Prevalence and patterns of opioid misuse and opioid use disorder among primary care patients who use tobacco.
Current data suggest that opioid misuse or opioid use disorder (OUD) may be over-represented among tobacco users. However, this association remains understudied in primary care settings. A better understanding of the extent of heterogeneity in opioid misuse among primary care patients who use tobacco may have implications for improved primary care-based screening, prevention, and intervention approaches. This study assessed the prevalence of opioid misuse and OUD by sociodemographic characteristics and past-year polysubstance use among a sample of 2000 adult (aged 18+) primary care patients across 5 distinct clinics (CTN-0059: the TAP Tool study). Latent class analysis (LCA) was used to identify heterogeneous subgroups of tobacco users according to past-year polysubstance use patterns. Multinomial logistic regression was used to examine variables associated with LCA-defined class membership.
Results found that past-year tobacco use was reported by >84% of participants who reported past-year opioid misuse or OUD. Among those reporting past-year tobacco use, the prevalence of past-year opioid misuse and OUD was 14% and 9.5%, respectively. The prevalence of opioid misuse or OUD was highest among tobacco users who were male or unemployed. Three LCA-defined classes among tobacco users were identified including a tobacco-minimal drug use group (78%), a tobacco-cannabis group (10.1%), and a tobacco-opioid/polydrug use group (11.9%). Class membership differed by sociodemographic characteristics.
Conclusions: Results from this study support the benefit of more comprehensive assessment of and/or monitoring for opioid misuse among primary care patients who use tobacco, particularly for those who are male, unemployed, or polydrug users. Primary care providers should not only recognize the association between tobacco use and opioid misuse, but also the differential liability of misuse among some patient subgroups, which may be used to inform prevention or early intervention groups.
Related protocols: CTN-0059