Health, Socioeconomic Status, and Opioid Use Disorder: Risk Factors Among Individuals With Nonmedical Opioid Use

Objectives: Concern is growing about rising opioid use disorder (OUD) rates and limited knowledge of how socioeconomic status (SES) and health factors interact. We examined whether health status moderates the relationship between SES and OUD among individuals with nonmedical opioid use. Methods: We analyzed data from 10 984 adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. Logistic regression estimated odds of OUD using self-reported health (good/very good/excellent vs fair/poor) and SES indicators (education, income, employment, and marital status). Interaction terms tested whether health status modified SES–OUD associations. Results: Fair/poor health increased OUD odds, whereas college graduation and employment were linked to lower odds. Interaction analyses showed that among those with fair/poor health, higher SES corresponded to increased OUD odds. Those with fair/poor health and a college degree had substantially higher odds of OUD (odds ratio [OR] = 3.35; P < .001) than less educated peers. Among those with fair/poor health, individuals with annual family incomes ≥$75 000 also had higher OUD odds (OR = 1.84; P = .03) than those with incomes <$20 000, and employment was associated with increased OUD odds (OR = 1.61; P = .008). Individuals who were widowed/divorced/separated (OR = 0.36; P < .001) and never married (OR = 0.48; P = .001) had lower OUD odds than married individuals. Conclusions: Health status significantly moderated SES–OUD associations. Among those in poor health, higher SES was linked to greater OUD odds. Prevention and treatment efforts should consider how SES and health jointly shape OUD vulnerability.