Incidence, Timing and Social Correlates of the Development of Opioid Use Disorder Among Clients Seeking Treatment for an Alcohol Use Problem: Changes Over the Three Waves of the Opioid Epidemic

Zackary Falls,1,* Xueqing Zhang,2,* Peter L Elkin,1 David Jacobs,3 Edward M Bednarczyk,4 Walter Gibson,4 Gail P Jette,5 Kenneth E Leonard6,* 1Department of Biomedical Informatics and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA; 2Department of Biostatistics and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA; 3School of Pharmacy and Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York, Buffalo, New York, USA; 4School of Pharmacy, University at Buffalo, The State University of New York, Buffalo, New York, USA; 5Division of Outcomes, Management, and Systems Information, Office of Addiction Services and Supports, Albany NY, United States; 6Department of Psychiatry and Clinical and Research Institute on Addiction, University at Buffalo, The State University of New York, Buffalo, New York, USA*These authors contributed equally to this workCorrespondence: Kenneth E Leonard, Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA, Email [email protected]: Opioid use disorder (OUD) and opioid overdose (OD) have shown to be strongly associated with alcohol use disorder (AUD). As a potential target population for secondary prevention, we examined the incidence and timing of OUD/OD among clients seeking treatment for alcohol problems and how this has changed over the three waves of the opioid epidemic corresponding to the primary opioid involved in fatal ODs, prescription painkillers (2007– 2009), heroin (2010– 2012), and fentanyl (2013– 2016). We also examined social determinants of health as predictors of OUD/OD.Methods: Clients (N = 59,186) presenting for a first treatment for alcohol use problems were extracted from the Client Data System (CDS) of the New York State Office of Addiction Services and Support (OASAS) and New York State (NYS) Medicaid Data Warehouse. Using this cohort, we employed the Kaplan–Meier method to determine the survival probabilities for patients admitted in each of the three waves of the epidemic.Results: Patients in Cohort 3 (2013– 2016) were diagnosed with OUD/OD more rapidly than patients in Cohort 1 (2007– 2009) or Cohort 2 (2010– 2012), although the overall estimated OUD/OD rate was comparable across the three cohorts.Discussion: These findings provide a useful estimate of the incidence and the expected time frame of an opioid use disorder in clients with an alcohol use problem. Moreover, it suggests that as the opioid epidemic progressed, OUD/OD developed more rapidly but the overall prevalence did not increase.Keywords: opioid use disorder, opioid overdose, substance use, alcohol, incidence