Almost half of hospitalized heroin users self-report good health

Nearly half of heroin users who are hospitalized for medical or surgical treatment perceive themselves to be in good, very good, or excellent health, "underlining a disconnect between addiction and perceived health status," according to a study of 112 patients.

The apparent disparity between self-reported health and disease burden suggests that "perceptions of health status may not actually reflect physical health but a different construct altogether," Lidia Z. Meshesa and her colleagues wrote.

The investigators enrolled 112 non–treatment-seeking hospitalized heroin users in the study. The average age of the participants was 40 years, and 72% were male, reported Ms. Meshesa, of the Clinical Research and Education (CARE) Unit at Boston Medical Center, and her coauthors (Addict. Behav. 2013;38:2884-7). None was currently in treatment for substance abuse. All the participants completed a standard questionnaire on health-related quality of life and were asked detailed questions about their drug use and mental and physical health histories.

The investigators found that each day of heroin use in the previous month was associated with 8% lower odds of reporting health as good or better (odds ratio, 0.92; 95% confidence interval, 0.87-0.97; P less than .05). While about 47% of subjects self-reported their health status as good, very good, or excellent, some 68% also reported having been diagnosed with one or more chronic diseases, including diabetes, viral hepatitis, cardiovascular disease, HIV, or cancer. The main causes of hospitalization were cellulitis, drug overdose or withdrawal, pneumonia, endocarditis or sepsis, and HIV disease.

For this cohort, perceptions of good health could be associated more with absence of withdrawal symptoms than presence of disease, the investigators suggested. Of the 21 subjects reporting an accidental overdose within the previous 6 months, 62% also rated their health as good or better. Such subjects "may have a sense of immortality or lack of vulnerability after having survived a near-death experience," the investigators wrote in their analysis. "Therefore, it may be seen that using heroin frequently is a way of alleviating health problems."

Although the study found the number of days of heroin use in the previous month to be correlated with self-rated health status, use of other substances such as cocaine, marijuana, cigarettes, and alcohol did not show significant correlations to perceptions of overall health. Some 63% of the cohort had reported using cocaine in the previous month.

"Our study adds to this body of literature demonstrating that there is a graded effect between number of days using heroin and health status. However, this study also suggests that patients with opiate addiction may not recognize other risky drug use behaviors as being important to their health," the investigators wrote.

Because perceptions of poor health have been shown in other studies to affect users’ likelihood of seeking treatment (J. Subst. Abuse Treat. 2006;31:143-50; Addict. Behav. 2006;31:1904-18), the finding of good self-reported health status in nearly half of a cohort of hospitalized heroin users "suggests that a perception of good health may be a barrier to engaging in substance use treatment. Providers may need to help patients reframe addictions and risky behaviors as important components of overall health," Ms. Meshesha and her colleagues wrote.

The investigators described as limitations of their study the use of a single question to define self-perceived health status and the fact that all subjects were hospitalized when interviewed, limiting the generalizability of findings. Finally, "neurocognitive deficits due to drug use may contribute to impaired self-awareness," they wrote.

The study was funded by a grant from the National Institute on Drug Abuse. None of its authors declared conflicts of interest.

Nearly half of heroin users who are hospitalized for medical or surgical treatment perceive themselves to be in good, very good, or excellent health, "underlining a disconnect between addiction and perceived health status," according to a study of 112 patients.

The apparent disparity between self-reported health and disease burden suggests that "perceptions of health status may not actually reflect physical health but a different construct altogether," Lidia Z. Meshesa and her colleagues wrote.

The investigators enrolled 112 non–treatment-seeking hospitalized heroin users in the study. The average age of the participants was 40 years, and 72% were male, reported Ms. Meshesa, of the Clinical Research and Education (CARE) Unit at Boston Medical Center, and her coauthors (Addict. Behav. 2013;38:2884-7). None was currently in treatment for substance abuse. All the participants completed a standard questionnaire on health-related quality of life and were asked detailed questions about their drug use and mental and physical health histories.

The investigators found that each day of heroin use in the previous month was associated with 8% lower odds of reporting health as good or better (odds ratio, 0.92; 95% confidence interval, 0.87-0.97; P less than .05). While about 47% of subjects self-reported their health status as good, very good, or excellent, some 68% also reported having been diagnosed with one or more chronic diseases, including diabetes, viral hepatitis, cardiovascular disease, HIV, or cancer. The main causes of hospitalization were cellulitis, drug overdose or withdrawal, pneumonia, endocarditis or sepsis, and HIV disease.

