The length of time spent in the United States by first-generation immigrants is associated with opioid use, according to a recent study in JAMA Network Open. There are an estimated 41.5 million adult immigrants in the United States, of which approximately 3.2 million (7.8%) report using prescription opioids. Because the current opioid crisis originated from within the US healthcare system, researchers sought to determine the degree to which cultural influences endemic to the United States are associated with opioid prescribing.

The researchers conducted a cross-sectional study with deidentified and publicly available data from the National Expenditure Panel Survey. A sample of 13,635 adult immigrants was identified using an aggregate of survey data from 2014 and 2016 with additional independent samples. For the purpose of the study, researchers categorized immigrants as new (<5 years in the United States), semi-established (5 to <15 years), and long-standing (≥15 years). They used a list of National Drug Codes to identify prescription opioid use, and developed national estimates with survey design methods. The resulting data allowed the researchers to examine variations in opioid use across immigration status, race/ethnicity, and family income level.

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The study found that nonimmigrants were much more likely to use prescription opioids than first-generation immigrants. In addition, most of the immigrants who were opioid users had arrived in the United States as adults. Between new immigrants and long-standing immigrants, there was a more than 10% increase in the rate of prescription opioid use. Overall, the demographic categories most associated with prescription opioid use were nonimmigrants (32.5 million), immigrants older than 18 years at the time of immigration (8.3 million), non-Hispanic whites (25.8 million), and those in high family annual income households (13.5 million). Long-standing immigrants were next most likely after nonimmigrants to use prescription opioids, with the likelihood of prescription opioid use decreasing with shorter lengths of stay in the United States.

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The researchers concluded that independent of demographic characteristics and other variables, the more time spent in the United States, the more likely immigrants are to become prescription opioid users. Although other studies have identified risk factors for opioid prescribing, these results point to some specific aspect of American culture possibly promoting the use of opioids among immigrants.

The researchers acknowledge that their study did not take into account any time-sensitive cultural factors that could influence the initiation of opioid therapy and they did not analyze assimilation as a factor influencing prescription opioid use. However, the researchers do suggest that policy efforts to decrease opioid reliance could benefit from understanding any cultural factors in the United States that could promote the use of prescription opioids.


Sites BD, Davis MA. Association of length of time spent in the United States with opioid use among first-generation immigrants. JAMA Netw Open. 2019;2(10):e1913979.