Nonmedical Use Of Pain Relievers Research Articles

Prescription Opioid Misuse and Property Crime

AbstractWhile there is an extensive literature on the relationship between drug use and crime, research on crime stemming from the recent uptick in opioid misuse is surprisingly sparse, and much of it provides contradictory answers. Using state‐level data and dynamic panel techniques, we find evidence of a large, positive association between nonmedical use of pain relievers and property crime. The correlation is strongest for the youngest users, holds for multiple classes of property crime, and its magnitude suggests hundreds of thousands of excess property crimes over the study period resulting from even modest increases in opioid abuse. We also present evidence of a link between prescribing rates and crime. Evidence of a link between pain relievers and violent crime is much weaker, as is evidence of an association between other drugs and crime. Our use of robust panel inference helps to address endogeneity concerns that can arise in other studies, many of which also draw conclusions from small or nonrepresentative samples.

Association between Nonmedical Marijuana and Pain Reliever Uses among Individuals Aged 50+

ABSTRACTMarijuana and pain reliever use for medical and nonmedical purposes has been increasing among older adults. Using the 2012–2013 U.S. National Survey on Alcohol and Related Conditions (NESARC-III), this study examined: (1) the association between past-year nonmedical marijuana and pain reliever use among adults aged 50+ years (N = 14,715); and (2) sociodemographic, health, and pain-related correlates of nonmedical marijuana and/or pain reliever use. The findings show that 3.87% and 3.12%, respectively, used marijuana and pain relievers nonmedically and 14.40% of marijuana users, compared to 2.67% of nonusers, used pain relievers nonmedically. Controlling for sociodemographics, health status, pain interference, and mental and other substance use disorders, marijuana use anduse disorder were significantly associated with nonmedical pain reliever use and opioid use disorder, respectively. Compared to marijuana users (with or without nonmedical use of pain relievers), nonmedical pain reliever users (without marijuana) are older, married, and women. Users of both substances nonmedically are a small group (0.56% of the 50+ age group), but they are at greatest risk of lifetime opioid, alcohol, and nicotine use disorders. Pain interference is a significant correlate of nonmedical pain reliever use. Healthcare providers should assess for the nonmedical use of these medicines/drugs and help older adults receive effective pain treatment.

The nonmedical use of pain relievers among African-Americans: a test of primary socialization theory

Using primary socialization theory (PST), we examined the nonmedical use of prescription pain relievers among African-American adolescents in the National Survey of Drug Use and Health (NSDUH) 2013. Self-reported nonmedical use of pain relievers, PST constructs, and covariates were addressed using cluster logistic regression. The results indicated that the perception of associating with substance using peers and poor parental bonds were more likely to nonmedically use prescription pain relievers. The limitations and implications for future research are noted.

In vitro assessment of the potential for abuse via the intravenous route of oxycodone DETERx® microspheres.

Abuse of prescription analgesics is a well-recognized problem, with nearly 2 million people aged 12 years or older initiating nonmedical use of pain relievers in 2012. The prevalence of opioid abuse via intravenous (IV) injection has led to the development of dosage forms designed to deter abuse using different inactive ingredients and formulation strategies. This study evaluated the IV abuse potential for a novel, microsphere-encapsulated abuse-deterrent formulation of oxycodone, Xtampza™ ER (referred to as "oxycodone DETERx"). The extraction of oxycodone DETERx and two comparators, extended-release oxycodone (oxycodone ER) and immediate-release oxycodone (oxycodone IR), was evaluated in small volumes (5 and 10 mL) of water after manipulation of the dosage forms. The syringeability and injectability of these products were evaluated to determine the feasibility of using these products via IV injection. The extraction of oxycodone from oxycodone DETERx was nominal, with <12 percent extracted under any test condition. Oxycodone ER and oxycodone IR had as much as 83 and 98 percent oxycodone extracted, respectively. Injectability and syringeability analyses showed that injection of oxycodone DETERx microspheres in suspension is not feasible. In contrast, oxycodone ER and oxycodone IR suspensions were more easily drawn into and expelled from a syringe. Furthermore, injection of molten oxycodone DETERx microspheres was also shown to be ineffective. The chemical and physical properties of oxycodone DETERx provide barriers to manipulating the microspheres for the purpose of IV injection.

