Medication Misuse Research Articles

Prescription opioid misuse and the need to promote medication safety among adolescents.

Misuse of prescription opioids and associated negative health outcomes is a leading public health crisis among adolescents in the US. Opioid prescription rates, misuse, and overdose deaths have increased among adolescents in the last twenty years. This commentary highlights trends in prescribing opioids and medication misuse among adolescents in the US and sheds light on reasons and motives for misuse of prescription opioids among adolescents. It discusses recent educational initiatives which promote medication safety, describes current practices, and recommends effective strategies to enhance prescription opioid safety among adolescents. Opportunities to enhance opioid medication safety among adolescents are frequently overlooked. A critical strategy to combat opioid misuse and overdose deaths among adolescents involves increasing awareness and knowledge about safe medication use.

April 2018 Flores Settlement Suit Challenges Unlawful Administration of Psychotropic Medication to Immigrant Children.

A lawsuit filed in April 2018 alleges unlawful administration of psychotropic medications to detained immigrant children in US custody. The suit, under jurisdiction of the Flores Settlement Agreement of 1997, alleges misuse of psychotropic medication to chemically restrain and control immigrant children and prolong their detention. This article describes the legal scope of the suit and considers significant ethically and clinically relevant questions it poses.

HEALTH CARE PROVIDERS` KNOWLEDGE AND SKILLS RELATED TO INHALER MEDICATIONS TECHNIQUES AT MANSOURA CHEST DISEASE HOSPITAL

Background:Inhaled therapy is the cornerstone of asthma management in that it optimizes the delivery of the medication to the site of action. The effectiveness of inhaled therapy is affected by the correct choice of the device and proper inhalation technique. Misuse of an inhaler medication is common in clinical practice, and proper training of patients and health care providers is important. The aim was to assess health care provider`s knowledge and skills related to inhaler medications techniques at Mansoura Chest Disease Hospital. Method the study use a descriptive exploratory research design. Setting: The study was conducted at Mansoura Chest Disease Hospital .The study sample: was all available health care providers( 102 nurse and 40 physician) affiliated to the previously mentioned setting. Tools: Structured Interview Questionnaire 1) Socio-Demographic characteristic 2) health care provider`s knowledge related to inhaler medications 3) Inhaler medications checklist. Consists of three parts꞉ 3.1:Metered dose inhaler (MDI) checklist. 3.2:Accuhaler Inhaler Technique (Diskus) checklist.3.3:aerolizer /Handhaler Technique checklist. Results, showed that the majority (90.2%) of the nurses reported that they didn’t receive any training courses regarding inhaler whereas, more than two fifths (42.5%) of physician received. There was a significant relation between the participant age, years of experience, and training courses. There was a highly statistical significant relation between nurses and physician and their total level of knowledge and skills. Recommendation, study recommended that development of educational program for doctors and nurses to improve their knowledge and skills regarding inhalers to prevent misuse of inhalers.

HEALTH CARE PROVIDERS` KNOWLEDGE AND SKILLS RELATED TO INHALER MEDICATIONS TECHNIQUES AT MANSOURA CHEST DISEASE HOSPITAL

Background:Inhaled therapy is the cornerstone of asthma management in that it optimizes the delivery of the medication to the site of action. The effectiveness of inhaled therapy is affected by the correct choice of the device and proper inhalation technique. Misuse of an inhaler medication is common in clinical practice, and proper training of patients and health care providers is important. The aim was to assess health care provider`s knowledge and skills related to inhaler medications techniques at Mansoura Chest Disease Hospital. Method the study use a descriptive exploratory research design. Setting: The study was conducted at Mansoura Chest Disease Hospital .The study sample: was all available health care providers( 102 nurse and 40 physician) affiliated to the previously mentioned setting. Tools: Structured Interview Questionnaire 1) Socio-Demographic characteristic 2) health care provider`s knowledge related to inhaler medications 3) Inhaler medications checklist. Consists of three parts꞉ 3.1:Metered dose inhaler (MDI) checklist. 3.2:Accuhaler Inhaler Technique (Diskus) checklist.3.3:aerolizer /Handhaler Technique checklist. Results, showed that the majority (90.2%) of the nurses reported that they didn’t receive any training courses regarding inhaler whereas, more than two fifths (42.5%) of physician received. There was a significant relation between the participant age, years of experience, and training courses. There was a highly statistical significant relation between nurses and physician and their total level of knowledge and skills. Recommendation, study recommended that development of educational program for doctors and nurses to improve their knowledge and skills regarding inhalers to prevent misuse of inhalers.

