Prescription opioid misuse among African-American adults: A rural-urban comparison of prevalence and risk

Background: Prescription opioid misuse (POM) remains a public health concern in the United States. Although the problem has been studied extensively, little research attention is paid to POM among African-Americans (AAs), and even fewer studies consider rural status in their analysis. The goal of this study, therefore, was to identify and compare prevalence and predictors of POM among rural and urban AA adults using data from a nationally representative sample. Methods: Using pooled data across five years (2012-2016) of the National Survey on Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with POM among AA adults. Results: Findings show that urban and rural AAs have comparable prevalence rates of POM, which is somewhat surprising given that POM often varies based on rural status. A number of factors (e.g., receiving government assistance, religiosity, smoking tobacco or marijuana, misuse of other prescription medications) were significantly correlated with POM for urban and rural AAs, while others (e.g., being age 50+, graduating high school, visiting an emergency department, being arrested, binge drinking) varied by rural status. Conclusion: Results indicate that AA nonmedical prescription opioid users are not a monolith and have distinct demographic, clinical, and psychosocial profiles based on geographic region. Because AAs have been virtually ignored in the POM literature, our findings are an important step towards understanding POM among this understudied group. These results invite additional investigation into AA POM and encourage researchers to consider rural status in their analysis of POM among AAs.