Patterns of co-use Sample Clauses

Patterns of co-use. As noted earlier, recent studies document shifts in demographic correlates of NMPO and heroin use. Evidence that NMPO-only users transition to heroin use and subsequently co-use both opioids depending on availability indicates that co- use may be growing (Church et al., 2011; Xxxxxxx et al., 2015; Xxxxxxxx et al., 2009; Xxxxx, 2013; Mars et al., 2014). However, we lack empirical evidence of the trends in and characteristics of co-use, compared to opioid use in general. To our knowledge, only two studies categorize NMPO and heroin co-use and find differences in characteristics of co-users relative to heroin-only users, not NMPO users (Xxxxxxx et al., 2008; Xxxx & Xxxxxx, 2015). In a study that aggregated data from 2005-2013 among problem opioid users, the prevalence of co-use was over 8% and associated with male sex relative to female, non-Hispanic White race/ethnicity relative to Hispanic, age over 18 relative to younger age, and urban residence relative to non-urban (Wu, Zhu, & Xxxxxx, 2016). The existing literature does not compare NMPO-only to co-users, does not examine trends over time, examines abuse and dependence but not use, and is not theoretically-framed, limiting our ability to respond systematically to shifts in opioid use. Available theories emphasize the importance of examining trends frequently and exploring individual-level characteristics, which manifest differently due to factors at higher levels (Keyes, Cerdá, Xxxxx, Xxxxxx, & Xxxxx, 0000; Xxxxxx, 2009). Patterns in opioid use and associated xxxxx can change quickly and are dependent on the interaction between the individual and their environment (Xxxxxx, 2009). Trend theory explains these trends as dynamic and a function of context, with some population segments being affected more than others. It posits that people 1) marginalized from power, 2) with access to drugs through a new delivery system, and 3) affected by changes in policies related to drug use are more likely to initiate drug use and likely share demographic characteristics (Agar & Xxxxxxxxx, 2001). This provides context to increased opioid use and related outcomes in groups with historically lower rates including women relative to men, non-Hispanic Whites relative to other races/ethnicities, those with private health insurance relative to no insurance, and those residing in non-urban counties relative to urban counties (Jones, Logan, et al., 2015; Paulozzi & Xx, 0000; Xxxxx et al., 2013). It also highlights a link between e...