Bone health in adult women with ED: A longitudinal community-based study

Although Eating Disorders (ED) are known to affect bone health and development, little is known about the longitudinal effect of ED and ED behaviours on bone health in community dwelling adult women.Women (n = 3507) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) participated in a two-phase prevalence study to assess lifetime ED and ED behaviours (fasting, restrictive eating, vomiting and misuse of medication). Crude and adjusted linear regression methods investigated the association between ED diagnoses and behaviours, and total body, hip, leg and arm bone mineral density (BMD) DXA scans at mean ages of 48 and 52 years.Lifetime occurrence of Anorexia Nervosa (AN) was associated with lower BMD Z-scores for the whole body (mean difference (MD) = −0.28; 95% CI: -0.49, −0.05), hip (MD = −0.45; 95% CI -0.74, −0.16), leg (MD = −0.28; 95% CI -0.52, −0.03) and arm (MD = −0.44; 95% CI -0.68, −0.19) compared to no ED. This effect was mostly accounted for by lowest ever BMI. In post-hoc analyses, Restrictive AN, but not Binge-Purge AN was associated with a lower total body BMD Z-scores (MD = −0.37; 95% CI -0.62, −0.12). Lifetime Fasting and Restrictive Eating were associated with low BMD of the total body, hip, arm and leg in adjusted analyses, all p < 0.05.Both lifetime ED diagnoses and ED behaviours in a large community sample were predictive of low BMD in mid-life. This study confirms that the effects of AN, fasting and restrictive eating, and low BMI on bone health seen in clinical samples also occur in community samples.

Prescription Medication Misuse.

In the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pain, seizures, spasticity) where the prescriptions of medications with misuse potential are indicated. It is therefore imperative that neurologists understand which medications are liable to misuse and institute strategies to minimize the harm associated with these medications. The authors review the most common medications prescribed by neurologist with misuse potential, and briefly discuss the behaviors that are suggestive of medication misuse and tools for monitoring patients to minimize medication-related harm from misuse.

Age-specific risk of substance use disorders associated with controlled medication use and misuse subtypes in the United States

ObjectiveTo examine the age-specific risk of past-year substance use disorders (SUDs) associated with use and misuse of prescription opioids, stimulants, sedatives and tranquilizers. MethodsThe authors analyzed nationally representative data from 114,043 U.S. individuals aged 12 and older in the 2015–2016 National Survey on Drug Use and Health. For each controlled medication class, logistic regression was used to model any past-year SUD as a function of use pattern: no use or misuse, use without misuse, prescription drug misuse (PDM). Among individuals reporting PDM, logistic regression was used to model any past-year SUD as a function of PDM subtype (misuse of someone else's medication only, misuse of one's own medication only, and misuse of one's own and someone else's medication). Analyses were stratified by age group. ResultsControlled medication use was associated with higher odds of any past-year SUD compared to no use in many age groups and medication classes. Compared to non-use, PDM was associated with higher odds of any past-year SUD across virtually all age groups and medication classes. Compared to misuse of one's own medication only, misuse of both someone else's and one's own medication was associated with higher odds of any past-year SUD for many age groups and medication classes among individuals reporting PDM. ConclusionsClinicians should screen all controlled medication users for PDM and SUDs. Age-specific screening may be required due to heterogeneity in the prevalence and risks of use and misuse of different medications. Determination of PDM subtype can guide interventions to prevent SUDs.

