Patterns Of Prescription Opioid Abuse and Comorbidity Among Participants In Publically Funded Substance Abuse Treatment Programs In Los Angeles County

BACKGROUND:   Prescription opioid abuse is a serious public health problem in the United States. The National Institute on Drug Abuse estimates that opioids prescriptions totaled 210 million in 2010, up from 76 million in 1991.  Concomitant with this growth, national overdose deaths involving opioids rose from 2,901 in 1999 to 11,499 in 2007, a 269% increase.  In Los Angeles County (LAC), over 14 million prescriptions for opioids were issued during last five years and an average of 185 LAC residents per year died from opioid overdose. However, very little is known about opioid drug abuse treatment needs. This study examined the impact of age, gender, and race/ethnicity on physical and mental comorbid conditions among prescription opioid abuse population in publically funded substance abuse treatment programs in Los Angeles County. 

METHODS: Subset data collected via the Los Angeles County Participant Reporting System (LACPRS) between 2005 and 2010 were analyzed. LACPRS secures data from 480 publicly funded substance abuse treatment programs contracted by Los Angeles County Department of Public Health/Substance Abuse Prevention and Control. Clients who reported  prescription opioids (i.e., not heroin) as a primary drug problem were 4,912 (54% Male, 46% Female). Demographic variables (e.g., age, gender, race/ethnicity), diagnosed with a mental illness (Yes vs. No), amd physical health problem were analyzed. Chi-Square and multivariate logistic regressions were utilized to access the association between age, gender, and race/ethnicity and physical and mental health status.  

RESULTS: Multivariate logistic regressions indicated that the odds of women having mental illness were much greater than those of men (OR=1.38; CI=1.25,1.51). The odds of whites (reference ) having mental illness and physical health problem were much greater than those of Blacks (OR=0.69, CI=0.62-0.78; OR=0.88, CI=0.83-0.93), Latinos (OR=0.51, CI=0.48-0.53; OR=0.77, CI=0.73-0.82), Asians (OR=0.69, CI=0.62-0.78; OR=0.76, CI=0.65-0.89), but similar to Native  Americans (OR=1.0, CI=0.87-1.16; OR=1.09, CI=0.91-1.31). The odds of those individuals older than 55 years having mental illness and physical health problem were five times greater than those younger than 17 years (OR=5.16, CI=4.59-5.80; OR=5.81, CI=4.99-6.75).

CONCLUSIONS: Among prescription opioid abuse population in publicly funded substance abuse programs in Los Angeles County, females, whites and Native Americans, and older adults were more likely to have physical and mental comorbid conditions. Our results suggest that it is imperative to move beyond “one-size-fits-all” approach to prevention and treatment of prescription opioid abuse that ignores the impact of age, gender, race, and comorbid psychiatric and physical conditions.