Adolescent Nonmedical Use of Prescription Pain Relievers, Stimulants, and Depressants, and Suicide Risk

Background: Although the link between drug abuse and suicide risk is established, few studies have examined the relationship between the nonmedical use of prescription drugs (NMUPD) and suicide risk, particularly among adolescents. Objectives: To explore the relationship between NMUPD and suicide risk among 4,148 adolescents in grades 9–12 enrolled in five public high schools. Methods: Logistic regression models were constructed for the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD. Models were estimated before and after controlling for key covariates. Results: About 21% of respondents reported lifetime NMUPD. After covariate adjustment, students who had reported any NMUPD were between 1.7 and 2.3 times more likely to report suicidal ideation, but not a suicide attempt (p < .0001). When stratified by sex and drug, nonmedical use of pain relievers, stimulants, and depressants were significantly associated with greater odds of suicidal ideation and behavior for both males and females (p < .05). However, NMUPD of pain relievers were not associated with greater odds of suicide attempts for males or females or among males who reported nonmedical use of stimulants. Nonmedical use of depressants was associated with greater odds of suicide attempts for both males and females (OR = 1.61 and 2.25, respectively) and among females who reported nonmedical use of stimulants (OR = 2.06, p < .01). Conclusions/Importance: Results suggest that some adolescents may be inappropriately self-medicating psychological distress with prescription medications or NMUPD may promote suicide risk, especially for males and females who use depressants and females who use stimulants.

SAMHSA Data May Help Inform Efforts to Prevent College Students’ Drug Use

Back to table of contents Previous article Next article Professional NewsFull AccessSAMHSA Data May Help Inform Efforts to Prevent College Students’ Drug UseVabren WattsVabren WattsSearch for more papers by this authorPublished Online:28 Sep 2015https://doi.org/10.1176/appi.pn.2015.9b19AbstractEfforts to intensify parental monitoring or substance use prevention messaging during the peak months may serve to amplify their impact.A new study by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that summer months and the periods surrounding final examinations may be the riskiest times for college students to initiate illicit substance use.“Illicit drug and alcohol use are common practices for many college students with about 1 out of every 5 full-time college students aged 18 to 22 having used illicit drugs in the past month and over half having drunk alcohol,” wrote Rachel Lipari, Ph.D., a statistician at SAMHSA’s Center for Behavioral Health Statistics and Quality and author of the report. “However, less is known about initiation of substance use by college students, particularly about monthly variations in initiation.”Lipari’s analysis, which included combined data from the National Survey on Drug Use and Health (NSDUH) studies from 2002 to 2013, examined the average number of full-time college students using illicit substances for the first time per day for the year, broken down by month.The results showed that when it comes to alcohol use, 450,000 underage full-time college students (aged 18 to 20) started drinking in the past year, which Lipari calculated to be around 1,200 students per day on average throughout the year. Underage drinking initiation peaked among those students in June, with an average of 1,883 underage college students starting to drink each day of that month. Alcohol use is defined as having more than a sip or two from a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink containing liquor.The month of June also reigned as the riskiest month for first-time marijuana use, with approximately 1,500 students using marijuana for the first time each day (around 500 more students initiating use daily than the average for the year). June was also the most popular month for college students to have a first-time experience with inhalants such as nitrous oxide, amyl nitrite, cleaning fluid, and gasoline, with around 300 college students trying them for the first time (around 100 more students per day than the daily average for the year).First-time nonmedical use of prescription-type pain relievers and stimulants by college students peaked in the winter months; an average of 850 students reported the nonmedical use of pain relievers per day in December (around 150 more students initiating use daily than the average for the year) and an average of 585 students per day initiated stimulant use in November (about 180 more new users per day than the average for the year). “Although initiation of substance use can occur at any time, the summer months remain a period of unique vulnerability for young people,” Lipari wrote. “Intensifying parental monitoring or substance use prevention messaging during these peak months of initiation may amplify their impact.”Although the report was not designed to determine the cause behind the trends in the initiation of illicit substance abuse, Lipari noted that the uptick in first-time use of prescription stimulants for nonmedical use coincides with the times of the year that many college midterm and final exams occur. This timing, she added, may indicate that some full-time college students start nonmedical use of prescription stimulants in the belief that the drugs might enhance their academic performance. (Nonmedical use of stimulants has not been proven to improve academic performance and can pose serious medical risks, according to SAMHSA.)“Although college is a period of life when young people try many new experiences, substance use initiation during college is not a ‘rite of passage’ during the transition to adulthood,” Lipari wrote. “Providing college students with credible and accurate information about the harm associated with substance use is crucial to prevention programming,” she concluded. ■“Monthly Variation in Substance Use Initiation Among Full-Time College Students” can be accessed here. ISSUES NewArchived

