|Year : 2020 | Volume
| Issue : 4 | Page : 328-332
Determinants of opioid use among adult males in Myanmar: A case-control study
Ye Htut Oo1, Wongsa Laohasiriwong2
1 Master of Rural Development Management, Faculty of Graduate School, Khon Kaen University, Khon Kaen, Thailand
2 Dean, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
|Date of Submission||05-Oct-2019|
|Date of Decision||17-Jun-2020|
|Date of Acceptance||01-Aug-2020|
|Date of Web Publication||11-Dec-2020|
Ye Htut Oo
No. 88, 12th Street, Ward (5), Lanmadaw Township, Yangon
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Opioid abuse affects not only user's health but also productivity, security, and health-care costs. Better understanding about the risk factors of opioid use is in need in Myanmar as the country has heavy burdens of opioid abuse. Objectives: The present study aimed to identify the determinants of opioid use among adult males in Kachin State, Myanmar. Methods: This case–control study was conducted in Myitkyina city of Kachin State in August 2019. The ratio of case and control was 1:3, of which there were 109 opioid users and 327 controls who never used illicit drugs. Inclusion criteria for the participants were males of 18 years' old or above. Cases were recruited with the help of a nongovernmental organization, whereas controls were randomly selected from household registration of local government. Data were collected using face-to-face structured questionnaire interview. Multivariable logistic regressions were used to identify the determinants. Results: The factors associated with opioids use among males in Kachin state had peers who used opioids (adjusted odds ratio [AOR] = 21.67, 95% confident interval [CI]: 10.41–45.09), smoking cigarette or cheroot (AOR = 7.5, 95% CI: 4.03–13.94), aged 25 years or older (AOR = 3.46, 95% CI: 1.73–6.95), and were non-Kachin ethnic (AOR = 2.52, 95% CI: 1.36–4.64). Conclusion: The study indicated that peers had the strongest influence on opioid use, followed by smoking habits as well as age and ethnicity. Effective prevention programs are essential for vulnerable groups.
Keywords: Kachin, males, Myanmar, opioid abuse, risk factors
|How to cite this article:|
Oo YH, Laohasiriwong W. Determinants of opioid use among adult males in Myanmar: A case-control study. Indian J Public Health 2020;64:328-32
|How to cite this URL:|
Oo YH, Laohasiriwong W. Determinants of opioid use among adult males in Myanmar: A case-control study. Indian J Public Health [serial online] 2020 [cited 2021 May 13];64:328-32. Available from: https://www.ijph.in/text.asp?2020/64/4/328/303101
| Introduction|| |
Opioids have long been used in surgery to alleviate pain for many centuries. In spite of their usefulness, consequences such as dependency and addiction may arise, especially when they were used for nonmedical purposes. Both legal prescription opioids such as fentanyl and oxycodone and illegal opioids such as heroin may cause an epidemic of opioid deaths. Opioid abuse is a global concern which affects health, security, and development of the societies. It was also a global major disease burden which was accounted for about 9.2 million disability-adjusted life-years worldwide. The United Nations Office on Drugs and Crime reported in 2017 that opioids remained a major concern in Asian countries such as Afghanistan, China, and Myanmar. Afghanistan, the world's leading opium producer, had borne the socioeconomic burdens as the people including women and children suffered from opioid abuse. China reported that, in 2014, economic losses of more than $80 billion and at least 49,000 deaths are due to abuse of drugs such as heroin and amphetamine. Lately, the World Health Organization reported that approximately 27 million people experienced the drug abuse disorder in 2016.
Myanmar stood second in the top global opium poppy-producing countries and had a heavy burden for opioid use. Opium and heroin were the main drugs of choice and the most problematic drugs in the country as the users mainly injected them. Kachin is the most opium-producing state together with Shan State and has suffered socioeconomic burden of opioid abuse. Oo and Doe stated that drug users as well as their family members suffered drug abuse complications such as self-stigmatization, discrimination from the societies, and marital, economic, and health problems including hepatitis B virus, hepatitis C virus, and HIV/AIDS in Kachin State.