Misuse of anxiety medications in adult population in Serbia-National survey

Misuse of anxiety medications in adult population in Serbia-National survey

Misuse of anxiety medications in adult population in Serbia-National survey

Misuse of anxiety medications in adult population in Serbia-National survey

Computer-based personalized feedback intervention for cigarette smoking and prescription analgesic misuse among persons living with HIV (PLWH)

Pain, tobacco cigarette smoking, and prescription opioid misuse are all highly prevalent among persons living with HIV (PLWH). Smoking and pain medication misuse can lead to deleterious outcomes, including more severe pain and physical impairment. However, we are not aware of any interventions that have attempted to address these issues in an integrated manner. Participants (N = 68) were recruited from an outpatient infectious disease clinic and randomized to either a computer-based personalized feedback intervention (Integrated PFI) that aimed to increase motivation, confidence, and intention to quit smoking, and decrease intentions to misuse prescription analgesic medications, or a Control PFI. Results indicated that PLWH who received the Integrated PFI (vs. Control PFI) evinced greater post-treatment knowledge of interrelations between pain and tobacco smoking. Moreover, participants who received the Integrated PFI and smoked at least 10 cigarettes per day (but not < 10 CPD) reported greater confidence and readiness/intention to quit smoking. Effects of the Integrated PFI on knowledge of pain and opioid misuse, and attitudes/intentions regarding prescription pain medication misuse were not statistically-significant. Taken together, these results indicate that this novel intervention strategy may offer promise for addressing a critical public health need in a population that is generally underrepresented in clinical research.

Prescription Drug Monitoring Programs: Does the Arizona CSPMP Provide More Information than Routinely Collected in an Inpatient Psychiatric Facility?

Background: Prescription drug monitoring programs (PDMPs) have been implemented as tools to help identify misuse of prescription medications. There has been mixed data regarding the efficacy of PDMP, and physician attitudes towards it vary. In an inpatient psychiatric hospital, history of substance use, including prescription medications, and results of urine drug screens (UDS) are obtained during the admission interview. Objectives: The aim was to determine if the substance use history and UDS are sufficient to identify substance use as compared to information obtained by Arizona’s Controlled Substance Prescription Monitoring Program (CSPMP) in an inpatient setting. Methods: A prospective chart review was completed on all newly admitted patients to the behavioral units within a 30-day period to identify those that had substance use disorder. CSPMP records were checked for all subjects for patterns of misuse. The test results were not normally distributed, so non-parametric tests were chosen for analyses. Results: Of the 220 patients admitted, 127 patients had a substance use diagnosis. Out of the 127 patients, 67(30.5 %) were diagnosed with either opioid, benzodiazepine or amphetamine and stimulant use disorder. Of the 125 (56.8%) patients who had a substance use disorder, the substance abuse diagnosis had been made by the psychiatrist in the medical chart. CSPMP identified only 2 (0.8%) additional patients that were missed during the intake. Conclusions: The CSPMP provided little benefit to improving substance abuse detection when compared with the clinical interview and UDS results. This is attributed to the comprehensive evaluation done during the intake.

Prescription opioid medication misuse among university students.

Prescription opioid misuse is an established problem in the United States. Less information is known regarding the clinical and cognitive characteristics of prescription opioid misusers, specifically in a college age population. This study sought to characterize individuals who misuse prescription opioids and the differences between current, past and non-misusers. A 156-item survey was administered to over 9,449 university students at a large, public Midwestern university. Survey questions obtained demographic information, self-reported grade point average, sexual behavior, mental health characteristics, and substance use. Participants also completed assessments that asked questions regarding impulsivity, mental health, substance use, and other impulsive behaviors including gambling and sexual activity. 3,522 students completed the survey and were included in the analysis. Of this group, 2.2% reported misusing prescription opioids in the last 12 months and another 5.3% reported misusing prescription opioids previously but not in the past year. This study found prescription opioid misusers to be more likely to live off campus, have a lower GPA, and exhibit increased impulsivity. Prescription opioid misusers were also more likely to report earlier age of sexual activity and were less likely to use barrier protection during sexual activity. This study identifies a number of risk factors for those misusing prescription opioids that can be used to develop and refine prescription opioid misuse screening tools for university health centers. It also identifies a number of concurring behaviors that can simultaneously be addressed when prescription opioid misusers are identified. (Am J Addict 2018;XX:1-7).

