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Abstract
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We read with interest the article by Banerjee and colleagues [1], entitled 'Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study', published in Addiction. The authors aimed to estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans. They analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans. A total of 3396 HIV-infected and uninfected patients were enrolled into the study. They found that non-medical use of prescription opioids (NMUPO) was associated positively and independently with heroin initiation. Banerjee et al. conclude that new-onset NMUPO is a strong risk factor for heroin initiation among HIV-infected and uninfected veterans in the United States [1].
We would like to comment that the major weakness of the study may be the sample bias, as the study used the subpopulation of VA patients who received care for infectious diseases such as HIV, hepatitis C virus (HCV) and others.
In 2014, a total of 10.3 million people reported using prescription opioids non-medically [2]. There was a significant decrease in the total number of non-medical use of prescription opioids (NMUPO) compared to 2010 (estimated 12.2 million) [3]. Paradoxically, the drop of 1.9 million NMUPO has not resulted in any improvement, neither in opioid mortality nor prevalence of heroin abuse or heroin mortality [4]. Ironically, there has been a significant increase in opioid overdose-related mortality, i.e. 16 007 deaths in 2012 but 18 893 deaths in 2014; namely, an 18% increase [5]. The number of people who used heroin peaked to 914 000 in 2014 versus 373 000 in 2007, a 145% increase [4]. Further, mortality related to heroin overdose has more than quintupled, from 1842 in 2000 to 10 574 deaths in 2014 [2], which is 2317 more than cited in Banerjee et al.'s [1] report.
In a recent review paper [6] entitled 'Relationship between nonmedical prescription-opioid use and heroin use', published in the New England Journal of Medicine, Compton et al. [6] opined that only a small percentage of non-medical users of prescription opioids initiate heroin use: '… the available data suggest that NMUPO is neither necessary nor sufficient for the initiation of heroin use…'. Indeed, Muhuri et al. found that 3.6% of non-medical users initiated heroin use within 5 years after beginning non-medical use of prescription opioids [7]....
Language: en |