Buprenorphine-naloxone treatment of prescription opioid abuse: does past performance predict future results?

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Misuse of prescription opioids is a national public health problem: In the United States, according to the 2012 National Survey on Drug Use and Health, 4.5 million, or 1.7%, of persons aged 12 or older reported current nonmedical use of pain relievers, and 335,000 reported currently using heroin. This is an upward trend, as heroin use has more than doubled since 2002. Transition from ingesting or insufflating (ie, snorting) prescription opioids to snorting or smoking (ie, inhaling the fumes) heroin has become more common and is driven by the increasing purity and lower cost.

A survey of nonmedical use of tranquilizers, stimulants, and pain relievers among college students: Patterns of use among users and factors related to abstinence in non-users

BackgroundThis study examined lifetime non-medical prescription drug use among college students at a small liberal arts college in the Northeast. We assessed the motives, frequency of use, sources, and perceived emotional/physical risks of nonmedical prescription drugs. Specifically, we examined the non-medical use of prescription pain relievers, stimulants, and anti-anxiety medication. MethodsWe sent an internet-based survey to 1/3 of the student body and 303 students completed the survey. ResultsWe found that 36.8% of the sample reported using prescription drugs for non-medical purposes. First-year students were less likely to have used the drugs than those in other class years. Of those reporting use, 48% reported non-medical use of pain relievers, 72.8% reported using stimulants, and 39.8% reported using anti-anxiety medication. The most commonly used pain relievers were Vicodin (hydrocodone/acetaminophen), OxyContin (oxycodone), and codeine (acetaminophen/codeine). The most commonly used stimulants were Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate), while the most commonly used anti-anxiety medication was Xanax (alprazolam). When non-users were asked what factors influenced their choice not to abuse prescription drugs, 82% cited a lack of interest, 61% responded it was due to a fear of damaging their physical health, and 60.1% responded fear of damaging their mental health. ConclusionThis study supports recent findings that show widespread non-medical use of prescription drugs among college students. Our report brings a more detailed understanding of the patterns of drug usage, and the factors influencing both drug use in those who use them and abstinence in those who choose not to use them.

