Social determinants of opioid use behaviors among adults in the United States

Background The non-medical use of prescription opioids and heroin use remain serious public health issues in the United States. Yet, there remains a lack of research attempting to systematically identify specific social determinants linked to these behaviors using national data sources. Methods Using data from the National Survey on Drug Use and Health and the social determinant of health framework, this study examines the associations between five specific social determinant of health domains and past-year opioid use behaviors - heroin and non-medical prescription opioid use - among U.S. adults aged 18 and older, controlling for more downstream determinants of health. The five social determinant of health domains included the following: (1) economic stability, (2) educational attainment, (3) health care access, (4) neighborhood, and (5) social and community context. Results Separate models investigating the independent relationships between the five domains and opioid use behaviors found that various social determinants were significant predictors, after controlling for individual behaviors and health status. The full model assessing all five domains showed that social and community context, economic stability, and neighborhood determinants were associated with opioid use behaviors. Conclusions Social determinants tied to opioid use behaviors among American adults may largely be driven by social and community context, economic stability, and neighborhood conditions. Limitations of this study are discussed.