For this cohort, perceptions of good health could be associated more with absence of withdrawal symptoms than presence of disease, the investigators suggested. Of the 21 subjects reporting an accidental overdose within the previous 6 months, 62% also rated their health as good or better. Such subjects "may have a sense of immortality or lack of vulnerability after having survived a near-death experience," the investigators wrote in their analysis. "Therefore, it may be seen that using heroin frequently is a way of alleviating health problems."

Although the study found the number of days of heroin use in the previous month to be correlated with self-rated health status, use of other substances such as cocaine, marijuana, cigarettes, and alcohol did not show significant correlations to perceptions of overall health. Some 63% of the cohort had reported using cocaine in the previous month.

"Our study adds to this body of literature demonstrating that there is a graded effect between number of days using heroin and health status. However, this study also suggests that patients with opiate addiction may not recognize other risky drug use behaviors as being important to their health," the investigators wrote.

Because perceptions of poor health have been shown in other studies to affect users’ likelihood of seeking treatment (J. Subst. Abuse Treat. 2006;31:143-50; Addict. Behav. 2006;31:1904-18), the finding of good self-reported health status in nearly half of a cohort of hospitalized heroin users "suggests that a perception of good health may be a barrier to engaging in substance use treatment. Providers may need to help patients reframe addictions and risky behaviors as important components of overall health," Ms. Meshesha and her colleagues wrote.

The investigators described as limitations of their study the use of a single question to define self-perceived health status and the fact that all subjects were hospitalized when interviewed, limiting the generalizability of findings. Finally, "neurocognitive deficits due to drug use may contribute to impaired self-awareness," they wrote.

The study was funded by a grant from the National Institute on Drug Abuse. None of its authors declared conflicts of interest.

Nearly half of heroin users who are hospitalized for medical or surgical treatment perceive themselves to be in good, very good, or excellent health, "underlining a disconnect between addiction and perceived health status," according to a study of 112 patients.

The apparent disparity between self-reported health and disease burden suggests that "perceptions of health status may not actually reflect physical health but a different construct altogether," Lidia Z. Meshesa and her colleagues wrote.

The investigators enrolled 112 non–treatment-seeking hospitalized heroin users in the study. The average age of the participants was 40 years, and 72% were male, reported Ms. Meshesa, of the Clinical Research and Education (CARE) Unit at Boston Medical Center, and her coauthors (Addict. Behav. 2013;38:2884-7). None was currently in treatment for substance abuse. All the participants completed a standard questionnaire on health-related quality of life and were asked detailed questions about their drug use and mental and physical health histories.

The investigators found that each day of heroin use in the previous month was associated with 8% lower odds of reporting health as good or better (odds ratio, 0.92; 95% confidence interval, 0.87-0.97; P less than .05). While about 47% of subjects self-reported their health status as good, very good, or excellent, some 68% also reported having been diagnosed with one or more chronic diseases, including diabetes, viral hepatitis, cardiovascular disease, HIV, or cancer. The main causes of hospitalization were cellulitis, drug overdose or withdrawal, pneumonia, endocarditis or sepsis, and HIV disease.

For this cohort, perceptions of good health could be associated more with absence of withdrawal symptoms than presence of disease, the investigators suggested. Of the 21 subjects reporting an accidental overdose within the previous 6 months, 62% also rated their health as good or better. Such subjects "may have a sense of immortality or lack of vulnerability after having survived a near-death experience," the investigators wrote in their analysis. "Therefore, it may be seen that using heroin frequently is a way of alleviating health problems."

Although the study found the number of days of heroin use in the previous month to be correlated with self-rated health status, use of other substances such as cocaine, marijuana, cigarettes, and alcohol did not show significant correlations to perceptions of overall health. Some 63% of the cohort had reported using cocaine in the previous month.

"Our study adds to this body of literature demonstrating that there is a graded effect between number of days using heroin and health status. However, this study also suggests that patients with opiate addiction may not recognize other risky drug use behaviors as being important to their health," the investigators wrote.

Because perceptions of poor health have been shown in other studies to affect users’ likelihood of seeking treatment (J. Subst. Abuse Treat. 2006;31:143-50; Addict. Behav. 2006;31:1904-18), the finding of good self-reported health status in nearly half of a cohort of hospitalized heroin users "suggests that a perception of good health may be a barrier to engaging in substance use treatment. Providers may need to help patients reframe addictions and risky behaviors as important components of overall health," Ms. Meshesha and her colleagues wrote.

The investigators described as limitations of their study the use of a single question to define self-perceived health status and the fact that all subjects were hospitalized when interviewed, limiting the generalizability of findings. Finally, "neurocognitive deficits due to drug use may contribute to impaired self-awareness," they wrote.

The study was funded by a grant from the National Institute on Drug Abuse. None of its authors declared conflicts of interest.