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The Prevalence of Common Infectious Diseases among Nonmedical Prescription Opioid Users: Preliminary Findings from the National Prescription Opioid Misuse, Abuse, and Diversion (NOMAD) Study

Novak SP,Ball EL,Winstock AR,Peiper N

Background: Little population data exist on the lifetime prevalence of risk-based infectious diseases, both those that are sexually transmitted and blood-borne via needle sharing among persons using prescription opioids for nonmedical purposes, such as those using for euphoria and/or to self-treat medical conditions. Objective: This study examined the lifetime prevalence and characteristics of persons reporting Common Infectious Diseases (CID) related to sexual risk and drug use in a national study of persons engaging in past-year nonmedical prescription opioid use (NMPOU) in the United States. Methods: The Nonmedical Prescription Opioid Misuse, Abuse, and Diversion (NOMAD) study collected selfreported survey assessments via an online questionnaire (ages 18+). Participants were recruited from online advertisements as well as referrals from ongoing research studies of prescription drug abusers in the United States. Participants were asked to self-report prior medically confirmed diagnoses of blood borne infectious diseases like HIV/AIDS, hepatitis (Hep A, Hep B, Hep C), and sexually transmitted infections like Syphilis. Risk behaviors, such as unprotected sex and needle sharing, were ascertained via standardized survey items drafted from the Composite International Diagnostic Interview. Results: Of the 344 past-year nonmedical prescription opioid users, 72.5% reported at least one lifetime CID. The most common were Hep B (18.8%), Hep A (8.9%), and Hep C (8.4%). Over 5% reported an HIV/AIDS diagnosis. The risk of onset for a CID was between 18 and 35, with 80% of the risk of a first STD in this window. Injection practices were associated with CIDs, and in particular Hep C and Hep A. The characteristics significantly associated with a lifetime CID were having bipolar disorder (O.R.=16.3), an opioid use disorder (O.R.=8.3), and a lifetime mood disorder (O.R.=6.83). Jail/prison and drug treatment were associated with a lower risk of disease risk. Most (95.4%) of the infectious diseases onsets prior to initiation of the NMPOU. Conclusion: This study highlights that common infectious diseases, both STDs and injection-based (e.g., Hep- A,B,C) are very common among NMPOUs, though the risk onset is largely in early adulthood prior to the initiation of NMPOU.