Prevalence of heroin markers in urine for pain management patients

Surveys of current trends indicate heroin abuse is associated with nonmedical use of pain relievers. Consequently, there is an interest in evaluating the presence of heroin-specific markers in chronic pain patients who are prescribed controlled substances. A total of 926,084 urine specimens from chronic pain patients were tested for heroin/diacetylmorphine (DAM), 6-acetylmorphine (6AM), 6-acetylcodeine (6AC), codeine (COD), and morphine (MOR). Heroin and markers were analyzed using liquid chromatography tandem mass spectrometry (LC–MS–MS). Opiates were analyzed following hydrolysis using LC–MS–MS. The prevalence of heroin use was 0.31%, as 2871 were positive for one or more heroin-specific markers including DAM, 6AM, or 6AC (a known contaminant of illicit heroin). Of these, 1884 were additionally tested for the following markers of illicit drug use: 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MAMP), 11-nor-9-carboxy-Δ9-tetracannabinol (THCCOOH), and benzoylecgonine (BZE); 654 (34.7%) had positive findings for one or more of these analytes. The overall prevalence of heroin markers were as follows: DAM 1203 (41.9%), 6AM 2570 (89.5%), 6AC 1082 (37.7%). MOR was present in 2194 (76.4%) and absent (<LOQ) in 677 (23.6%) of the heroin-positive specimens. COD was present in 1218 (42.4%) specimens. Prevalence of combinations for specimens containing MOR were as follows: DAM only 13 (0.59%), 6AM only 1140 (52.0%), 6AC only 24 (1.1%), DAM/6AM/6AC 710 (32.4%), 6AM/6AC 188 (8.6%), DAM/6AM 113 (5.2%), DAM/6AC 6 (0.27%). Importantly, the prevalence of combinations for specimens without MOR were as follows: DAM only 161 (23.8%), 6AM only 217 (32.1%), 6AC only 92 (13.6%), DAM/6AM/6AC 50 (7.4%), 6AM/6AC 7 (1.0%), DAM/6AM 145 (21.4%), DAM/6AC 5 (0.74%). Unexpected patterns of excretion were observed, such as the presence of DAM and 6AC in the absence of 6AM and MOR; therefore, multiple heroin markers may be useful to assess for heroin use.

Adult Nonmedical Prescription Drug Use: An Examination of Bond Theory

Using data from the 2010 National Survey of Drug Use and Health (NSDUH), this research examines the extent to which social bonds predict nonmedical prescription drug use among adults. Logistic regression analyses reveal that marital bonds are consistently and negatively related to various types of nonmedical drug use net other social and medical factors; however, employment bonds are only significant and negative in models predicting nonmedical pain reliever use. Analyses of interaction terms between gender and social bonds are examined but are found non-predictive. Issues concerning a lack of data availability for adult nonmedical drug use and the quality of adult bonds are discussed.

Nonmedical Use of Prescription Medications Among Adolescents in the United States: A Systematic Review

The purpose of this review was to systematically summarize research on nonmedical use of prescription medications (NMUPM) among U.S. adolescents, with specific focus on scheduled medications falling into one of the following drug classes: pain relievers, stimulants, sedatives, or tranquilizers. Databases were searched for peer-reviewed primary quantitative research published between January 2000 and June 2011 on NMUPM among out-of-treatment U.S. adolescents aged 12-17 years (or age 18 if enrolled in high school). Thirty publications met inclusion criteria. A total of 25 studies were represented; 15 involved nationally representative samples. The prevalence and correlates of NMUPM varied across studies and by drug class. Nonmedical use of pain relievers was more prevalent than for stimulants, sedatives, and tranquilizers. Female gender was generally associated with pain reliever use and, to a lesser degree, with tranquilizer use. White adolescents also appeared to have a higher prevalence of NMUPM, although there was some evidence to the contrary. Older age, illicit drug use, and delinquency were consistently associated with NMUPM across studies. This review identified several areas for further research, including that of racially/ethnically diverse samples of adolescents, more focus on sedative and tranquilizer use, and longitudinal research to examine temporal patterns in NMUPM and other illicit drug use, delinquency, and substance abuse and dependence.

