title: Lifetime history of heroin use is associated with greater drug severity among prescription opioid abusers.
abstract: BACKGROUND
  While research suggests primary prescription opioid (PO) abusers may exhibit less severe demographic and drug use characteristics than primary heroin abusers, less is known about whether a lifetime history of heroin use confers greater severity among PO abusers.
  
  
  OBJECTIVE
  In this secondary analysis, we examined demographic and drug use characteristics as a function of lifetime heroin use among 89 PO-dependent adults screened for a trial evaluating the relative efficacy of buprenorphine taper durations. Exploratory analyses also examined contribution of lifetime heroin use to treatment response among a subset of participants who received a uniform set of study procedures.
  
  
  METHODS
  Baseline characteristics were compared between participants reporting lifetime heroin use ≥5 (H(+); n=41) vs. <5 (H(-); n=48) times. Treatment response (i.e., illicit opioid abstinence and treatment retention at end of study) was examined in the subset of H(+) and H(-) participants randomized to receive the 4-week taper condition (N=22).
  
  
  RESULTS
  H(+) participants were significantly older and more likely to be male. They reported longer durations of illicit opioid use, greater alcohol-related problems, more past-month cocaine use, greater lifetime IV drug use, and greater lifetime use of cigarettes, amphetamines and hallucinogens. H(+) participants also had lower scores on the Positive Symptom Distress and Depression subscales of the Brief Symptom Inventory. Finally, there was a trend toward poorer treatment outcomes among H(+) participants.
  
  
  CONCLUSIONS
  A lifetime history of heroin use may be associated with elevated drug severity and unique treatment needs among treatment-seeking PO abusers.
authors.affiliation: Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Meyer
authors.affiliation: Department of Psychology, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Mollie E
authors.initials: ME
authors.lastname: Miller
authors.affiliation: Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA; Department of Psychology, University of Vermont, Burlington, VT 05401, USA. Electronic address: stacey.sigmon@uvm.edu.
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Sigmon
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D002047:Buprenorphine / Q000627:therapeutic use; D002908:Chronic Disease; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006556:Heroin Dependence / Q000523:psychology; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D063487:Prescription Drug Misuse / Q000523:psychology
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D009271:Naltrexone
keywords: Abuse; Dependence; Heroin; Opioid; Prescription opioid