Impact on Public Health Indicators of Injecting in a Population of Prescription Opioid Abusers in Treatment

Stephen F. Butler, Ph.D., Thomas A. Eaton, Ph.D., Simon H. Budman, Ph.D.

Presented at APS Public Health 2011

“Impact on Public Health Indicators of Injecting in a Population of Prescription Opioid Abusers in Treatment”

The consequences of prescription opioid (RxO) abuse are a growing public health problem. In 2006, 33.5 million Americans used RxOs nonmedically (to get high). Opioid abusers may progress from swallowing their RxOs orally to snorting and injecting opioids (including heroin). As the abuser experiments with injecting, the likelihood of acquiring blood borne diseases (e.g., hepatitis) increases. To discourage the use of RxOs by alternative routes of administration (ROAs), abuse deterrent formulations (ADF) are designed to resist manipulation and tampering. Although these ADFs are not designed to reduce opioid abuse overall, they might reduce abuse of RxOs by specific alternate ROAs. We asked what impact such ADFs might have on public health indicators (PHIs; e.g., hepatitis/liver disease). The data came from the ASI-MV® Connect, which collects product-specific abuse of RxOs in the past 30 days, including ROAs, from adults in substance abuse treatment. To assess the impact an ADF might have on public health, we compared those who injected RxOs only and those who injected RxOs and heroin with RxO abusers who do not inject on variables that might reflect public health impact (e.g., hepatitis/liver disease, HIV, ER Stay >2days, chronic pain). Eight percent of clients who inject RxOs but not heroin (n=96) reported hepatitis/liver disease versus 5% of non-injecting RxO abusers (n=968; p<0.001). There was also a trend for HIV/AIDS (1.4% of RxO injectors/no heroin (n=16) reported HIV/AIDS vs. 0.8% for non-injectors (n=160; p=0.051)). For RxO abusers who also inject heroin (n=156), 1.8% reported HIV/AIDS, significantly more than the non-injecting abusers (0.8%; n=160; p<0.001). These results highlight some possible public health events that may be impacted by ADFs.