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Heroin Addiction and Related Clinical Problems: 2015, 17, 1 (pages: 65 - 72)

Prospective pathways between heroin use and nonmedical use of prescription opioids: Trajectories among young Swiss men

Baggio S., Iglesias K., Fournier N., Studer J., N'Goran A., Deline S., Mohler-Kuo M., and Gmel G.

Summary: Background. So far few studies have focused on the last steps of drug-use trajectories. Heroin has been described as a final stage, but the non-medical use of prescription opioids (NMUPOs) is often associated with heroin use. There is, however, no consensus yet about which one precedes the other. Aims. The objective of this study was to test which of these two substances was likely to be induced by the other using a prospective design. Material and methods. We used data from the Swiss Longitudinal Cohort Study on Substance Use Risk Factors (C-SURF) to assess exposure to heroin and NMUPO at two times points (N = 5,041). Cross-lagged panel models provided evidence regarding prospective pathways between heroin and NMUPOs. Power analyses provided evidence about significance and clinical relevance. Results. Results showed that heroin use predicted later NMUPO use (β = 1.217, p < 0.001) and that the reverse pathway was non-significant (β = 0.240, p = .233). Heroin use seems to be an important determinant, causing a 150% risk increase for NMUPO use at follow-up, whereas NMUPO use at baseline increases the risk of heroin use at follow-up by a mere non-significant 20%. Conclusions. Thus, heroin users were more likely to move to NMUPOs than non-heroin users, whereas NMUPO users were not likely to move to heroin use. The pathway of substance use seemed to include first heroin use, then NMUPO use.