Prescription Opioid Use Among Patients Seeking Treatment for Opioid Dependence

Abstract

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

Opioid Use Disorders

“…Typically, inhaled (smoked or snorted) heroin is a precursor to injection heroin use xlii .There are varying estimates of the proportion of adolescents with any form of opioid addiction who transition to injection heroin use, ranging from 40-90% ii,xxxv Almost 70% of young heroin users (age 18-25) eventually transition from nasal to injection heroin xliii ,and almost half of adolescents with current heroin addiction are injection heroin users xviii,xliv . Among patients seeking treatment for heroin addiction, the percentage of injection heroin use is even higher (62-83%) xvi,xxxiii,xxxvi .…”

Dependência de opioide em pacientes com dor crônica

“…Ocorre dependência em até cerca de 25% dos indivíduos que utilizam opioides 17,19,20 . É importante salientar que em um estudo a dependência a opioide ocorreu por prescrição legal em 30% a 40% 21,22 . Após tornarem-se dependentes os indivíduos obtêm também opioide de fonte ilícita 21 .…”

“…É importante salientar que em um estudo a dependência a opioide ocorreu por prescrição legal em 30% a 40% 21,22 . Após tornarem-se dependentes os indivíduos obtêm também opioide de fonte ilícita 21 . Deve ser feita prescrição responsável para o tratamento da dor para reduzir a possibilidade de abuso e dependên-cia 23 .…”

Sources of Pharmaceutical Opioids for Non-Medical Use among Young Adults

“…These increases have resulted in escalating rates of unintentional overdose deaths (Paulozzi, Budnitz, & Xi 2006; Paulozzi & Annest 2007; Paulozzi & Xi 2008), a rising prevalence of prescription opioid abuse and dependence disorders (McCabe, Cranford & West 2008; SAMHSA July 15, 2010) and expanded pathways to heroin addiction (Siegal et al 2003; Lankenau et al 2011; Peavy et al 2012; Canfield et al 2010; Muhuri, Gfroerer, & Davies 2013; Jones 2013). …”