Source of prescription drugs used nonmedically in rural and urban populations

Wang, Karen; Fiellin, David A.; Becker, William C.

doi:10.3109/00952990.2014.907301

Cited by 18 publications

(14 citation statements)

References 47 publications

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“…Demographic differences between the drug use populations included an older age, more women and higher socioeconomic status of persons identified with the hypnotics and tramadol compared to subjects taking benzodiazepines. Most subjects in our study lived in the region of a large city, which we consideredWe considered living in the region of a large city as a factor possibly affecting illegal drug market and health care availability availability to the illegal drug market and to health care (including pharmacies) as well as determining traffic police density, but our results suggest that drug diversion is as common in rural as in urban areas, in line with some studies (Wang et al, 2014) but not with others . Altogether, our study suggests that non-prescribed use of psychoactive prescription drugs is related to some factors typical of substance use disorders, but not to some others, indicating, as some other studies (Agrawal et al, 2006;Karjalainen et al, 2011;Rigg and Monnat, 2015;Wu et al, 2015), that prescription drug misusers may differ from illicit drug users.…”

Section: Main Findings and Their Interpretationsupporting

confidence: 82%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a confirmed intake of a psychoactive prescription drug, and to identify associated factors. Methods:Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was defined as a confirmed use of a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with nonprescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with nonprescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

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Section: Main Findings and Their Interpretationsupporting

confidence: 82%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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“…First, we created three mutually exclusive categories to characterize respondents’ most recent source of prescription pain medications: 1) one or more physicians; 2) friends or family; or 3) all other sources (i.e., theft, purchase from drug dealer) (Becker et al, 2011; Wang et al, 2014). Second, we created a dichotomous variable to identify individuals reporting past year opioid withdrawal symptoms.…”

Section: Methodsmentioning

confidence: 99%

Non-medical use of prescription pain medications and increased emergency department utilization: Results of a national survey

Frank

Binswanger

Calcaterra

et al. 2015

Drug and Alcohol Dependence

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Background There are no population-based studies of emergency department (ED) utilization by individuals using prescription pain medications non-medically. We examined whether non-medical use of prescription pain medications was independently associated with increased ED utilization. Methods We conducted a retrospective analysis of a nationally representative sample of the non-institutionalized, civilian U.S. population in the National Survey on Drug Use and Health, 2008–2013. We used multivariable logistic regression to examine the association between past year ED utilization and non-medical use of prescription pain medications, defined as use of medications “not prescribed for you or that you took only for the experience or feeling they caused”. Results An estimated 10.5 million adults annually reported past year non-medical use (NMU) of prescription pain medications, and 39%, or 4.1 million adults annually, also reported one or more past year ED visits. After adjustment for sociodemographic and clinical characteristics, adults with past year NMU of prescription pain medications had increased odds of past year ED utilization (adjusted odds ratio 1.32; 95% confidence interval 1.24–1.41). In secondary analyses, individuals with more frequent NMU had increased odds of ED utilization in unadjusted analyses, but this association was attenuated with adjustment for the source of prescription pain medication (i.e., physician, friend/family, other source). Conclusions Non-medical use of prescription pain medications is associated with increased ED utilization. Further work is needed to identify the optimal role of ED settings in providing screening, education, and treatment referral for individuals using prescription pain medications non-medically.

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“…Evidence now suggests there are qualitative differences in the experience of opioid use disorder within rural versus urban settings. First, opioid users in rural settings are more likely to abuse prescription opioids (versus heroin) relative to those in urban settings (Cicero, Surratt, Inciardi, & Munoz, 2007; Rigg & Monnat, 2015; Wang, Becker, & Fiellin, 2013; Wang, Fiellin, & Becker, 2014). Second, relative to urban settings, rural settings have substantially lower availability for opioid use disorder treatments (Heil, Sigmon, Jones, & Wagner, 2008; Hirchak & Murphy, 2016; Paulozzi & Xi, 2008; Paulozzi & Xi, 2008; Rosenblum et al, 2011; Rosenblum et al, 2011; Stein et al, 2015; Stein et al, 2015), which could otherwise serve as a protective factor against opioid overdose (Schwartz et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…This information can aid in the development of public health campaigns and interventions tailored to opioid users in those areas. The majority of studies that have evaluated relative risk factors between rural and urban drug users have done so using epidemiological data from the National Survey on Drug Use and Health (Rigg & Monnat, 2015; Wang et al, 2013; Wang et al, 2014). No studies, as of yet, have reported a prospective, comprehensive evaluation of opioid overdose risk behaviors and knowledge among individuals in predominately rural versus urban geographic areas.…”

Section: Introductionmentioning

confidence: 99%

Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural Versus an Urban Setting

Dunn

Barrett

Yepez-Laubach

et al. 2016

Journal of Substance Abuse Treatment

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Background-Opioid use is highly prevalent in the United States and there has been an increased incidence in the rate of opioid-related overdose. While evidence suggests there are substantial differences in opioid use among rural versus urban settings, the rate of overdose and corresponding frequency of opioid overdose risk behaviors and overdose knowledge between rural and urban settings have not been examined.Methods-Individuals with opioid use disorder from rural (N=98) and urban (N=247) settings completed a self-report survey regarding their lifetime history of overdose and overdose risk behaviors. Participants also completed the Brief Opioid Overdose Knowledge (BOOK) questionnaire, a 12-item self-report measure of opioid overdose knowledge.Results-Overall, 35.6% of participants had experienced an overdose, and prevalence of overdose was significantly higher (p<.01) among rural (45.9%) vs. urban (31.6%) participants, though fewer rural participants reported past 30-day risk behaviors. There were few differences observed between the subset of rural and urban participants who had experienced an overdose, and fewer rural participants with a history of overdose reported past 30-day risk behaviors. Both rural and urban participants performed poorly on the BOOK, though the percent of correct responses was lowest among rural participants with a history of overdose.Conclusion-Results demonstrate higher rates of overdose among rural opioid users, though rural participants were less likely to report recent risk behaviors. Results also suggest that Corresponding Author: Kelly Dunn, Ph.D. 5510 Nathan Shock Drive, Baltimore MD 21224. P: 410-550-2254, F: 410-550-0030, kdunn9@jhmi.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript knowledge regarding key factors related to opioid overdose is severely lacking, particularly among rural opioid users, which could be a potential target for future intervention efforts.

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Source of prescription drugs used nonmedically in rural and urban populations

Cited by 18 publications

References 47 publications

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Non-medical use of prescription pain medications and increased emergency department utilization: Results of a national survey

Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural Versus an Urban Setting

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