Since opioid use affects not only the health of users but also productivity, security, and health-care costs, it is essential to find out determinants of opioids use. Thus, the objective of the study was to identify the determinants of opioid use among adult males in Kachin State, Myanmar. Knowing these factors would be helpful for policymakers, local authorities, and nongovernmental organizations to develop relevant policies and implement effective interventions to prevent opioid abuse.
| Materials and Methods|| |
Study design and population
This case–control study was conducted among males in Myitkyina city of Kachin State in Myanmar. Only males were focused since almost all opioid users (obtained from a local nongovernmental organization) are males. The study was conducted in August 2019.
Sampling and selection of cases and controls
The sample size of 436, containing 109 cases and 327 controls (1:3), was needed to assess factors affecting opioid use in Myitkyina Township. It was calculated using an online statistics software “OpenEpi,” the method of Fleiss for a continuity correction for an unmatched case–control study, assuming a two-sided α of 0.05, beta (β) of 0.20, and hypothetical proportion of cases and controls with exposure of 0.351 and 0.193 (from Zain, Rampal, and Rampal) which was then added an additional 10% for adjustment of other factors.
Cases were adult male opioid users obtained from a local nongovernmental organization, Substance Abuse Research Association and its network. The inclusion criteria for cases were male of 18 years and older who had used opioids for more than 6 months on a regular basis. Controls were males aged 18 years' old and older who live in Kachin State and had never used illicit drugs. Eligible controls were selected randomly from the general population in the same area of Kachin State, Myanmar. The exclusion criteria for both cases and controls were who had serious physical and mental problems as well as could not verbally communicate with researcher.
Variables, tools, and technique Data collection
The tool for data collection was a structured questionnaire for interviews that consisted of three sections: socioeconomic and demographic characteristics, opioid use, and environmental factors. Socioeconomic and demographic variables included age, current marital status, education level, ethnicity, religion, level of religious belief and practice, employment status, monthly income, financial situation, place of living, and information about accommodation sharers. The second section contained outcome variable (opioid use or not) and information about the use of drugs other than opioids. Environmental factors consisted of media (ever seen drug use on media or not), availability (perception: very easy to very difficult), price, use of opioids by family members, accommodation sharers, and peers as well as migration. The questionnaire was forward (English to Myanmar) and backward translated (Myanmar to English) as well as was tested by three experts for content validity. The data were collected by the trained interviewers with a written guideline.
Participants were briefed about the purpose of the study and their informed consent was obtained before data collection by interviewing them. Approval for this research was received from Khon Kaen University Ethics Committee in Human Research (Reference number HE622140) on July 26, 2019.
All analyses were performed using Stata 14.2 (StataCorp (2015). Statistical Software: Release 14. College Station, TX: StataCorp LP). The categorical variables were described as number and percentage, whereas the continuous variables were described as mean (standard deviation) and median (minimum : maximum). For inferential statistics, simple logistic regression was applied to identify the association between each independent variable and opioid use. The variables which might associate with outcome variable (P < 0.25) were continued into the final model of multivariable analysis using a multiple logistic regression. The magnitude of association was presented as an adjusted odds ratio (AOR) and 95% confident interval (CI).
| Results|| |
A total of 436 respondents which included 109 cases and 327 controls were studied. The background characteristics of the cases and controls are described in [Table 1]. The mean age of case group was 33.4 (±9.1) years, while that of the control group was 34.4 (±15.9) years. The marital status of both cases and controls was almost the same, as 42.2% among cases and 44.3% in controls were married. Regarding educational attainment, most of the cases (82.6%), but only 57.5% of controls, finished secondary school. Only 43.1% of cases were Kachin ethnic, whereas most of the controls were Kachin. About half of cases (45.0%) had a monthly income of =100,000 Myanmar Kyats which was 53.8% among the control group.
|Table 1:Socioeconomic and demographic characteristics of cases and controls (n=436)|
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Factors associated with opioid use
In bivariate analysis, 12 variables were found to be associated with opioid use. In terms of age, adults (25 years and above) were 3.33 times (95% CI: 1.94–5.72, P < 0.001) likelier to consume the drugs than youths (18–24 years). The survey also observed that Bamars and other ethnic groups such as Shan, Kayin, and Sikhs were 3.17 times (95% CI: 2.03–4.97, P < 0.001) more susceptible to opioid abuse than Kachin people. Cigarette or cheroot smokers (odds ratio [OR] = 8.04, 95% CI: 4.83–13.39, P < 0.001) were more prone to use opioids than nonsmokers. Having peers who used opioids were also 17.33 times (95% CI: 9.11–32.98, P < 0.001), more likely to be associated with opioid use than not having peers who used the drugs [Table 2].
