title: Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study.
abstract: To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.
  
  
  
  Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.
  
  
  
  Veterans Health Administration (VHA) infectious disease and primary care clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh and Washington, DC.
  
  
  
  A total of 3396 HIV-infected and uninfected patients enrolled into the Veterans Aging Cohort Study who reported no life-time NMUPO or heroin use, had no opioid use disorder diagnoses at baseline and who were followed between 2002 and 2012.
  
  
  
  The primary outcome measure was self-reported incident heroin use and the primary exposure of interest was new-onset NMUPO. Our final model was adjusted for socio-demographics, pain interference, prior diagnoses of post-traumatic stress disorder and/or depression and self-reported other substance use.
  
  
  
  Using a multivariable Cox regression model, we found that non-medical use of prescription opioids NMUPO was associated positively and independently with heroin initiation [adjusted hazard ratio (AHR) = 5.43, 95% confidence interval (CI) = 4.01, 7.35].
  
  
  
  New-onset non-medical use of prescription opioids (NMUPO) is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States who reported no previous history of NMUPO or illicit opioid use.
authors.affiliation: Department of Epidemiology, Brown School of Public Health, Providence, RI, USA.
authors.forename: Geetanjoli
authors.initials: G
authors.lastname: Banerjee
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.|Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.|APT Foundation Pain Treatment Services, New Haven, CT, USA.
authors.forename: Declan T
authors.initials: DT
authors.lastname: Barry
authors.affiliation: Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA, Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.affiliation: Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.affiliation: Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA.|Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gaither
authors.affiliation: Center for Health Equity Research and Promotion (CHERP) & Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Kirsha S
authors.initials: KS
authors.lastname: Gordon
authors.affiliation: Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA, Connecticut Healthcare System, West Haven, CT, USA.|Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.|Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Department of Epidemiology, Brown School of Public Health, Providence, RI, USA. brandon_marshall@brown.edu.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid
keywords: Heroin; longitudinal study; non-medical prescription drug use; opioid-related disorders; polysubstance use; veterans