How American Culture May Explain Opioid Use Among Immigrants

How American Culture May Explain Opioid Use Among Immigrants

The longer immigrants live in the United States, the more likely they are to use prescription opioids, according to new research.

The finding contradicts popular views linking wealth and health, and suggests that American culture is uniquely favorable toward prescribing opioids.

In an adjusted analysis, researchers found that immigrants who lived in the US between five and 15 years were more than three times as likely as new immigrants to use opioids. Further, immigrants in the US longer than 15 years were four times likelier to use opioids than new immigrants, and US-born residents were more than five times likely to use prescription opioids than new immigrants.

American culture and opioids

Researchers examined the influence of American culture on opioid use among the estimated 42 million adult immigrants. Nearly 8% of immigrants use prescription opioids, compared to 16% of adults born in the US.

“Our results indicate that American culture has a potent influence on opioid prescribing, as evidenced by the dramatic time effect that is associated with a massive increase in prescription opioid use among immigrants to the United States,” says Matthew Davis, associate professor at the University of Michigan School of Nursing and Medical School.

The uptick occurred even when researchers controlled for pain levels, health care access, and income.

“This research was important to focus on because it was a unique opportunity to evaluate the effect of American culture on opioid prescribing,” says Brian Sites, an anesthesiologist at the Dartmouth-Hitchcock Medical Center.


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Increased opioid use among people who have been in the US longer, provides stronger evidence of a unique American culture that promotes opioid use, the researchers say.

‘Immigrant paradox’

Although the study doesn’t explicitly identify assimilation into American culture, the researchers suspect the adoption of American attitudes and culture likely influences the dynamic between health care providers and immigrant patients.

The findings are a great example of the immigrant paradox, which challenges assumptions about people from disadvantaged backgrounds, Davis says. In this case, the paradox is that that new immigrants are often healthier than nonimmigrants despite their poorer backgrounds, which contradicts popular beliefs about health and wealth.

Policy efforts to decrease opioid reliance would potentially benefit from acknowledgment of unique American cultural factors that influence opioid use, Sites says.

The researchers used data from the national Medical Expenditure Panel Survey.

Original Study

About the Authors/Researchers

Brian D. Sites, MD, MS and Matthew A. Davis, MPH, PhD

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