In an article that forms part of the PLoS Medicine series on Big Food, Corinna Hawkes and colleagues provide a perspective from South Africa on the rise of multinational and domestic food companies, and argue that government should act urgently through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.
The increased number of prescriptions written for hydrocodone and oxycodone between 1995 and 2004 was associated with similar increases in non-medical use and the number of ED visits during this time period.
Objective-This study was designed to assess non-medical prescription opioid use among a sample of opioid dependent participants.Methods-A cross-sectional survey was conducted with a convenience sample of patients hospitalized for medical management of opioid withdrawal. We collected data related to participant demographics, socio-economic characteristics, the age of first opioid use, types of opioids preferred, and routes of administration. We also asked participants to describe how they first began using opioids and how their use progressed over time.Results-Among the 75 participants, the mean age was 32 years (SD: ± 11, range: 18-70), 49 (65%) were men, 58 (77%) considered themselves to be "white," 55 (74%) had a high school diploma or equivalent, and 39 (52%) were unemployed. All of these participants considered themselves to be "addicted." Thirty-one (41%) felt that their addiction began with "legitimate prescriptions," 24 (32%) with diverted prescription medications, and 20 (27%) with "street drugs" from illicit sources; however, 69 (92%) had reported purchasing opioids "off the street" at some point in time. Thirtyseven (49%) considered heroin to be their current preferred drug, and 43 (57%) had used drugs intravenously.Conclusions-We found that many treatment-seeking opioid dependent patients first began using licit prescription drugs before obtaining opioids from illicit sources. Later, they purchased heroin, which they would come to prefer because it was less expensive and more effective than prescription drugs.
Keywords(MeSH) Opiate dependency; drug and narcotic control; (non-MeSH) etiologyIn the United States, recent recommendations to adequately treat pain have been associated with an increase in the number of prescriptions written for opioids. 1, 2 Clinicians who prescribe these opioids often struggle with "a question of balance" between risk and benefit. 3 On the one hand, if their prescribing practices are too liberal clinicians risk contributing to the problem of prescription drug abuse; while on the other hand, they may compromise the clinical benefit of adequate pain control for their patients if their practices are too conservative.There are individual patients who have both clear objective evidence for a chronic pain disorder and a well-documented drug use disorder; however, many physicians do not feel prepared to
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