title: Racial differences in the association between nonmedical prescription opioid use, abuse/dependence, and major depression.
abstract: BACKGROUND
  African Americans (AAs) have lower rates of depressive disorders and are less likely to receive opioid analgesics for chronic pain than whites. Given the evidence that prescription opioid use is associated with depression, we hypothesized that the opioid abuse/dependence and depression comorbidity would be less common among AAs compared with whites.
  
  
  METHODS
  A cross-sectional secondary analysis of the public use files for the 2012 (n = 55,268) and 2013 (n = 55,160) National Survey on Drug Use and Health (NSDUH) was used to obtain past-year, DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria diagnoses of nonmedical prescription opioid use (NMPOU), abuse/dependence, and major depressive episode (MDE). Covariates included anxiety disorder, alcohol and illicit drug abuse/dependence, smoking, age, gender, education, marital status, health insurance, county urbanicity, and income. Logistic regression models estimating the association between opioid use and MDE were computed before and after adjusting for covariates and separately for AAs and whites.
  
  
  RESULTS
  AAs and whites had similar past-year prevalence of NMPOU (3.5% vs. 3.7%) and abuse/dependence (0.7% vs. 0.9%). MDE was significantly more prevalent among whites (7.4% vs. 5.5%; P < .0001). Among whites, NMPOU and abuse/dependence were associated with MDE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.12-1.64 and OR = 2.22, 95% CI = 1.67-2.94, respectively). Among AAs, there were no significant associations between NMPOU, abuse/dependence, and MDE (OR range: 0.80-0.95).
  
  
  CONCLUSIONS
  In a nationally representative sample, co-occurrence of past-year depression, NMPOU, and abuse/dependence was determined in whites but not AAs. Additional research is needed to establish the contribution of pain and temporal relationships.
authors.affiliation: a Department of Family and Community Medicine , Saint Louis University School of Medicine , Saint Louis , Missouri , USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Salas
authors.affiliation: a Department of Family and Community Medicine , Saint Louis University School of Medicine , Saint Louis , Missouri , USA.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.affiliation: b Department of Psychiatry , Washington University School of Medicine , Saint Louis , Missouri , USA.|c The Bell Street Clinic , John Cochran Hospital , St. Louis VA Medical Center , St. Louis , Missouri , USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lustman
authors.affiliation: a Department of Family and Community Medicine , Saint Louis University School of Medicine , Saint Louis , Missouri , USA.
authors.forename: F David
authors.initials: FD
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D000367:Age Factors; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D015995:Prevalence; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Depression; epidemiology; opioids; racial disparities