Medical marijuana legalization and associated illicit drug use and prescription medication misuse among adolescents in the U.S.

BackgroundUse of illicit drugs and misuse of prescription medications among U.S. adolescents have been major public health issues. As over half of the states have implemented medical marijuana laws (MMLs), it is unclear if MML implementation is associated with use of illicit drugs and misuse of prescription medications among adolescents. MethodsThis study used data from the 2013–2014 National Survey of Drug Use and Health and included adolescents aged 12–18 with a total of 26,826 participants after the propensity-score matching used to reduce selection bias between states that had and had not implemented MML. Seven logistic regressions were conducted to examine MML implementation and associated use of illicit drugs (including cocaine/crack, heroin, hallucinogens, and inhalants) and misuse of prescription medications (including pain relievers, tranquilizers/sedatives, and stimulants), controlling for sociodemographics and use of cigarettes, alcohol, and marijuana. ResultsAdolescents residing in the states that had legalized medical marijuana were more likely to use cocaine/crack and heroin in the past 12 months (OR = 1.63, 2.61, respectively; both ps < 0.05). However, MML implementation was not associated with the likelihood of using other illicit drugs or misusing prescription medications. ConclusionsThe study findings suggest that for the states that have implemented MML, policy and educational interventions should as well be implemented to prevent not only marijuana use but also use of other harder drugs such as cocaine/crack and heroin among adolescents. States that have yet implemented MML should consider the possible associations between MML implementation and use of other illicit drugs when legislating MML.

Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults.

Suicide in older adults is a major public health issue. Past research across the US adult population has linked prescription medication misuse with suicidal ideation. No work has evaluated associations between prescription opioid or benzodiazepine misuse and suicidal ideation in older adults, and this work aimed to address that gap. Data were from adults 50years and older participating in the 2015 to 2016 National Survey on Drug Use and Health (n=17608). Design-based logistic regression evaluated links between any past-year prescription opioid or benzodiazepine use without misuse or prescription misuse and past-year suicidal ideation, after controlling for sociodemographic, physical health, mental health, and substance use correlates associated with suicidal ideation. After controlling for all correlates, past-year use without misuse of prescription opioids or benzodiazepines was not associated with past-year suicidal ideation in older adults. In contrast, past-year opioid misuse (AOR=1.84, 95% CI=1.07-3.19) and benzodiazepine misuse (AOR=2.00, 95% CI=1.01-3.94) were significantly associated with past-year suicidal ideation, even after controlling for all covariates. While 2.2% of US older adults not engaged in either opioid or benzodiazepine misuse reported past-year suicidal ideation, 25.4% of those who misused both medication classes endorsed such suicidality (AOR=4.73, 95% CI=2.07-10.79). Both past-year prescription opioid and benzodiazepine misuse are associated with past-year suicidal ideation in US older adults. Clinicians encountering older adult patients at-risk for or engaged in prescription medication misuse also should screen for suicidality.

Practices Surrounding Pain Management Among American Indians and Alaska Natives in Rural Southern California: An Exploratory Study.

