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

BackgroundOpioid 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. MethodsA 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. ResultsThe 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. ConclusionOpioid 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.