Correlates of Opioid Use Disorders among People with Severe Mental Illness in the United States

Background/Objectives: The number of Americans with opioid use disorders (OUDs: prescription painkillers or heroin) has increased dramatically, yet little is known about OUD among people with severe mental illness (SMI). Methods: Using the National Survey on Drug Use and Health (N=502,467), logistic regression was used to: (1) identify factors associated with past-year OUD among people with SMI; and (2) examine associations between OUD and adverse outcomes (e.g., suicide attempt). Results: After controlling for a number of factors, correlates of OUD among people with SMI included male gender, younger age, marital status (never been married), use of certain drugs before age 18 (especially marijuana), and ease of obtaining certain drugs. People with prescription painkiller use disorder (only) were 7.43 times more likely (CI=4.55-12.14, p<.001) than people without substance use disorder to have criminal justice system involvement, while those with: (1) heroin use disorder (only) were 18.78 times more likely (CI=9.22-38.24, p<.001); (2) both prescription painkiller and heroin use disorder (only) were 25.83 times more likely (CI=14.06-47.47, p<.001); and (3) all other substance use disorders were 5.15 times more likely (CI=3.95-6.72, p<.001). People with prescription painkiller use disorder (only) were 2.40 times more likely (CI=1.72-3.35, p<.001) to attempt suicide than those without substance use disorder, and those with all other substance use disorders (i.e., apart from OUD) were 79% more likely (OR=1.79, CI=1.45-220, p<.001). Conclusions/Importance: My findings on OUD and OUD outcomes can help identify and understand individuals with SMI who could benefit from OUD prevention and intervention efforts.