Prescription painkiller misuse and the perceived risk of harm from using heroin

Background Prescription opioid pain reliever misuse is associated with initiation of heroin use. The perceived risk of harm from substance use is a key factor in initiation. We hypothesized that prescription pain reliever misuse is associated with a lower perceived risk of harm from trying heroin and from regular use. Methods Using the 2015–6 National Survey on Drug Use and Health (NSDUH), we evaluated the perceived risk of trying and regularly using heroin among heroin never-users. We estimated logistic regressions to assess the association between past-year prescription pain reliever misuse with the perceived risk of heroin initiation and regular use, adjusting for potential confounders. Results The sample contained 84,312 adults and 27,814 adolescents. Four percent of adults and 3.7% of adolescents reported past-year prescription pain reliever misuse. 87.9% of adults and 65.9% of adolescents perceived trying heroin as a great risk. Pain reliever misuse was associated with a significantly lower odds of perceiving great risk of harm from trying heroin (adults: AOR = 0.760, 95%CI 0.614–0.941, p = 0.013; adolescents: AOR = 0.817, 95%CI 0.672–0.993, p = 0.042). Both age groups were more likely to report perceiving regular heroin use as a great risk of harm compared to trying heroin once or twice, but only adults showed significant association with of pain reliever misuse. (AOR = 0.539 95%CI 0.390–0.744, p Conclusions Past-year prescription pain reliever misuse was associated with lower perceived risk of harm from heroin initiation and regular use. Further understanding of risk perception and the association with heroin initiation might inform development of primary prevention interventions.