Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

Baumgartner, Richard

Committee Co-Chair (if applicable)

Hall, Martin

Committee Member

Hall, Martin

Committee Member

Peiper, Nicholas

Committee Member

Taylor, Kira

Committee Member

Wallis, Anne Baber

Author's Keywords

substance use; epidemiology; public health


Introduction: Mortality due to overdose has been increasing since 2010 in the U.S., with an increase in the reported use of heroin and co-use of heroin and prescription opioids. Trends and correlates of polydrug use need to be analyzed to propose policies to reduce overdose risk. The overall objective of this study is to characterize high-risk polydrug groups among people who use opioids (PWUO) to understand the patterns of co-used substances and overdose risk factors. Methods: Publicly available data from the 2002-2017 National Survey on Drug Use and Health were analyzed to obtain weighted prevalence rates and trends for PWUO groups, core substance use among each group, as well as polydrug latent classes. Trend analyses consisted of Rao-Scott Chi-square (χ2) tests and joinpoint regression modeling. Multinomial logistic regression was used to determine associations between latent class membership and correlates such as sociodemographic factors, past year opioid use disorder (OUD) and residential transience. Results: Overall prevalence of all individuals who reported the use of either a prescription pain reliever (PPR) or heroin in the past month has declined since 2006, however, the prevalence of the combination opioid use group has been increasing since v 2002. Multiple substance use by the past month combination opioid use group was substantially greater than those who exclusively used PPR or heroin in the past month, a finding that aligns with past research. Although it was hypothesized the combination opioid class would be characterized as having the highest risk of past year OUD, this was not the case; the Class with the highest adjusted odds of having past year OUD had the highest probability of reporting the past month use of heroin, marijuana, and other illicit substances [aOR (95% CI): 11.03 (6.46, 18.82)]. Conclusion: The increasing prevalence of polydrug use populations among people who use opioids, particularly those who have reported heroin use, underscores the need for prompt action from local, state, and federal stakeholders to pursue more aggressive action to stem the opioid crisis. Policies should conform to a unified public health framework, (e.g., Cascade of Care) and address both individual- and population-level strategies.

Included in

Epidemiology Commons