Understanding multi‐pill ingestion of prescription opioids: Prevalence, characteristics, and motivation

Abstract

Purpose Oral use is the primary route of administration among non‐medical prescription opioid users. While progression to non‐oral routes and shifts to stronger opioids have been previously studied as ways to cope with tolerance, the prevalence and patterns of those who cope by increasing the number of pills/tablets ingested at one time (ie, multi‐pill use) has not been assessed. Methods A subset (N = 231) of treatment‐seeking opioid users from a national opioid surveillance system, participating in the Researchers and Participants Interacting Directly (RAPID) Program, completed an online survey centered on multi‐pill use. Results Over two‐thirds of non‐medical prescription opioid users had a history of multi‐pill use (67.7%), defined as ingesting four or more of the same pill, intact and at the same time. Among these (n = 154), the median maximum number of pills taken at one time was eight, with over 20% ingesting 11 or more pills in a single instance. Nearly half engaged in multi‐pill ingestion more than once a day in the past month (43.8%), with accessibility to lower dose pills being the primary motivator (85.4%). Hydrocodone immediate‐release (IR) compounds were by far the most frequently endorsed (90.3%), followed by oxycodone IR tablets with acetaminophen (76.0%) and oxycodone IR tablets containing no acetaminophen/ibuprofen (56.5%). Conclusions These results indicate that the ingestion of multiple opioid pills/tablets is extremely common among treatment‐seeking opioid users. This, and other forms of non‐medical oral use of prescription opioids, should be taken under consideration when developing prevention and intervention efforts targeting the opioid epidemic.

The Association Between Fecal Short-Chain Fatty Acids, Gut Microbiota, and Visceral Fat in Monozygotic Twin Pairs

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Analysis of correlations between gut microbiota, stool short chain fatty acids, calprotectin and cardiometabolic risk factors in postmenopausal women with obesity: a cross-sectional study

“…SCFA also play a role in the balance of fatty acid synthesis, fatty acid oxidation, and lipolysis in the body's tissues through peroxisome proliferator-activated receptors [ 90 ]. Dietary supplementation with acetate, propionate, butyrate or their mixture can significantly inhibit the body weight gain induced by high-fat diet feeding [ 91 ].…”

Evaluation of Abuse and Route of Administration of Extended-Release Tapentadol Among Treatment-Seeking Individuals, as Captured by the Addiction Severity Index–Multimedia Version (ASI-MV)

“…Analysis of routes of administration reveals that the majority of participants who reported tapentadol ER abuse and ADF ER opioid abuse swallowed tablets whole (58.70% and 53.81%, respectively). Swallowing tablets whole is recognized as the primary pathway of nonmedical use [ 31 ], and ADFs do not surmount this route of administration. Taking more opioids than prescribed, generally, or swallowing more tapentadol than prescribed can result in side effects and possibly death [ 4 , 5 , 28 , 32–35 ].…”