VARIABLE-CENTERED VERSUS PERSON-CENTERED APPROACHES IN EXAMINING THE U.S. OPIOID EPIDEMIC: UNDERSTANDING METHODOLOGICAL DIFFERENCES

Abstract

In 2017, the U.S. Department of Health and Human Services acknowledged the U.S. opioid epidemic, although the first wave was traced to the 1990s. As each year passed, the overall incidence and prevalence of opioid misuse, as well as the human and economic costs, increased. Current conventional misuse interventions targeting opioid prescription incidence have provided little amelioration to the public health burden and are projected to have a negligible impact in the coming years. Although current analytic approaches have been instrumental in identifying the risk factors associated with opioid misuse, these analytic approaches have been limited. The majority of these analytic approaches have been variable-centered, which help identify risk factors by estimating relationships on variables, not persons at risk. Person-centered approaches provide the ability to not only identify risk factors but also identify previously unobserved risk profiles. To identify opioid misuse risk factors and at-risk groups, I first performed a systematic literature review. I identified all known risk factors associated with opioid misuse from January 1999 to January 2019 from the review. I then used a variable-centered approach on the 2017 National Survey on Drug Use and Health (NSDUH) among noninstitutionalized U.S. adults aged 18 and older to test the associations of known risk factors by means of logistic regression. The logistic regression findings indicated that age, residence, employment, criminality, overall health, mental health, and other substance dependences/abuses were significant population-level risk factors. The person-centered approach using latent class analysis on the 2017 NSDUH identified four opioid misuse subgroups: (1) single opioid users (25.7% of sample); (2) prescription or combination opioid user (4.7% of sample); (3) prescription opioid user (14.5% of sample); and (4) mixed opioid use (55.2% of sample). Prescription or combination opioid users were considered to be the highest risk subgroup because they had the highest conditional probability of using a combination of heroin and prescription opioids. This subgroup represents a possible transition group from purely prescription opioids to combinatorial use. Findings revealed that the opioid epidemic is multifaceted and should use both targeted variable-centered and person-centered approaches to tailor salient intervention programs to stem the opioid epidemic.