Substance Use and Clinical Correlates of Opioid Dependence: A Multifactorial Analysis

Background Opioid dependence poses a growing public health challenge in low- and middle-income countries (LMICs), yet data from sub-Saharan Africa remain scarce. This study examines sociodemographic, clinical, and substance use correlates of opioid dependence among adolescents and young adults in Zambia.

A cross-sectional analysis of 427 medical records (aged 10–27 years) from a tertiary hospital in Southern Zambia (2022–2024) was conducted. Univariable and multivariable logistic regression models assessed associations between opioid use, sociodemographic factors, psychiatric comorbidities, and physiological markers.

The median age was 21 years (IQR: 18–23), with 77.5% male participants. Opioid use prevalence was 15.5%, strongly associated with cannabis use (76.7% vs. 7.8%, p < 0.0001) and alcohol abuse (15.5% vs. 10.3%, p = 0.0002). Psychosis was less prevalent among opioid users (12.1% vs. 19.7%, p = 0.032). In adjusted models, systolic blood pressure (SBP) inversely correlated with opioid use (AOR = 0.80, 95% CI: 0.65–0.99; p = 0.040), while diastolic blood pressure (DBP) showed a positive association (AOR = 1.37, 95% CI: 1.03–1.81; p = 0.027). Alcohol abuse retained significance (AOR = 3.76, 95% CI: 1.47–95,874.35; p = 0.036), though wide confidence intervals indicated instability.

Opioid dependence in this Zambian cohort is closely linked to polysubstance use, particularly cannabis and alcohol. The paradoxical inverse relationship between SBP and opioid use may reflect confounding by comorbidities or antihypertensive treatment, while elevated DBP aligns with regional studies on opioid-related cardiovascular risk. Despite limitations, including sparse data and cross-sectional design, these findings underscore the need for integrated substance use and mental health interventions in LMICs. Future research should prioritize longitudinal designs and community-based sampling to address methodological gaps and inform context-specific policies. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Mulungushi University Research Ethics Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵# Co-first Authors Data Availability All relevant data are within the manuscript and its Supporting Information files.