Effective policies to support autonomous attempts to quit opioid use - a cross-sectional study across 14 countries

Background: Scaling up medication-assisted treatment for severe opioid use disorder is key to end the overdose crisis in the US and beyond. However, some people who use opioids can recover autonomously. Kratom is discussed as a safe alternative. Little is known about quitting opioid use among the non-treatment seeking population and how policies affect such attempts.

Methods: Data from the Global Drug Survey (GDS) 2018, the largest anonymous web survey on drug use, were analyzed to identify people who quit heroin and/or injection drug use and profile kratom use. Fourteen countries (AT, AU, CA, CH, DE, DK, FI, HU, IT, NL, NZ, PL, UK, US; N=106,695) had 2.6% (DK) to 21.5% (US) of the sample (n>100) who were experienced with heroin, and/or kratom and/or injection drug use. Additionally, results from a new module in the GDS2019 will be included to better understand why and how people quit opioid use and whether reversing overdoses with Naloxone makes it less or more likely for people to consider reducing opioid use.

Results: One-quarter of the selected sample (n=6,372) was female (24.6%), mean age was 29 years (SD=11.5). Less than 5% had ever used fentanyl and less than 1% the novel opioids AH7921, carfentanil, T-HFF, U51754, or W18. Half of the sample had used heroin and/or injected drugs but not in the last 30 days (50.9%). In the last 30 days, about 1 in 10 had used heroin and/or injected a drug (11.9%); equally, 10.9% had used kratom. Most never tried heroin (80.4%) and only one fifth (14.4%) of those who had recently used kratom had quit heroin use. Recent heroin use was associated with self-reported depression and psychosis (p<.001).

Conclusion: This is the first multinational analysis that analyzed substance use patterns of people who successfully quit heroin and/or injection drug use. Independent of other substance use, overcoming mental health symptoms may help people to quit opioid use or successfully engage in substitution treatment. This presentation will highlight the importance of meeting people where they are at to support opioid quit attempts if the policy environment enables the early detection of problematic use and allows for the analysis of underlying motives for use to inspire social change.