WITHDRAWN: Opioid Misuse Among Latino Primary Care Patients in Los Angeles

Introduction: 52,404 deaths were caused by drug overdose in the United States in 2015. Of these, opioid misuse is driving this epidemic with 33,091 (63.1%). The rate of overdose deaths among Hispanics has increased an average of 2% per year from 1999-2015 (5.4 to 7.7 deaths per 100,000). Given these alarming rates of opioid misuse and overdose deaths, in this paper, we examine the rates and correlates of opioid misuse among predominantly Latino primary care patients and the patterns of polysubstance misuse that could put them at greater risk for opiate-related overdose.

Methods:

A Cross-sectional study investigating opioid use in two primary care clinics of a federally qualified health center (FQHC) in Los Angeles.

Participants: 2,504 adult patients in the clinic waiting rooms eligible to be screened with the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (88.8 % response rate). Patients anonymously self-administered a computerized version of the WHO ASSIST from March to October 2013.

Results: Mean age of the sample was 38.8 years, 92.7% were Latino and 67% female. Overall, 4.6% (n=106) of patients misused opioids (moderate-to-high risk level; ASSIST >4). Among, moderate-to-high risk opioid users, many were also using other substances at a risky level: 53% marijuana, 45% alcohol (ASSIST >12), and 40% sedatives. About 72% of the patients using opioids at a risky level had a comorbid chronic medical condition. In the logistic regression analysis, females had a lower odds (adjusted odds ratio (AOR) = 0.63, 95% confidence interval (CI): 0.49, 0.81; p<.001) of moderate-to-high opioid use than males and patients who were born in the United States (vs. foreign born), had higher odds (AOR= 3.55, 95% CI: 2.68, 4.70; p<.001) of moderate-to-high opioid use. Patients who were homeless the previous night, and diagnosed with high blood pressure has twice the odds of moderate-to-high opioid use.

Conclusions: Moderate-to-high risk opioid use was 3x higher than the rates of current nonmedical use of opioids in the general adult population aged 26 or older (4.6% vs. 1.4%). Prevention and screening services for opioid misuse should be considered as part of in primary care routine care. Moreover, understanding the patterns of opioid misuse in Latino primary care patients could help enhance the design of culturally-tailored and gender-sensitive primary-care based screening and behavioral interventions to reduce risky opioid use and prevent opioid use disorders among the Latino community. Lastly, among moderate-to-high opioid users, polysubstance risky use was common. Our findings indicate that interventions developed to reduce opioid misuse must also include strategies to address the co-occurring risky use of other substances, which could reduce the risk of opioid overdose.