Trends in Medical Use and Abuse of Sustained-Release Opioid Analgesics: A Revisit

Novak, Suzanne; Nemeth, William C.; Lawson, Kenneth A.

doi:10.1111/j.1526-4637.2004.04001.x

Cited by 76 publications

(47 citation statements)

References 7 publications

(9 reference statements)

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“…3 Moreover, several studies have documented that the (changing) levels of POA available in the population are strongly associated with (changing) levels of POA-related morbidity (for example, emergency department or substance use treatment admissions) and mortality (for example, overdose deaths). 66,67 While current national estimates of NMPOU for the Canadian general adult population are problematic, Ontario-based estimates suggest that this prevalence may be as high as 6.5%; this value would translate into more than 1.5 million Canadians aged 16 years and older. 6,68 Further, surveys have shown that most people with NMPOU obtain their POAs by diversion or nonmedical sourcing from family or friends.…”

Section: Discussionmentioning

confidence: 99%

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

et al. 2011

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Objective: In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. Method:A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.Results: Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. Conclusions:The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.Can J Psychiatry. 2011;56(8):495-502. Clinical Implications• Mental health and (or) pain comorbidities are highly coprevalent in people engaging in NMPOU.• When observing NMPOU in patients, undiagnosed or untreated mental health and (or) pain must be examined as a possible cause.• People in need of medical POA care for pain should be screened for mental health problems. Limitations• A systematic review and meta-analysis is needed to further validate and add statistical precision findings.• NMPOU was inconsistently defined and operationalized across different studies.• Most studies were cross-sectional, thus directionality of the association cannot be determined.

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Section: Discussionmentioning

confidence: 99%

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

et al. 2011

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“…It is possible that OxyContin® is more likely to be used nonmedically by adults than by adolescents (SAMHSA, 2003). Data from the DAWN report suggest significant increases in misuse or abuse of fentanyl, morphine, oxycodone, methadone, and hydrocodone (Novak et al, 2004;SAMHSA, 2003). Our data suggest that American adolescents may be most likely to use hydrocodone products (Vicodin®, Lortab®, Lorcet®, Lorcet Plus®, and hydrocodone), which were used by 52% of all users of non-prescribed pain relievers.…”

Section: Discussionmentioning

confidence: 99%

“…Prescription pain relievers include opioids, such as preparations containing oxycodone (Oxycontin®, Percocet®), hydrocodone (Lortab®, Vicodin®), codeine (Tylenol with codeine®), propoxyphene (Darvon®), methadone (Dolophine®), and hydromorphone (Dilaudid®). Data from the U.S. Drug Abuse Warning Network (DAWN) and the Treatment Episode Data Set (TEDS) show an upward trend in opioid-related admissions to emergency departments (Gilson et al, 2004;Novak et al, 2004; SAMHSA [Substance Abuse and Mental Health Services Administration], 2003) and publicly funded substance abuse treatment facilities (SAMHSA, 2004). For example, an analysis of data from the 1997−2002 DAWN report indicates an increase in opioid-related visits to emergency departments: 642% for fentanyl, 347% for oxycodone, and 342% for hydromorphone (Gilson et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Non-prescribed use of pain relievers among adolescents in the United States

Pilowsky

Patkar

2008

Drug and Alcohol Dependence

128

133

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Background-We examined gender-specific prevalences, patterns, and correlates of nonprescribed use of pain relievers-mainly opioids-in a representative sample of American adolescents (N = 18,678).Methods-Data were drawn from the public use data file of the 2005 U.S. National Survey on Drug Use and Health, a survey of non-institutionalized American household residents. The patterns of nonprescribed use of prescription pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use.Results-Approximately one in 10 adolescents aged 12−17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in females). The mean age of first nonprescribed use was 13.3 years, which was similar to the mean age of first use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use.Conclusions-Use of non-prescribed pain relievers occurs early in adolescence. Research is needed to understand whether early use of non-prescribed pain relievers is related to later drug use.

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“…Increases in opioid prescribing nationally have been associated with increases in rates of opioid-related serious adverse effects such as overdose mortality (p. 26), prescription pain medication misuse, and opioid-related emergency department visits [20].…”

Section: Serious Adverse Effectsmentioning

confidence: 99%

Measurement of adherence to clinical practice guidelines for opioid therapy for chronic pain

Midboe

Lewis

Paik

et al. 2011

Behav. Med. Pract. Policy Res.

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The safe and effective prescribing of opioid therapy for chronic pain has become a significant health care priority over the last several years. Substantial research has focused on patient-oriented interventions toward preventing problematic use, but provider and system level factors may be more amenable to quality improvement approaches. Here, we outline administrative data-based metrics that are intended to assess adherence to key practices outlined in the 2010 Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for management of opioid therapy for chronic pain. In addition to the metrics, we discuss their development process, which was done in consultation with experts on chronic opioid therapy.

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Trends in Medical Use and Abuse of Sustained-Release Opioid Analgesics: A Revisit

Abstract: Using this method of analysis, the rates of drug abuse, and resultant morbidity secondary to the use of opioid analgesics, remain low in spite of the increase in medical use of these substances.

Cited by 76 publications

References 7 publications

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Non-prescribed use of pain relievers among adolescents in the United States

Measurement of adherence to clinical practice guidelines for opioid therapy for chronic pain

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