Correlation of Socio-Economic Determinants to Initial Low Risk Substance Use, subsequent Opioid Use Disorder and negative prognostic treatment indicators.
J. Bobby Miglani*, Ronveer S. Miglani
Affiliation
Mount Rogers Community Services, 770 W. Ridge Road, Wytheville, VA 24382, USA
Meridian High School, 121 Mustang Alley, Falls Church, VA 22043, USA
Corresponding Author
J. Bobby Miglani, Chief Medical officer, Mount Rogers Community Services, 770 W. Ridge Road, Wytheville, VA 24382, E-mail: bobby.miglani@mountrogers.org
Citation
Miglani, J.B., et al. Correlation of Socio-Economic Determinants to Initial Low Risk Substance Use, Subsequent Opioid use Disorder and Negative Prognostic Treatment Indicators. (2021) J Addict Depend 6(1): 1-2.
Copy rights
© 2021 Miglani, J.B. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
Abstract
Objectives: Our country lacks universal health care and even the insurance (if available) to poor, vulnerable, racialized and marginalized sections of our society, provides inadequate coverage. There is a major social justice need to objectively identify the healthcare inadequacies and provide appropriate care to such patients. In pursuit of this goal, the authors aimed to explore the correlation of lower socio-economic strata or LSES (as reflected by using a sample of Medicaid or indigent patients) against a cohort of commercially insured & private pay patients to determine if LSES poses an independent risk variable in early use of “low risk” substances. A secondary goal was to determine if the vulnerable group of patients in LSES was also at a marked disadvantage for subsequent onset of opioid use disorder.
Methods: A random sample of 12 patients each, treated primarily for opioid use disorder for at least 6 months in 2019 at two clinics were selected as sample cohort. Each clinic while located in the same catchment area, served two distinct patient cohorts. One dealt with marginalized patients from LSES and the other clinic had exclusively commercially insured or private pay patients. Retrospective chart reviews were done to assess demographic and clinical factors of these patients
Results: LSES patients in our sample had earlier exposure to “low risk” substances and a faster onset of opioid use disorder when compared to privately insured patient cohort. LSES group also suffered from multiple negative health factors that add to disease burden such as higher rates of nicotine use, intravenous substance use and comorbid psychiatric illness.
Conclusion: There is an urgent need to perform early screening and intervention for “low risk” substances in the LSES patients. Further study is needed to determine if early intervention can decrease the onset of opioid use and other health risk factors in this subgroup.
Introduction
It is often claimed in literature that early use of “low-risk drugs” (Nicotine, Alcohol and Marijuana) still create harm because of “gateway effects” leading to subsequent use of high-risk alternatives such as opioids[1,2]. Opioid use disorder is a national emergency and a leading cause of morbidity and mortality of thousands of Americans every year[3]. This is also occurring in the background of lack of universal health care in our country. There are also frequent inadequacies as well as treatment gaps in provision of mental health and substance use care for Medicaid and indigent patients[3].
The authors set to study the correlation of the socio-economic factors specifically whether lower socio-economic strata is an independent factor in the early use of “low risk” substances and an accelerant to development of subsequent opioid use disorder. We wanted to know if low risk substance use in either socio-economic cohort influences ability to obtain substance use treatment and whether lower socio economic status is comorbid factor in negative health indicators such as intravenous drug use, nicotine use and overlapping mental health diagnosis.
The lead author is affiliated with two different psychiatric clinics that serve different socio-economic populations (Medicaid/Indigent vs. commercial/private pay) in a similar geographic area of suburban Virginia. A Random sample of 12 patients treated primarily for opioid use disorder for at least 6 months in 2019 at each of the two clinics was selected as sample cohort. The authors analyzed the data by completing retrospective chart reviews. We looked at correlation of age of onset of substance use in each cohort to first episode of opioid use and subsequent time to receiving formal substance use treatment. We also looked at the comorbid health determinants that may indicate worse medical prognosis in each cohort such as ongoing nicotine use, intravenous drug use and non-substance use psychiatric diagnosis.
The results are summarized in Table 1.
Table 1: Comparison of measured indicators between medicaid patients vs privately insured patients
|
|
Patients in Medicaid/Indigent Clinic (N=12) |
Patients in Private Pay/Commercial Insurance (N=12) |
|
Average Age |
40.16 Years |
34.3 Years |
|
Average Age at Initial “Low Risk” Substance Use |
12.5 Years |
17.8 Years |
|
Average Age at Initial Opioid Use |
19.1 Years |
24.5 Years |
|
Average Time Between Initial Substance Use and Initial opioid Use |
6.6 Years |
6.7 Years |
|
Average Time Elapsed between Initial Opioid Use to First Substance use treatment episode |
11.4 Years |
5.3 Years |
|
Average Age at First Substance use Treatment |
30.5 Years |
29.8 Years |
|
Number of patients with history of Intravenous Drug Use |
11 |
4 |
|
Number of Current Nicotine Users |
10 |
5 |
|
Average Number of Concurrent Non-Substance Use related Mental Health Diagnosis |
1.08 |
0.08 |
While correlation is not causation, the authors notice a disturbing trend that the “low risk” use of substances occurred earlier in lifespan of Medicaid/Indigent patient cohort when compared to patients from private pay/commercial insurance cohort. The time to occurrence of opioid use disorder from the age of first substance use is roughly similar in both cohorts. However, in terms of real chronological age, it occurs earlier in the lower socio-economic cohort. The patients in the Medicaid/Indigent cohort also tend to delay seeking treatment for substance use disorders. This is also complicated by greater correlation with higher prevalence of nonsubstance use mental health diagnosis, nicotine use and intravenous drug use in this cohort. Further research needs to be focused on studying whether earlier screening and increasing the access to early treatment of substance use can lead to improved outcomes in the lower socio-economic patient cohort.
|
Medicaid |
In Commerical Insurance |
Private Pay Patients |
|
Average Age |
19.1 |
24.5 |
|
Average Time |
6.6 |
6.7 |
|
Average Time |
11.4 |
5.3 |
References
- 1. Williams, A.R. Cannabis as a Gateway Drug for Opioid Use Disorder. (2020) J Law Med Ethics 48(2): 268-274.
- 2. Scholl, L., Seth, P., Kariisa, M, et al. Drug and opioid-involved overdose deaths—United States, 2013–2017. (2018) MMWR Morb Mortal Wkly Rep 67(5152): 1419–1427.
- 3. McCarty, D., Gu, Y., McIlveen, J.W., et al. Medicaid expansion and treatment for opioid use disorders in Oregon: an interrupted time-series analysis. (2019) Addict Sci Clin Pract 14(1): 31.
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