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Incidence of and Determinants for Substance Use Disorders Among Individuals With Long-Term Prescription Opioid Use: A
Håkon Høydal Nestvold1, Eirik Haarr2,3, Aleksi Hamina1,4
1Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Purpose:
To assess the incidence of substance use disorders (SUDs) after long-term prescription opioid use (LTOU) and to identify socioeconomic and clinical risk factors associated with SUD among individuals with LTOU.
Methods:
Cohort study using linked nationwide registers (2011-2019). We identified 114 916 individuals who used opioids for more than 3 months (LTOU) without previous LTOU or SUD diagnosis. Outcomes were any incident SUD diagnosed in primary or secondary care (ICPC-2: P15-P16, P18-P19; ICD-10: F10-F16, F18-F19) and opioid use-related disorders (OUD) diagnosed in secondary care (ICD-10: F11). We calculated age- and sex-stratified incidence rates (IR), incidence rate ratios (IRR) and age-standardized incidence rates (ASIR). Adjusted hazard ratios (aHR) were calculated using Cox proportional hazards regression.
Results:
In total, 5.3% (6069/114916) were diagnosed with SUD (ASIR = 28.7 per 1000 person-years), and males had higher IRs compared to females (IRR). Males had higher risk of SUD in both the younger (aHR = 1.59, 95% CI 1.47-1.72) and older (1.66, 1.54-1.78) age group. Low education (1.87, 1.66-2.11) and unemployment (1.26, 1.15-1.38) had the strongest association with SUD in the younger age group versus low income (1.37, 1.21-1.57) and living alone (1.53, 1.41-1.65) in the older age group. Previously diagnosed mental disorders and use of benzodiazepines- or benzodiazepine-related drugs (BZDRs) were associated with SUD in both age groups (1.85, 1.71-2.01; 2.37, 2.18-2.57). Being male and having used BZDRs were the covariates strongest associated with OUD.
Conclusions:
Being male, young, having low socioeconomic status, previous mental disorders or BZDR use were associated with SUD diagnosis among individuals with LTOU.
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