Powell David, Jacobson Mireille
RAND, Arlington, Virginia.
University of Southern California, Los Angeles.
JAMA Health Forum. 2025 May 2;6(5):e250809. doi: 10.1001/jamahealthforum.2025.0809.
Illicit opioids, particularly illicitly manufactured fentanyl (IMF), are major contributors to overdose deaths in the US. Understanding the prevalence and characteristics of illicit opioid use is crucial for addressing the opioid crisis.
To estimate the prevalence of illicit opioid use, including IMF, and initial opioid exposure among those reporting illicit opioid use.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using an online survey with targeted demographic quotas from June 10, 2024, to June 17, 2024. A total of 1515 participants aged 18 years and older from the US completed the survey. The analysis was conducted between June 30, 2024, and February 13, 2025.
The primary outcome was self-reported illicit opioid use within the past 12 months. Secondary outcomes included initial exposure to opioids and perceived likelihood of overdose. Logistic regression was used to analyze associations with demographic and geographic factors.
A total of 1515 respondents completed the survey, including 770 female individuals (50.8%), 20 American Indian or Alaska Native (1.3%), 101 Asian or Pacific Islander (6.7%), 215 Black (14.2%), 1087 White (81.7%), and 24 multiracial (1.6%); 186 (12.3%) were aged 18 to 24, 242 (16.0%) 25 to 34, 327 (21.6%) 35 to 44, 280 (18.5%) 45 to 54, 281 (18.5%) 55 to 64, 139 (9.2%) 65 to 74, and 60 (4.0%) 75 to 84 years. Among this sample, 166 (10.96%; 95% CI, 9.38%-12.52%) reported nonprescription opioid use within the past 12 months, including 114 (7.52%; 95% CI, 6.20%-8.85%) of the 1515 respondents reporting IMF use. Among those reporting nonprescription opioid use within the past 12 months, 65 (39.16%; 95% CI, 31.73%-46.58%) reported that their first opioid use involved opioids prescribed to them, whereas 60 (36.14%; 95% CI, 28.84%-43.45%) reported that their first use involved prescription opioids not prescribed to them. Only 41 (24.70%; 95% CI, 18.14%-31.26%) answered that their first exposure involved illicit opioids. Seventy-one (4.69%; 95% CI, 3.62%-5.75%) of all respondents reported that it was very likely they would have an overdose due to opioid use. This rate increased to 33.33% (95% CI, 24.68%-41.99%) among those who had used IMF within the past 12 months. Illicit opioid use was higher among men, Black respondents, and younger age groups.
The findings of this cross-sectional study indicate a higher prevalence of illicit opioid use than previously reported, highlighting the need for more timely and accurate data to inform policy and intervention strategies. Enhanced data collection efforts are essential for understanding and mitigating the opioid crisis.
非法阿片类药物，尤其是非法制造的芬太尼（IMF），是美国过量用药死亡的主要原因。了解非法阿片类药物使用的流行情况和特征对于应对阿片类药物危机至关重要。
估计非法阿片类药物使用（包括IMF）的流行率，以及报告非法阿片类药物使用情况者的首次阿片类药物接触情况。
设计、背景和参与者：这项横断面研究于2024年6月10日至2024年6月17日使用具有目标人口配额的在线调查进行。共有1515名年龄在18岁及以上的美国参与者完成了调查。分析于2024年6月30日至2025年2月13日进行。
主要结局是过去12个月内自我报告的非法阿片类药物使用情况。次要结局包括首次接触阿片类药物和感知的过量用药可能性。使用逻辑回归分析与人口统计学和地理因素的关联。
共有1515名受访者完成了调查，其中包括770名女性（50.8%）、20名美洲印第安人或阿拉斯加原住民（1.3%）、101名亚裔或太平洋岛民（6.7%）、215名黑人（14.2%）、1087名白人（81.7%）和24名多民族（1.6%）；186人（12.3%）年龄在18至24岁之间，242人（16.0%）年龄在25至34岁之间，327人（21.6%）年龄在35至44岁之间，280人（18.5%）年龄在45至54岁之间，281人（18.5%）年龄在55至64岁之间，139人（9.2%）年龄在65至74岁之间，60人（4.0%）年龄在75至84岁之间。在这个样本中，166人（10.96%；95%CI，9.38%-12.52%）报告在过去12个月内使用过非处方阿片类药物，其中1515名受访者中有114人（7.52%；95%CI，6.20%-8.85%）报告使用过IMF。在过去12个月内报告使用非处方阿片类药物的人中，65人（39.16%；95%CI，31.73%-46.58%）报告他们的首次阿片类药物使用涉及开给他们的阿片类药物，而60人（36.14%；95%CI，28.84%-43.45%）报告他们的首次使用涉及未开给他们的处方阿片类药物。只有41人（24.70%；95%CI，18.14%-31.26%）回答他们的首次接触涉及非法阿片类药物。所有受访者中有71人（4.69%；95%CI，3.62%-5.75%）报告他们很可能因使用阿片类药物而过量用药。在过去12个月内使用过IMF的人中，这一比例升至33.33%（95%CI，24.68%-41.99%）。男性、黑人受访者和较年轻年龄组的非法阿片类药物使用率较高。
这项横断面研究的结果表明，非法阿片类药物使用的流行率高于先前报告的水平，突出了需要更及时和准确的数据来为政策和干预策略提供信息。加强数据收集工作对于理解和缓解阿片类药物危机至关重要。
