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A large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described. To describe prescription opioid use in the year preceding heroin overdose. Case-control study comparing prescription opioid use with a heroin-involved overdose, non-heroin-involved opioid overdose, and non-overdose controls from 2015 to 2017. Oregon Medicaid beneficiaries with linked administrative claims, vital statistics, and prescr