Paper Preview: Consequences of Heroin Use

Today is the start of my ongoing desire to a write blog post on each of my publications. I plan to keep a consistent format to make this easy to read; the idea is to provide an overview of the paper so you can know if you want to read more.

I will start with the first paper of my MD/PhD program: Developing a scale of domains of negative consequences of chronic use.

Title Page

Summary: There are many negative consequences associated with heroin use; they can be divided into subcategories. There may be unique risk factor profiles associated with increased risk for each category of consequence.

Why this topic?
This topic is important to me because in substance use literature there is a lot of talk about “negative consequences” of substance use. These are keys to the diagnostic integrity of substance use disorder (SUDs); to be diagnosed with an SUD per the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), your substance use must be causing negative symptoms that impact your life in a manner in spite of which you still use that substance. There are a lot of types of negative consequences, ranging from those we hear about in the news a lot (e.g. overdose, legal problems) to those that have a greater impact on social functioning (e.g. financial problems, problems with friends and family). In the literature there is a lot of discussion on certain types of substance use (e.g injection drug use) being associated with a larger number of negative consequences. I wasn’t sure that this type of general grouping of consequences made sense. We believed that there might be sub-types of consequences (e.g. health-related) that were associated with certain risk factors like injection use, but that these risk factors may not necessarily result in increases across all types of consequences. We wanted to see if certain types of consequences might group together to give us a better understanding of who may be at risk for these problems.

SUD DSM5.png
The 4 groups of DSM-V criteria for SUDs (Source)

What did we do?
We had a large set of screening data from people with heroin use disorder who had come into the lab for previous studies (N=370). All data were collected from individuals aged between 18 and 55 in Detroit, MI, who were currently using heroin regularly and did not want to seek treatment. These screening data covered a wide variety of questions about  their substance use characteristics and their lifetime experience of 21 different potential consequences of their heroin use.

To establish whether any of these consequences group together, we conducted an exploratory principal component analysis (PCA) for all 21 items; this is a way to examine how certain responses group together within a sample (for specific details on the methods, see paper). Once we had our 5 statistically determined subcategories (termed factors) from the PCA, we looked for relationships between these factors and certain characteristics of substance use (e.g age of first use of other substances) and specific risk factors (e.g. injection heroin use or regular use of another substance).

What did we find?
The results of the PCA showed that 20 of the consequences split into 5 factors; one of the consequences (fights and quarrels) did not load in any group. Although we chose not to develop specific labels for these factors, they do fall into clearly distinct groups which I view as encompassing health, school, occupational, social, and more long-term effects. The fact that the exploratory PCA provided these distinct groupings suggests that our hypothesis of differing types of negative consequences may be correct.

Factors Figure
Figure showing the way the 20 consequences divide across the 5 different factors

By further exploring whether certain characteristics of substance use are associated with different consequence group, we can gain further support for our hypothesis. For these analyses we excluded the “school” factor since the majority of our participants used heroin for the first time after they would have finished school (at approximately 24 years). Below are the consequence factors and what they were associated with.

  • Factor 1 consequences (visited emergency room, overdose, health problems, accident/injury, arrested/legal problems, unexpected reaction) were higher in people who had:
    • Previously injected heroin
    • Never used marijuana regularly
    • Regularly used prescription sedatives not as prescribed (i.e. bought from street or used more that prescribed).
  • Factor 2 consequences (lost job, warning at work, missed work, high at work) were higher in people who had:
    • First used marijuana at a younger age
    • Never used marijuana regularly
  • Factor 4 consequences (financial problems, family problems, drove under the influence, and couldn’t stop using) were higher in people who had:
    • First used marijuana at a younger age
    • Never used marijuana regularly
  • Factor 5 consequences (seizure and fits, shakes and tremors, memory lapse or blackout) were no different between any of the characteristics or risk factor groups we examined.


Why is this important?

  1. We found that not all negative consequences of heroin use are created equal. A person who may be at increased risk of one type of consequence might not be at increased risk of another type.
  2. This knowledge helps us identify which types of consequences a person may be experiencing so that we can provide them the support they need. For example, if we know that person who injects heroin is at higher risk of certain health problems we can try to connect them with the right support systems and harm reduction methods to protect their health.
  3. Further exploration of these unique factors may help us develop a better understanding of who is at greater risk for different types of consequences, this could allow for the development of brief clinical screening tools that will allow for the development of more tailored plans for harm reduction and (if desired) treatment.



  • Citations for any facts mentioned here can be found in the paper.
  • Let me know if you need a PDF of the paper, I am happy to send it to you. 
  • Please share any questions/comments/criticisms, I would love to talk more about this paper!

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