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Study: New immigrants less likely to use prescription opioids

  • Dr. Brian Sites, a Dartmouth-Hitchcock anesthesiologist, authored a recent paper in JAMA Network Open that found that new immigrants to the U.S. are less likely to use prescription opioids than native-born Americans.(courtesy photo D-H)

Valley News Staff Writer
Published: 11/4/2019 9:58:59 PM
Modified: 11/4/2019 9:58:54 PM

LEBANON — A recently published study by a Dartmouth-Hitchcock Medical Center anesthesiologist has found that new immigrants to the U.S. are less likely to use prescription opioids than native-born Americans.

Dr. Brian Sites, who is also a professor of anesthesiology at the Geisel School of Medicine, said the results published in the journal JAMA Network Open last month point to a cultural factor in the use of opioids. Because of that, Sites said he thinks the response necessary to address the problem of opioid use will need to take culture into account.

The “effect is so profound, it’s unlikely that this is going to be an easy fix,” Sites said in a phone interview last week.

Sites and his co-author Matthew Davis, an associate professor at the University of Michigan School of Nursing, concluded that of the 41.5 million adult immigrants in the U.S., 7.8%, or 3.2 million, use prescription opioids. That’s less than half the rate of 16.1% at which native-born Americans use prescription opioids.

The newer the immigrants were, the less likely they were to use opioids. New immigrants, those who had lived in the U.S. for fewer than five years, used opioids at a rate of 4.7%, while those who had lived in the U.S. for more than 15 years used opioids at a rate of 14.8%.

After adjusting for age, sex, race, ethnicity, self-reported pain, health insurance status, physical health, mental health and family income, long-standing immigrants were more than four times more likely to use prescription opioids than new immigrants. And non-immigrants were more than five times more likely to use the drugs, according to the study.

It’s “very hard to ignore that,” Sites said.

To make these findings, the researchers used data from the national Medical Expenditure Panel Survey, MEPS, for 2014 and 2016. They used a sample of 13,635 immigrants, sorting that group into smaller groups based on their length of time in the U.S.

The MEPS is a set of surveys of U.S. families and individuals, their medical providers and employers on the health services that patients use, how often they use them, the costs they incur and how they pay.

Richard Wright, a geography professor at Dartmouth College who was not involved in the study, said that these results seem to fit with what other research has shown about immigrant health.

Immigrants generally have better health outcomes than the native-born, Wright said. This is true in terms of life expectancy, as well as the risk of illnesses such as cancer and cardiovascular disease, he said.

But “these advantages erode with time in the country,” he said. “They adopt what native-born Americans are doing.”

This phenomenon is known as the “epidemiological paradox,” said Emily Walton, an associate professor of sociology at Dartmouth who also was not involved in the study.

Despite the fact that immigrants generally have a lower socioeconomic status than native-born Americans, Walton said they start out healthier when they first arrive, but over time as they adapt to American culture, they lose that advantage.

Though Walton couldn’t speak to opioid use, she said other research has shown, for example, that immigrants’ eating behaviors change over time in U.S. They eat more fats and sugars and exercise less.

Less well documented is the idea that immigrants are exposed to discrimination and marginalization once they arrive and that has a negative effect on their health, she said. That type of stress might have effects on immigrants’ physical and mental well-being, she said.

Regardless of the reason, understanding that immigrants become more likely to use prescription opioids over time ought to inform public health campaigns about opioid use, Walton said.

Rather than waiting until immigrants interact with the medical system, Walton said public health efforts ought to anticipate this change by making “sure that we have educational and diagnostic tools available for everyone.”

For Sites, the study helps illustrate the fact that the country’s response to the opioid epidemic can’t simply be requiring clinicians to undergo continuing education or check a database before prescribing opioids.

Other factors that may affect the way Americans think about pain and the reliance on opioids to address that pain might include pharmaceutical advertisements and a lack of access, including insurance coverage, to alternative pain treatments, Sites said.

“It’s really complicated, and we’re not going to have a quick fix,” Sites said.

Sites and Davis, who earned his doctorate at Dartmouth College and a master’s in public health from Geisel School of Medicine, have previously collaborated on research examining the connection between mental illness and opioid use.

Nora Doyle-Burr can be reached at or 603-727-3213.

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