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<p>Opioid misuse and the use of other illicit drugs continue to pose major public health challenges in the United States. This study examined the associated disparities across large, small, and nonmetropolitan areas in opioid misuse and illicit drug use. We analyzed adult participants from the National Survey on Drug Use and Health (2021–2023; unweighted <i>n</i> = 138,331). Outcomes included opioid misuse, marijuana use, and other illicit drug use in the past 12&#xa0;months. We performed biased-corrected estimation of multivariable logistic regression models separately, applying the NSDUH weighting schemes to examine the associations. We controlled multiple comparisons using a false discovery rate approach. Approximately 3.35%, 21.95%, and 5.54% of participants reported opioid misuse, marijuana use, and sedative use in the past 12&#xa0;months, respectively. No statistically significant disparities across large, small, and nonmetropolitan areas were found in opioid misuse and marijuana use in the past 12&#xa0;months across study periods. Individuals who resided in small (AOR = 0.54, 95% CI 0.39, 0.74) and nonmetropolitan (AOR = 0.33, 95% CI 0.22, 0.48) areas had lower odds of reporting cocaine use, compared with those who lived in large metropolitan areas. For heroin, only participants residing in small metropolitan areas reported lower odds of using it than those from the large metropolitan areas (AOR = 0.41, 95% CI 0.22, 0.79). These findings highlighted the importance of developing prevention and intervention strategies targeting residents from large metropolitan areas, particularly for illicit drugs such as cocaine and heroin. Controlling availability and accessibility in urban areas may be a key to reducing use.</p>

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Opioid Misuse and Illicit Drug Use Among Adults Across Large, Small, and Nonmetropolitan Areas in the United States

  • 期刊论文

  • 发表日期：

    2026年5月21日

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  • Yen-Han Lee,
  • Yen-Chang Chang,
  • Dong-Chul Seo

摘要

Opioid misuse and the use of other illicit drugs continue to pose major public health challenges in the United States. This study examined the associated disparities across large, small, and nonmetropolitan areas in opioid misuse and illicit drug use. We analyzed adult participants from the National Survey on Drug Use and Health (2021–2023; unweighted n = 138,331). Outcomes included opioid misuse, marijuana use, and other illicit drug use in the past 12 months. We performed biased-corrected estimation of multivariable logistic regression models separately, applying the NSDUH weighting schemes to examine the associations. We controlled multiple comparisons using a false discovery rate approach. Approximately 3.35%, 21.95%, and 5.54% of participants reported opioid misuse, marijuana use, and sedative use in the past 12 months, respectively. No statistically significant disparities across large, small, and nonmetropolitan areas were found in opioid misuse and marijuana use in the past 12 months across study periods. Individuals who resided in small (AOR = 0.54, 95% CI 0.39, 0.74) and nonmetropolitan (AOR = 0.33, 95% CI 0.22, 0.48) areas had lower odds of reporting cocaine use, compared with those who lived in large metropolitan areas. For heroin, only participants residing in small metropolitan areas reported lower odds of using it than those from the large metropolitan areas (AOR = 0.41, 95% CI 0.22, 0.79). These findings highlighted the importance of developing prevention and intervention strategies targeting residents from large metropolitan areas, particularly for illicit drugs such as cocaine and heroin. Controlling availability and accessibility in urban areas may be a key to reducing use.