This is a presentation explaining a brief background of Opioid Use Disorder, the methods of National Survey on Drug Use and Health, data analysis of selected risk factors to OUD, and possible solutions.

1. OPIOID USE
DISORDER
Bryanna Harlan

2. BACKGROUND
01
Introduction, Literature
Review, and Purpose

3. Substance use disorders are chronic, complex
disorders that are manifested by compulsive
substance use despite harmful consequences.
The diagnosis of a substance use disorder is
based on a pathological pattern of behaviors,
which is categorized into four groupings of 11
criteria, and is further classified by the specific
substance the individual misuses.
Opioids include both illicit and prescription
drugs that influence the opioid receptors on
the nerve cells in the body and brain to help
reduce feelings of pain.
SUBSTANCE USE DISORDER & OPIOID USE DISORDER
These drugs include the illegal drug heroin, synthetic opioids such as fentanyl, and prescriptions,
such as oxycodone, hydrocodone, codeine, morphine, and many others.

4. THE BURDEN OF OPIOID USE DISORDER
UNITED STATES GLOBAL
808,000
People over the age
of 12 in the US had
used heroin in 2018
33.17%
Of substance use
deaths in the US
between 1999-2017
Opioid use disorder is associated with a mortality rate as high as 1.5%–2% per year.
In 2018, between 1% and 2% of the entire
world population had a substance use disorder
with 55% of those being opioid use disorders.

5. RISK FACTORS
Young agePersonal history of
substance abuse
History of criminal
activity
History of severe
mental illness
Increased availability
of opioids
Unemployment &
Poverty

6. RELATIONSHIP WITH OPIOID USE DISORDER
MENTAL ILLNESS
Doubles the odds
of being an opioid
user.
HISTORY OF ILLICIT
DRUG USE
3-19% of people who
take prescription pain
medications develop
an addiction to them.
PERCEIVED
AVAILABILITY
51.3% of Americans
obtained their illegal
pain medication from
a friend or relative.
SOCIODEMOGRAPHIC
FACTORS
Criminal activity, age,
SES, employment,
etc. are all risk
factors of OUD.

7. How does mental illness, history
of illicit drug use, and perceived
availability affect the odds of
having an opioid use disorder?
What are the trends regarding
age, SES, employment, and
criminal history in individuals
with opioid use disorder?
PURPOSE

8. METHODS
02
Study Population, Data
Collection, and Statistical
Analyses

9. STUDY POPULATION
12-17
Years old
16,820
18-25
Years old
16,561
26-49
Years old
24,113
50+
Years old
10,297
The total number of participants in the 2018 NSDUH was
67,791 with 32,394 males and 35,397 females.
The respondents of the NSDUH include
civilian, noninstitutionalized individuals
who are over the age of 12 years or older,
and who reside within the United States.

10. SAMPLE DESIGN
STATES
Stratification
5
6
7
4
2
3
1
STATE
SAMPLING
REGIONS
CENSUS
TRACTS
DWELLING
UNITS
AREA
SEGMENTS
CENSUS
BLOCK
GROUPS
2 RESIDENTS
12+ YEARS
OLD
The NSDUH is a yearly, cross-sectional
study.
The sample design is state based, with
an independent, multistage area
probability sample within each state
and the District of Columbia.
This sample design allows for more
interviews in the largest 12 states, thus
making the sample sizes more
proportional to the state population
sizes which improves the precision of
national NSDUH estimates.

11. DATA COLLECTION
LETTERS
Are sent to sampled
addresses, followed by
a field investigator (FI)
visit.
SCREENING
5-minute screening
portion to collect basic
demographic data.
CAPI
Computer-assisted personal
interviewing (CAPI) is read
and entered by the FI, and
consists of initial
demographic questions.
ACASI
Audio computer-assisted
self-interviewing (ACASI) is
self-administered by the
respondent, and consists of
sensitive questions.
INCENTIVE
After completion, each
respondent is given a
$30 cash incentive.
CAPI CONCLUSION
The FI then concludes
with questions regarding
household composition.