This exploratory study examined pain management practices among American Indians and Alaska Natives in the service area of a rural tribal clinic in Southern California. Researchers invited 325 individuals to complete an anonymous survey in clinic waiting rooms and tribal gatherings. Analyses of the 295 eligible responses included calculating frequencies and conducting multiple logistic regressions and a Mantel-Haenszel analysis. Among respondents in this study, being male, younger, and having less education were strong predictors for riskier methods for managing pain. Understanding the methods individuals use to manage pain in a rural setting constitute a stepping-stone to develop strategies for reducing and preventing misuse and abuse of prescription medications and other drugs in rural American Indian and Alaska Native communities.

Is ADHD, independent of ODD, associated with whether and why college students misuse stimulant medication?

Although previous research suggests that undergraduates with untreated or undertreated attention-deficit/hyperactivity disorder (ADHD) symptoms may have academic motives for stimulant medication misuse, no previous work has examined the relation of ADHD symptoms, controlling for comorbid oppositional defiant disorder (ODD), to misuse, or has explored how these symptoms are differentially related to motives for misuse. Among a sample of 900 students from one public university, the current study first tested whether increased ADHD symptomology (using the Current Symptoms Scale, CSS) was associated with an increased likelihood of misusing stimulant medication, controlling for comorbid ODD. We then examined whether those with increased ADHD symptomology were more likely to report academic motives for misuse. The prevalence rate of misuse in the past year was 22%. Participants who met symptom count criteria for ADHD (controlling for comorbid ODD) were 2.90 times more likely to misuse stimulant medication than those who did not. Among misusers, those who met ADHD criteria were also 2.80 times more likely to report academic motives for misuse. These results support that stimulant medication misuse is likely driven, in part, by inadequate or absent care for the executive functioning impairments associated with ADHD. Therefore, a greater focus on assessment and treatment of college students with ADHD symptoms is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Marijuana use by middle-aged and older adults in the United States, 2015–2016

BackgroundMarijuana use is increasing among middle-aged and older adults in the US, but little is understood of its pattern of use by this population. MethodsWe performed a cross-sectional analysis of responses from 17,608 adults aged ≥50 years from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. Prevalence of past-year marijuana use was estimated and compared between middle-aged adults (age 50–64) and older adults (≥65). Characteristics of past-year marijuana users including demographics, substance use, chronic disease, and emergency room use, were compared to non-marijuana users and stratified by age group. Marijuana use characteristics were also compared between middle-aged and older adults. We used multivariable logistic regression to determine correlates of past-year marijuana use. ResultsPrevalence of past-year marijuana use was 9.0% among adults aged 50–64 and 2.9% among adults aged ≥65. Prevalence of past-year alcohol use disorder (AUD), nicotine dependence, cocaine use, and misuse of prescription medications (i.e., opioids, sedatives, tranquilizers) were higher among marijuana users compared to non-users. In adjusted models, initiation of marijuana use <19 years of age [adjusted odds ratio (AOR) = 13.43, 95% confidence interval (CI) 9.60, 18.78)], AUD (AOR = 2.11, 95% CI 1.51, 2.94), prescription opioid misuse (AOR 2.49, 95% CI 1.61, 3.85), nicotine dependence (AOR = 1.90, 95% CI 1.59, 2.26), and cocaine use (AOR 7.43, 95% CI 4.23, 13.03), were all associated with increased odds of past-year marijuana use. ConclusionMarijuana use is becoming more prevalent in this population and users are also at high risk for other drug use.

Prospective Validation of Clinical Criteria to Identify Emergency Department Patients at High Risk for Adverse Drug Events.

