):126-36
references.pmid: 18028518
references.citation: Drug Alcohol Depend. 2006 Jan 4;81(1):37-45
references.pmid: 16040201
references.citation: Addiction. 2008 Jul;103(7):1060-2
references.pmid: 18397360
references.citation: Pain Physician. 2006 Jul;9(3):215-25
references.pmid: 16886030
references.citation: Addiction. 2008 Feb;103(2):258-68
references.pmid: 18042194
references.citation: Br J Addict. 1992 Nov;87(11):1527-36
references.pmid: 1458032
references.citation: Addiction. 2003 Dec;98 Suppl 2:1-12
references.pmid: 14984237
references.citation: J Subst Abuse Treat. 1992;9(3):199-213
references.pmid: 1334156
references.citation: J Psychoactive Drugs. 2003 Oct-Dec;35(4):445-53
references.pmid: 14986873
references.citation: Int J Methods Psychiatr Res. 2008;17(2):89-103
references.pmid: 18393262
references.citation: Drug Alcohol Depend. 2006 Apr 28;82(2):135-42
references.pmid: 16236466
references.citation: Drug Alcohol Depend. 2004 Jun 11;74(3):235-44
references.pmid: 15194201
references.citation: Am J Public Health. 1987 Feb;77(2):169-72
references.pmid: 3467596
references.citation: Drug Alcohol Depend. 2003 Jul 20;71(1):57-64
references.pmid: 12821206
references.citation: J R Soc Med. 1992 Aug;85(8):469-72
references.pmid: 1404196
references.citation: Addict Behav. 2005 May;30(4):789-805
references.pmid: 15833582
references.citation: Addiction. 2007 Jan;102(1):94-104
references.pmid: 17207127
references.citation: Arch Pediatr Adolesc Med. 2009 Aug;163(8):739-44
references.pmid: 19652106
references.citation: Addiction. 2005 Jan;100(1):96-106
references.pmid: 15598197