Elsevier

Drug and Alcohol Dependence

Volume 169, 1 December 2016, Pages 68-72
Drug and Alcohol Dependence

Short communication
Delay discounting in opioid use disorder: Differences between heroin and prescription opioid users

https://doi.org/10.1016/j.drugalcdep.2016.10.009Get rights and content

Highlights

  • Delay discounting is the tendency to overvalue immediate vs. delayed reward.

  • Adults with opioid use disorder completed a measure of delay discounting.

  • Prescription opioid (PO) users had lower delay discounting vs. heroin users.

  • Any use of heroin was associated with greater delay discounting than POs alone.

  • Heroin use is associated with a more impulsive style of decision-making.

Abstract

Background

Among those with opioid use disorder, heroin use is associated with poorer prognosis relative to use of prescription opioids alone. However, relatively little is known about distinguishing features between those who use heroin relative to those who use prescription opioids. In the present study we evaluated differences in delay discounting in those with opioid use disorder based on primary opioid of use. Delay discounting is associated with a range of negative outcomes and is an important therapeutic target in this population.

Methods

Treatment-seeking adults with opioid dependence completed self-report measures including past-month opioid use and the Monetary Choice Questionnaire (Kirby and Marakovic, 1996; Kirby et al., 1999), a measure of delay discounting. Participants were divided into two groups based on whether they used any heroin in the past 30 days or only prescription opioids, and delay discounting scores were compared between the groups. Group differences in sociodemographic or clinical variables were included in the analysis as covariates.

Results

Results from a forward stepwise linear regression indicated that heroin use was associated with significantly higher delay discounting (B = −0.99, SEB = 0.34, t = −2.88, p = 0.005), even when considering covariates.

Conclusions

Adults with opioid dependence who exclusively used prescription opioids had lower delay discounting relative to those who used heroin. This finding contributes further to the literature suggesting that heroin use is associated with greater clinical severity among those with opioid use disorder.

Introduction

The prevalence of heroin use and heroin use disorders has risen sharply in recent years, with the rate of past-year heroin use disorders almost doubling between 2002 and 2013 in the U.S. (Jones, 2013, Jones et al., 2015). Following years of increases in prescription opioid misuse, many new heroin users report having initiated opioid use with opioid analgesic medications (Cerda et al., 2015, Jones, 2013, Novak et al., 2016). The initiation of heroin use in this population is associated with a significantly poorer prognosis (Brands et al., 2004, Moore et al., 2007, Potter et al., 2013, Rosenblum et al., 2007, Sigmon, 2006, Weiss et al., 2011). However, little is known about mechanisms that might explain differences between prescription opioid and heroin users, or facilitate the transition from prescription opioids to heroin.

One major difference between prescription opioids and heroin is that prescription opioids can be obtained legally for medical purposes. This may foster the belief that prescription opioids are less risky than heroin (Daniulaityte et al., 2012, Lord et al., 2011). Accordingly, greater impulsivity may be a distinguishing feature of those who use heroin relative to those who use only prescription opioids. Those who are more impulsive perceive risky behaviors to be less harmful (Arria et al., 2008, Doran et al., 2011, Robbins and Bryan, 2004), and may be more likely to engage in such behaviors, even adjusting for perceived risk (Ryb et al., 2006).

The tendency to over-value immediate relative to delayed reward, i.e., delay discounting, is a common feature of substance use and other addictive disorders (Bickel et al., 2014, MacKillop et al., 2011, Reynolds, 2006). Those with higher delay discounting act quickly on current needs, while devaluing future needs. This facet of impulsivity is particularly notable in opioid use disorder; heroin users not only show a dramatically larger preference for immediate rewards relative to healthy comparison samples (Kirby et al., 1999, Madden et al., 1997), but also have higher discounting rates compared to people who abuse alcohol, and rates similar to those who abuse cocaine (Kirby and Petry, 2004). Delay discounting has also been associated with negative treatment outcome in a variety of substance use disorder populations (MacKillop and Kahler, 2009, Stanger et al., 2012, Washio et al., 2011). However, only one published study has examined delay discounting among those who are dependent upon prescription opioids (Yi et al., 2007). To date, no published studies have examined differences in delay discounting between those with opioid use disorder who use prescription opioids vs. heroin.

The objective of the present study was to compare levels of delay discounting in a sample of adults with opioid use disorder, based on the type of opioid abused in the past month. We hypothesized that heroin users would show elevated delay discounting relative to prescription opioid users.

Section snippets

Participants

A sample of 151 participants seeking treatment for opioid use disorder was recruited from an inpatient detoxification unit as part of a larger study. In this sample, 139 participants completed the delay discounting measure. Eligible participants were 18 years or older, met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (American Psychiatric Association, 2000) criteria for opioid dependence, and were undergoing a buprenorphine stabilization and taper protocol as part of

Results

Descriptive statistics for sociodemographic and drug use variables are presented in Table 1. Based on self-reported opioid use in the 30 days prior to hospital admission, 60 participants (43.2%) were defined as heroin users, 33 (23.7%) were defined as prescription opioid users, and 46 (33.1%) were defined as combined users. The groups differed significantly with respect to age, education, current cigarette smoking, and diagnosis of a stimulant use disorder (see Table 1). Mean k scores for heroin

Discussion

In a sample of adults hospitalized for opioid use disorder, we found that those who used heroin (whether with or without prescription opioids) exhibited greater delay discounting than those who exclusively used prescription opioids. These differences remained statistically significant after controlling for sociodemographic and drug use variables that differed between groups. Delay discounting is of significant clinical concern in substance-using populations due to its association with the

Conflict of interest

Dr. Weiss has served as a consultant to Indivior, U.S. WorldMeds, and GW Pharmaceuticals. All other authors declare they have no conflicts of interest.

Role of funding source

This work was supported by National Institute on Drug Abuse (NIDA) grants K23 DA035297 (Dr. McHugh) and K24 DA022288 (Dr. Weiss). NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Drs. Weiss, McHugh, and Griffin designed the original study. Dr. McHugh and Ms. Karakula designed this secondary analysis. Ms. Karakula, Dr. McHugh, and Ms. Borges undertook the statistical analysis, and wrote the first draft of the manuscript. Dr. Weiss, Dr. Griffin, Ms. Borges, and Mr. Bailey contributed to the interpretation and presentation of study findings. All authors contributed to and have approved the final manuscript.

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