12. DESCRIPTIVE ANALYSIS
The Chi-Square test will be used to
assess if there is a statistically
significant difference between variables
above in relation to having an opioid
use disorder to determine the
frequency of the population who
exhibit these characteristics.
All calculations will be
performed using SAS.
VARIABLES OF INTEREST
Criminal
Activity
Parole
No Parole
Probation
No Probation
Age
12-17
18-25
26 or older
Job Status
Full-Time
Part-Time
Unemployed
Other
SES
$20,000 or less
$20,000-$49,999
$50,000-$74,999
$75,000+

13. ANALYTIC ANALYSIS
A multiple logistic regression analysis
will be conducted to calculate odds
ratios (ORs) and 95% confidence
intervals (CI) for the selected risk
factors in relation to opioid use
disorder.
All calculations will be performed
using SAS.
Unable to assess the temporal
relationship between the risk factors
and opioid use disorder.
VARIABLES OF INTEREST
Perceived
Availability
Fairly/ Very
Easy to Obtain
Otherwise
Mental
Illness
Any Mental Illness
No Mental Illness
History of
Drug Use
Cocaine
Hallucinogens
Inhalants
Meth
Stimulants
Tranquilizers
Sedatives
Marijuana

14. RESULTS
03
Descriptive and Analytic
Table Analysis

15. AGE
● The individuals in this sample
with opioid use disorder are over
the age of 26 (58.71%).
● P-Value <0.0001, very statistically
significant
DESCRIPTIVE RESULTS
OPIOID USE DISORDER NO OPIOID USE DISORDER
VARIABLES FREQ. % FREQ. % P-VALUE
AGE
12-17 59 13.17% 13,228 23.68%
<0.000118-25 126 28.13% 13,511 24.19%
26 OR OLDER 263 58.71% 29,126 52.14%
CRIMINAL
ACTIVITY
ON PAROLE 31 6.92% 373 0.67%
0.3397
NOT ON PAROLE 414 92.41% 55,311 99.01%
ON PROBATION 55 12.28% 1,008 1.80%
0.7611NOT ON
PROBATION
390 87.05% 54,611 97.76%
CRIMINAL ACTIVITY
● The majority of sampled
individuals with opioid use
disorder are not on
parole/supervised release
(92.41%), or probation (87.05%).
● P-Values >0.05, not statistically
significant

16. SES/INCOME
● An equal percentage of
individuals with opioid use
disorder had a family income of
either less than $20,000 or a
family income of $20,000 to
$49,999 (32.81%).
DESCRIPTIVE RESULTS
OPIOID USE DISORDER NO OPIOID USE DISORDER
VARIABLES FREQ. % FREQ. % P-VALUE
SES
$20,000 or less 147 32.81% 9,981 17.87%
<0.0001
$20,000-$49,999 147 32.81% 16,670 29.84%
$50,000-$74,999 58 12.95% 8,621 15.43%
$75,000 or more 96 21.43% 20,593 36.86%
EMPLOYMENT
FULL-TIME 143 31.92% 22,957 41.09%
<0.0001
PART-TIME 61 13.62% 8,312 14.88%
UNEMPLOYED 73 16.29% 3,046 5.45%
OTHER 156 34.82% 15,037 26.92%
EMPLOYMENT
● 34.82% of those with an opioid
use disorder answered “other”,
meaning that they are not in the
labor force.
● 31.92% of these individuals stated
that they have full-time
employment.
BOTH P-VALUES WERE <0.0001, MEANING THE
RESULTS WERE HIGHLY STATISTICALLY
SIGNIFICANT.

17. PROC SORT:
● Sorted the data by opioid
use disorder
PROC GLM:
● Provided the p-values
PROC FREQ:
● Runs the Chi-Square test
● Provided the frequency
rates and percentages
SAS CODE FOR DESCRIPTIVE DATA

18. ANALYTIC RESULTS
MENTAL ILLNESS
● Those with a mental illness
had a greater risk of having an
opioid use disorder than those
without a mental illness by
almost fourfold (3.986 OR; CI
3.143, 5.056).
OPIOID USE DISORDER
VARIABLES FREQ.
CRUDE OR
(95% CI)
ADJUSTED OR
(95% CI)
MENTAL ILLNESS
ANY MENTAL ILLNESS 270
7.9778
(6.4224, 9.9099)
3.986
(3.143, 5.056)
NO MENTAL ILLNESS 119
PERCEIVED AVAILABILITY
FAIRLY OR VERY EASY TO
OBTAIN
220
5.4114
(4.4805, 6.5356)
3.199
(2.557, 4.001)
OTHERWISE 218
PERCEIVED AVAILABILITY
● The perceived availability of
opioids being fairly or very
easy to obtain increased the
odds of having an opioid use
disorder by threefold (3.199
OR; CI 2.557, 4.001).
CONFIDENCE INTERVALS EXCLUDES 1, MEANING THE
RESULTS WERE STATISTICALLY SIGNIFICANT.

