Factors Associated with Sustained Remission among Chronic Opioid Users

Identifying factors associated with opioid cessation in a biracial sample using machine learning

Aim

Racial disparities in opioid use disorder (OUD) management exist, however, and there is limited research on factors that influence opioid cessation in different population groups.

Methods

We employed multiple machine learning prediction algorithms least absolute shrinkage and selection operator, random forest, deep neural network, and support vector machine to assess factors associated with ceasing opioid use in a sample of 1,192 African Americans (AAs) and 2,557 individuals of European ancestry (EAs) who met Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for OUD. Values for nearly 4,000 variables reflecting demographics, alcohol and other drug use, general health, non-drug use behaviors, and diagnoses for other psychiatric disorders, were obtained for each participant from the Semi-Structured Assessment for Drug Dependence and Alcoholism, a detailed semi-structured interview.

Results

Support vector machine models performed marginally better on average than other machine learning methods with maximum prediction accuracies of 75.4% in AAs and 79.4% in EAs. Subsequent stepwise regression considered the 83 most highly ranked variables across all methods and models and identified less recent cocaine use (AAs: odds ratio (OR) = 1.82, P = 9.19 × 10^-5; EAs: OR = 1.91, P = 3.30 × 10^-15), shorter duration of opioid use (AAs: OR = 0.55, P = 5.78 × 10^-6; EAs: OR = 0.69, P = 3.01 × 10^-7), and older age (AAs: OR = 2.44, P = 1.41 × 10^-12; EAs: OR = 2.00, P = 5.74 × 10^-9) as the strongest independent predictors of opioid cessation in both AAs and EAs. Attending self-help groups for OUD was also an independent predictor (P < 0.05) in both population groups, while less gambling severity (OR = 0.80, P = 3.32 × 10^-2) was specific to AAs and post-traumatic stress disorder recovery (OR = 1.93, P = 7.88 × 10^-5), recent antisocial behaviors (OR = 0.64, P = 2.69 × 10^-3), and atheism (OR = 1.45, P = 1.34 × 10^-2) were specific to EAs. Factors related to drug use comprised about half of the significant independent predictors in both AAs and EAs, with other predictors related to non-drug use behaviors, psychiatric disorders, overall health, and demographics.

Conclusions

These proof-of-concept findings provide avenues for hypothesis-driven analysis, and will lead to further research on strategies to improve OUD management in EAs and AAs.