Denial of Prescription Opioids Among Young Adults with Histories of Opioid Misuse

Abstract

Objectives An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. Design Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. Participants One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. Results Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Self-medication often coincided with initiation of new risk behaviors and more intensive drug use. Conclusion Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors.

Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users

“…We also included three variables that were described as important correlates of NMUPO use in non-LCA studies (Nielsen et al, 2011; Fibbi et al, 2012; Wang et al, 2013): Metropolitan Statistical Area (large metropolitan area, small metropolitan area, and non-metropolitan area); health insurance (yes or no); and employment status (employed, unemployed, and missing).…”

Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis

“…In this study, many participants (44%) reported that prescription analgesia denial was commonly related to “being accused of drug seeking” (Voon et al, 2015a). Similarly, in a study of young adults who engaged in non-medical use of an opioid, tranquilizer and/or stimulant in the last 90 days, participants associated their experiences with being denied prescription analgesia with being identified as a drug user, a lack of health insurance, and having medication withheld by a parent or authority figure (Fibbi et al, 2012). Approximately 40% of young adults in this sample who did not receive treatment escalated their NMPO use or self-medicated with heroin.…”

“…Several recent reports suggest that misidentification of risk factors for and symptoms of OUD, as well as complexities associated with managing patients who are concurrently experiencing physical pain and receiving treatment for opioid addiction could increase some clinicians’ reticence to prescribe opioid medications (Rupp and Delaney, 2004; Fibbi et al, 2012; Dowden, 2014; King, 2014; Rutkow et al, 2015; Voon et al, 2015a). The high prevalence of untreated physical pain among patients who display symptoms of OUD, which has been shown to range in samples of individuals seeking methadone treatment from 37% to 61%, may also be related to frequent co-occurrence of other substance use disorders and mental health disorders (Jamison et al, 2000; Rosenblum et al, 2003; Savage et al, 2008; Pettes et al, 2015; Voon et al, 2015b).…”

“…Unmonitored frequent NMPO use could result also in professionally unmanaged opioid tolerance, recurrence of physical pain, and (subsequently) NMPO dose escalation and/or heroin initiation. One study of 150 young adult NMPO users in New York City and Los Angeles found that over half had self-medicated with an opioid to manage severe pain, and one-quarter had been denied prescription opioids for the treatment of pain (Fibbi et al, 2012; Voon et al, 2015a). Furthermore, self-medication frequently coincided with an escalation of more intensive drug use and new risk behavior (e.g., initiation of heroin use and sniffing, snorting, or injecting drugs).…”

“…This is especially true given the dynamic and complex nature of adolescence (both psychologically and physically), sex-specific differences in biological and perceptual pain processing mechanisms (Bartley and Fillingim, 2013), and documented gender-specific pain management experiences relevant to opioid use (Green et al, 2009). While recent studies have explored the potential relationship between under-treatment of physical pain among individuals who use prescription opioids non-medically or inject drugs (Fibbi et al, 2012; Voon et al, 2015a), there is a need for more sex and gender-specific analyses of the relationship between physical pain and NMPO use. Identification of sex-specific variables associated with self-medication and frequent non-medical use of prescription opioids could help improve screening tools used in clinical pain management practices, thereby decreasing unmitigated physical pain and escalating NMPO use (Green et al, 2009).…”