The Changing Face of Opioid Addiction: Prescription Pain Pill Dependence and Treatment

In recent years there has been a dramatic increase in the abuse of and dependency on prescription opioid pain medications (also known as narcotics). Viewed as safer than street drugs like heroin, prescription pain pill misuse is on the increase in all age ranges. Frequently abused prescription pain medications include hydrocodone (Lorcet, Lortab, Vicodin), oxycodone (OxyContin, Percocet, Percodan), codeine (Tylenol 2s, 3s, and 4s), fentanyl (Duragesic), and morphine (MS Contin). These drugs are commonly prescribed for acute pain (for example, tooth, post-injury, or surgery pain) or chronic pain (for example, back pain or pain associated with malignancy). Methadone, which is used both for the treatment of opioid dependence and for pain, is rising as a primary drug of abuse as well (Maxwell, 2006). Statistics over the past five years have shown that the misuse of prescription pain medications by students in grades 8 through 12 continues to rise, whereas use of illegal drugs, tobacco, alcohol, and steroids has decreased. Data from admissions to treatment facilities show that heroin as a primary drug of choice decreased from 2000 to 2005; during that same time period, admissions for other opioids increased (Center for Substance Abuse Research, 2007). According to the National Survey on Drug Use and Health (NSDUH) report (NSDUH, 2006), nonmedical use of prescription pain medications has increased among young adults ages 18 to 25. More people initiated use of prescription pain relievers in 2004 than began using marijuana or cocaine. Often these drugs are relatively easy to obtain, are viewed as safer than illegal drugs, and are less shameful to use. Although prescription pain pills are from the same class of drugs as heroin, the difficulty of diagnosis of abuse and dependence on them is increased because of their legitimate use and surrounding misconceptions. National Center of Health Statistics (Maxwell, 2006) data indicated that narcotic analgesics such as hydrocodone, oxycodone, and methadone were more likely to be the cause of death in accidental overdoses than either heroin or cocaine. The 213 percent increase in methadone accidental poisoning deaths between 1999 and 2003 was associated with the use of methadone as a pain medication rather than in opioid treatment programs (Maxwell, 2006). Such alarming statistics about the increase in the prevalence of prescription pain medication misuse with the corresponding damage to individuals and to society calls for study and better services. Individuals who abuse pain medication present a unique population in their sociodemographic characteristics and drug use patterns. More than half of the new users of prescription pain relievers are female, the average age of first nonmedical use of pain relievers was 25, and almost 90 percent of new users are white (NSDUH, 2006). This increase in the abuse of opioids by this group raises the need to target this population for treatment and to examine the effectiveness of existing treatment modalities. BUPRENORPHINE/NALOXONE AS A NEW PHARMACOLOGICAL TREATMENT Buprenorphine/naloxone, is an evidence-based pharmacological treatment that offers a new and different option for treatment of opioid dependence. This medication blocks the effects of other opioids and is difficult to abuse. It has been demonstrated to be effective with heroin dependence (Fiellin et al., 2002; Ling et al., 1998; Prescrire Editorial Staff, 2006), and studies are now being conducted by the National Institute on Drug Abuse (NIDA) to demonstrate its effectiveness with those dependent on prescription pain medication (see NIDA Clinical Trials Network at http://www.nida.nih.gov/ CTN/protocol/0030.html). Beginning in October 2002, physicians who take a sanctioned course can prescribe buprenorphine/naloxone as a sublingual tablet for opioid addiction from a private office rather than exclusively through specialized drug treatment centers. …

Drug Prevention Needs to Be Extended to Baby Boomers

Drug Prevention Needs to Be Extended to Baby Boomers

Prevalence of Illicit Drug use in Patients without Controlled Substance Abuse in Interventional Pain Management

Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. Various means suggested to avoid or monitor abuse in patients in treatment include urine/serum drug screening whenever requested, along with other precautions including one prescribing physician and one designated pharmacy, etc. Based on the present evidence, physicians assume that patients adhering to controlled substance agreements and without obvious dependency behavior do not abuse either illicit or licit drugs. Thus, it is accepted that there is no necessity to perform routine urine/drug testing in this specific group of the patient population. One hundred patients undergoing interventional pain management and receiving controlled substances were randomly selected for evaluation of illicit drug abuse by urine drug testing. They were selected from a total of 250 patients who were identified as non-abusers of prescription drugs. Results showed that illicit drug abuse in patients without history of controlled substance abuse was seen in 16 patients. Thirteen of the 16 patients tested positive for marijuana and 3 patients tested positive for cocaine. Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3%.