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Addiction Science Made Easy: Prevalence of Opioid Use Disorder Among Patients Who Use Tobacco

January 2019

Rates of tobacco use in the United States have been declining for many years, however disparities persist among vulnerable groups. One such group, data suggest, are adults who report opioid misuse or have opioid use disorder (OUD). Current smokers are over 3 times more likely than never-smokers to report having misused opioids or been diagnosed with OUD in the past month or past year, and past-month opioid misuse has increased among current smokers, but not among never-smokers.

The association between opioid misuse and tobacco use remains understudied in primary care settings. A better understanding of characteristics of patients who use tobacco and misuse opioids might help improve primary care-based screening, prevention, and intervention approaches.

This study assessed the prevalence of opioid misuse and OUD among a sample of 2000 adult primary care patients across 5 clinics participating in NIDA Clinical Trials Network study CTN-0059, which aimed to validate a brief substance use screening instrument called the TAPS Tool. Factors examined included past-year polysubstance use and sociodemographic characteristics such as age, race, ethnicity, marital status, and employment status.

Results found that:

  • Past-year tobacco use was reported by >84% of participants who also reported past-year opioid misuse or OUD.
  • Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14% and 9.5%, respectively.
  • The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed.
  • Three distinct classes of tobacco users were identified: 
    • a tobacco-minimal drug use group (78%), 
    • a tobacco-cannabis use group (10.1%), and 
    • a tobacco-opioid/polydrug use group (11.9%). 
  • Class membership differed by sociodemographic characteristics.

Conclusions: Results of this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users. Primary care providers should not only recognize the association between tobacco use and opioid misuse, but also be aware of which classes of patients are more prone to misuse, information that can then be used to inform prevention or early intervention efforts.

Citation: John WS, et al. Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco. Drug and Alcohol Dependence2019;194:468-475.

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