Comparing the Characteristics of U.S. Adult Heroin Users and Prescription Opioid Misusers

Prescription painkiller misuse (PPM) is a major public health problem in the United States (U.S.). PPM has been on the rise for nearly two decades and has become an economic burden of over $55 billion. However, as prescribing practices have tightened and painkillers have become more difficult to find or too expensive to purchase, many users have turned to heroin as a substitute to painkillers. This trend suggests that the profile of heroin users has likely changed over the past several years. Understanding the characteristics of these different groups of opiate users and the outcomes associated with each drug is important to properly tailor public health interventions. Accordingly, this study compared the demographic, socioeconomic, criminal justice, clinical, and drug use characteristics between heroin-only, PPM-only, and mixed PPM and heroin users using nationally representative data. Data are drawn from the 2010-2013 National Survey on Drug Use and Health (NSDUH). Our results show that important differences between the three user groups exist, but most importantly that the combined heroin and PPM group looks most different from the other two groups. In particular, their poorer mental health and higher odds of poly- and injection drug use call for targeted interventions. The heroin and PPM group is a young, white, male, unmarried population with mostly high school diplomas who are likely to be engaged in part-time work or be unemployed, have substantial criminal justice involvement, and high health care service utilization. Overall, these differences suggests that a one-size-fits-all approach to opiate treatment and prevention is not likely to succeed and that interventions need to account for the unique needs of these user groups. We also discuss opportunities and challenges for targeted interventions.