|Table 2: Bivariate analysis showing factors associated with opioid use among males in Kachin State, Myanmar|
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The associated factors from bivariate analysis were subjected to a multivariable logistic regression with backward elimination. The final model indicated that the significant determinants of opium use were having peers who used opioids (AOR = 21.67, 95% CI: 10.41–45.09, P < 0.001), being a smoker (AOR = 7.5, 95% CI: 4.03–13.94, P < 0.001), aged 25 years and older (AOR = 3.46, 95% CI: 1.73–6.95, P < 0.001) and were non-Kachin ethnic (AOR = 2.52, 95% CI: 1.36–4.64,
P < 0.01). The model predicting these determinants was found to be fit as evident from Hosmer–Lemeshow Test (P = 0.70) and 42% variation can be explained by this model (Pseudo R2 = 0.42) [Table 3].
|Table 3: Multivariable logistic regression showing the determinants associated with opioid use among males in Kachin State, Myanmar|
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| Discussion|| |
This case–control study aimed to identify the determinants of opioid use among adult males in Kachin State, Myanmar. It was found that peers had the strongest influence on opioid use (AOR = 21.51), followed by their personal habit of smoking (AOR = 7.5). Demographic and socioeconomic factors including age and ethnicity were also associated with opioid use. It might be that adult males mostly spent times with peers during works as well as sharing various things with peers. This was in line with the findings of Nicholson et al., Duru et al., and Whitesell et al.,,, which reported that peer pressure was significantly associated with substance abuse. Concerning smoking habit, it was similar to the study of öztas et al., which found out that those who used tobacco was seven times higher odds of drug abuse. A study which analyzed the 1994 National Household Survey on Drug Abuse in the United States also reported a significant association between drug use and smoking (OR = 16, 95% CI: 6.8–37.9).
Adult males =25 years were 3.42 times more likely to use opioids than younger age groups. The finding was consistent with a cross-sectional study on sociodemographic risk factors of substance use among the general population in Turkey which reported that drug misuse significantly increased with increasing age. However, it was different from the results of a case–control study on drug addiction among males in Malaysia which observed that people in 20–29 years of age had the highest risk (OR = 7.2, 95% CI: 3.8–13.7). The World Drug Report 2018 also stated that the highest drug use was among youths. The respondents who were 25 years' old and older might have more responsibilities of both family and works. These might increase their stress which increases their risk of drug use. Concerning ethnicity, previous studies identified ethnic/racial differences in illicit drug use. Bachman et al. showed that majority ethnic group (Native Americans) had higher levels of drug use. Similarly, the study in Malaysia noted that Malays had a higher risk than other minority groups. However, an association was observed between non-Kachin ethnic groups and opioid use in this study. A possible reason is that they were migrated from other states, dealing with various stress could led them to drug use. It may also because of containing Bamar in the group, who are dominant ethnic group of Myanmar.
There were some limitations to this case–control study. As this study was taken place in Kachin State, it could not represent other areas of Myanmar. The study also could not identify whether the exposures came before the outcome or not. Therefore, longitudinal studies are needed for identification of causal relationships. Selection bias may be the second limitation as the controls may have experience on using illicit drugs. However, during the recruitment, they were asked whether they had ever been used before. If they were the current users, they were recruited in the “case” group, and if they were ex-users, they were not selected in the study. Another challenge was that it was difficult to find drug users – the vulnerable population, and hence, help of a local nongovernmental organization was required for recruiting them. Most of them were males so the study was not able to include neither females nor other gender.
| Conclusion|| |
The study indicated that peers had the strongest influence on opioid use, followed by smoking habits as well as age and ethnicity. It is necessary to implement effective prevention programs among vulnerable groups, especially among adults and late adults as well as the emigrants to Kachin State. Opioid-related health education should also be promoted by using different languages for different ethnic groups so as to understand the drug problems, consequences, and how to deal with the issue. On the other hand, further studies with the appropriate design are also needed to identify the causal relationship between the factors and the drug use.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]