In 2016, one person died from a drug overdose in the United States every 9 minutes on average.1 Rising drug deaths are being driven by large increases in opioid-related overdoses. With more than 1 in 3 US adults reporting use of prescription opioids (ie, use of prescription opioids that were obtained legally or illegally), the opioid epidemic is now a national public health emergency,2,3 and a public health approach is required to address the crisis.4,5
Such an approach requires a comprehensive understanding of the populations affected and the systems in which they are involved. Prior work indicates that individuals who use opioids have complex behavioral health profiles and often pass through the criminal justice system, although much of this work focuses primarily on individuals who use heroin.6-11 The association between intensity of opioid use (ie, no opioid use vs prescription opioid use, misuse, or use disorder or heroin use) and important characteristics such as physical and mental health, co-occurring substance use, and involvement in the criminal justice system has not been comprehensively defined in a nationally representative sample.
Data stratified by intensity of opioid use are critically important as clinicians, communities, and policy makers grapple with strategies to combat the opioid epidemic. For example, if mental illness and involvement in the criminal justice system increase with intensity of opioid use, then interventions that exclude the justice system are likely to miss the highest-risk individuals. Identifying variation among individuals who use opioids can inform efforts to coordinate prevention and treatment efforts among public health, health care, and criminal justice systems and, ultimately, reduce opioid-related morbidity and mortality.12
To clarify the specific needs of individuals who use opioids, we examined the following 3 key domains by increasing intensity of opioid use: health characteristics, co-occurring substance use patterns, and involvement in the criminal justice system. We hypothesized that mental illness, polysubstance use, and involvement in the criminal justice system would increase with increasing intensity of opioid use, independent of sociodemographic differences.