ObjectivesAdverse drug events (ADEs) cause or contribute to one in nine emergency department (ED) presentations in North America and are often misdiagnosed. EDs have insufficient clinical pharmacists to complete medication reviews in all incoming patients, even though pharmacist‐led medications reviews have been associated with improved health outcomes. Our objective was to validate clinical decision rules to identify patients presenting with ADEs so they could be prioritized for pharmacist‐led medication review.MethodsThis multicenter, prospective study was conducted in two tertiary and one community hospital in Canada. We enrolled 1,529 adults presenting to EDs over 12 months. We applied two clinical decision rules and collected baseline variables prior to assessments by clinical pharmacists and physicians. We compared the physician and pharmacist diagnoses with the decision rule results. The primary outcome was a moderate or severe ADE, defined as an unintended and harmful event related to medication use or misuse, which required a change in medical therapy, diagnostic testing, consultation, or admission. An independent committee adjudicated uncertain and discordant cases. We calculated the diagnostic accuracy of both rules.ResultsAmong 1,529 patients, 184 (12.0%) were diagnosed with an ADE. Rule 1 contained the variables 1) having a preexisting medical condition or having taken antibiotics within 1 week and 2) age > 80 years or having a medication change within 28 days. They had a sensitivity of 91.3% (95% confidence interval [CI] = 86.3%–95.0%) and a specificity of 37.9% (95% CI = 35.3%–40.6%) for ADEs.ConclusionsOur study validated clinical decision rules that can be applied by clinical pharmacists to limit the number of patients requiring medication review, while identifying the majority of patients presenting with clinically significant ADEs.

Physician Training and Qualification to Educate Patients on Attention-Deficit/Hyperactivity Disorder Stimulant Diversion and Misuse.

The increased number of adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in recent years has raised concerns regarding diversion and misuse of prescription stimulant medications. As prescribers of these medications, physicians must be prepared to educate patients on these issues. This is the first study to evaluate physician training and qualification to educate adolescent patients on stimulant diversion and misuse. A questionnaire was developed and mailed to a national sample of child and adolescent psychiatrists (CAPs), child neurologists (CNs), and developmental-behavioral pediatricians (DBPs) in the United States. In addition to descriptive statistics, multivariable regressions (log-binomial and ordinal logistic) were performed to identify differences between subspecialists. The final sample consisted of 826 physicians who currently prescribe stimulants. Only 48% of physicians reported receiving formal training on prescription drug diversion (PDD) in medical school, residency, and/or fellowship. Twenty five percent and 48% of physicians felt inadequately qualified to educate patients on the health and legal consequences, respectively, of stimulant misuse and diversion. CAPs were more likely to have received formal training and felt better qualified to educate patients than CNs and DBPs. Physicians who received formal training were 2.4 times more likely to feel adequately qualified to educate patients on these issues. Only 58% of physicians correctly answered a legal question relating to stimulant diversion. Most physicians have not received formal training on PDD and many feel inadequately qualified to educate patients on the health and legal consequences of stimulant misuse and diversion. Increased training is needed so physicians can effectively educate patients with ADHD.

Development of a standardized chart review method to identify drug-related hospital admissions in older people.

We aimed to develop a standardized chart review method to identify drug-related hospital admissions (DRA) in older people caused by non-preventable adverse drug reactions and preventable medication errors including overuse, underuse and misuse of medications: the DRA adjudication guide. The DRA adjudication guide was developed based on design and test iterations with international and multidisciplinary input in four subsequent steps: literature review; evaluation of content validity using a Delphi consensus technique; a pilot test; and a reliability study. The DRA adjudication guide provides definitions, examples and step-by-step instructions to measure DRA. A three-step standardized chart review method was elaborated including: (i) data abstraction; (ii) explicit screening with a newly developed trigger tool for DRA in older people; and (iii) consensus adjudication for causality by a pharmacist and a physician using the World Health Organization-Uppsala Monitoring Centre and Hallas criteria. A 15-member international Delphi panel reached consensus agreement on 26 triggers for DRA in older people. The DRA adjudication guide showed good feasibility of use and achieved moderate inter-rater reliability for the evaluation of 16 cases by four European adjudication pairs (71% agreement, κ=0.41). Disagreements arose mainly for cases with potential underuse. The DRA adjudication guide is the first standardized chart review method to identify DRA in older persons. Content validity, feasibility of use and inter-rater reliability were found to be satisfactory. The method can be used as an outcome measure for interventions targeted at improving quality and safety of medication use in older people.