Clinical Review

Opioid Misuse Linked to Heroin Use in Study of Veterans

Researchers used the Veterans Aging Cohort Study to find a strong link between misuse of opioids and heroin use.


Researchers have found that veterans misusing opioids were 5.4 times more likely to use heroin than were veterans who did not misuse opioids. The study of 3,396 veterans found that 77% of heroin users reported previous misuse of opioids. The findings were reported in the Journal of Addiction and were based on an analysis of participants in the Veterans Aging Cohort Study (VACS).

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“Our findings demonstrate a pattern of transitioning from nonmedical use of prescription opioids to heroin use that has only been demonstrated in select populations,” David Fiellin, Yale public health and medical professor and director of the VACS intervention group told a Brown University reporter. “Our findings are unique in that our sample of individuals consisted of patients who were receiving routine medical care for common medical conditions.”

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All study participants reported no lifetime use of heroin or nonmedical use of opioids at baseline. The authors analyzed VACS data of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans. Annual behavioral assessments were conducted and contained self-reported measures of nonmedical use of prescription opioids and heroin use.

In addition to analyzing opioid use, the study authors also examined the role of gender, race, and use of stimulant drugs in heroin use. Risk of heroin use was greater for men (2.6 times), stimulant drug users (2.1 times), and blacks (2 times).

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“This paper shows that, as a general clinical practice, particularly for this population which does experience a lot of chronic pain and other risks for substance use including PTSD, screening for nonmedical painkiller use, whether you are prescribing an opioid or not, may be effective to prevent even more harmful transitions to heroin or other drugs,” Brandon Marshall, an assistant professor at the Brown University School of Public Health told the Brown University reporter.

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