Understanding the demand side of the prescription opioid epidemic: Does the initial source of opioids matter?

- Initial source of drugs is largely irrelevant in progression of opioid abuse.
- Self-treatment of psychiatric issues motivates initial and sustained opioid abuse.
- Positive attributes of opioids waned and avoiding withdrawal became a key factor.

BackgroundThese studies were carried out to examine whether the onset and progression of an opioid substance use disorder (SUD) differed in those who first used opioids to get “high” compared to those who received a prescription from a doctor to relieve pain (Non-Rx vs. Rx groups, respectively).MethodsA subset of patients (N = 214) from an ongoing larger study of patients entering one of 125 drug treatment programs for opioid use disorder across the country agreed to give up their anonymity and participate in structured and open-ended online interviews examining drug abuse patterns.ResultsWith the exception that the Non-Rx group began their opioid abuse at a younger age than the Rx group and more quickly evolved from initial exposure to regular opioid abuse, there were relatively few differences in the characteristics, patterns and trajectories of opioid abuse. The vast majority of patients in both groups, most of whom had serious, antecedent psychiatric disorders, indicated that they used opioids to self-medicate psychological problems (67-73%) and/or stated that opioids provided a means to “escape” from the stresses of everyday life (79-85%). As the SUD progressed, for many individuals any “positive” attributes of opioids waned and avoidance of withdrawal became the overriding concern, often serving as the impetus for treatment.ConclusionsOur results suggest that self-treatment of co-morbid psychiatric disturbances is a powerful motivating force to initiate and sustain abuse of opioids and that the initial source of drugs-a prescription or experimentation-is largely irrelevant in the progression to a SUD.