19. ANALYTIC RESULTS
HISTORY OF DRUG USE
● An increased odds of having an
opioid use disorder can be seen
with the prior/current use of
cocaine, meth, tranquilizers,
sedatives, and marijuana.
● Stimulants had a small increased
odds ratio, however, the 95% CI
includes 1, so statistical
significance cannot be proven.
● Hallucinogens and inhalants had
a decreased odds of having an
opioid use disorder, making
them protective factors against
opioid use disorder.
OPIOID USE DISORDER
VARIABLES FREQ.
CRUDE OR
(95% CI)
ADJUSTED OR
(95% CI)
HISTORY OF DRUG USE
COCAINE
Y: 129
N: 319
17.4542
(14.1204, 21.5752)
2.728
(1.982, 3.753)
HALLUCINOGENS
Y: 86
N: 362
8.7664
(6.8908, 11.1525)
0.717
(0.496, 1.037)
INHALANTS
Y: 26
N: 422
5.1932
(3.4691, 7.7743)
0.434
(0.198, 0.954)
METH
Y: 91
N: 357
40.0853
(31.1301, 51.6167)
5.988
(4.297, 8.344)
STIMULANTS
Y: 99
N: 349
10.8137
(8.5980, 13.6004)
1.061
(0.751, 1.499)
TRANQUILIZERS
Y: 188
N: 260
31.2601
(25.7024, 38.0194)
6.914
(5.267, 9.077)
SEDATIVES
Y: 39
N: 409
26.5395
(18.5790, 37.9110)
3.320
(1.987, 5.547)
MARIJUANA
Y: 273
N: 175
6.3670
(5.2603, 7.7065)
1.797
(1.395, 2.315)

20. PROC FREQ 1:
● Provided the frequency
rates
PROC FREQ 2:
● Provided the crude Odds
Ratio
PROC LOGISTIC:
● Provided the adjusted
Odds Ratio
SAS CODE FOR ANALYTIC DATA

21. 04 SOLUTION
Treatment Options and
Recommendations

22. 5-POINT STRATEGY TO COMBAT THE OPIOID CRISIS
Improve access
to prevention,
treatment, &
recovery
support
services.
Support more
timely, specific
public health
data and
reporting.
Develop new,
effective, and
non-addictive
approaches to
prevent opioid
misuse.
Increase the
availability and
use of naloxone
to reverse
overdose.
ACCESS DATA PAIN OVERDOSES
Conduct
research on pain
& addiction to
inform clinical
practices &
reduce opioid
prescribing.
RESEARCH
1 3 52 4

23. MEDICATION-ASSISTED TREATMENT
Medication-assisted treatment (MAT)
is the use of medications with
counseling and behavioral therapies to
treat substance use disorders and
prevent opioid overdose.
This treatment approach has been
shown to:
● Improve patient survival
● Increase retention in treatment
● Decrease illicit opiate use and
other criminal activity
● Increase patients’ ability to gain
and maintain employment
● Improve birth outcomes

24. PRESCRIPTION DRUG MONITORING PROGRAMS
A prescription drug monitoring
program (PDMP) is an
electronic database that tracks
controlled substance
prescriptions.
Improving the way opioids are
prescribed will ensure patients
have access to safer, more
effective chronic pain
treatment while reducing
opioid misuse, abuse, and
overdose.

25. PAIN MANAGEMENT
RESTORATIVE
THERAPY
Acute and chronic pain
management consists of five
treatment approaches
informed by four critical
topics.
This is an individualized,
multimodal,
multidisciplinary approach.

26. NALOXONE
Naloxone reverses an
opioid overdose when
given intranasally or
intramuscularly at the
time of overdose.
Naloxone can be given via:
● Injectable
● Auto Injectable
(EVIZO)
● Prepackaged Nasal
Spray (NARCAN)

27. Any Questions?
THANK YOU!
Contact me at
willib69@ferri.edu

28. Melinda June McSween
October 5th, 1967- June 6th,
2017
This presentation is dedicated to
the loving memory of my mother
who died in June of 2017 as a result
of an opioid overdose.
You may be gone from my sight,
but you are never gone from my
heart.

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