Nonmedical Prescription Opioid Use Research Articles

The Relationship of Psychological Distress and Living with Children and Adolescents for Adult Non-medical Prescription Opioid Users

Prescription opioid use has been recognized as a major public health crisis in the United States. In 2015, more than 2 million persons had an opioid-related substance use disorder. Past research has directly linked opioid misuse to mental health problems. Child welfare systems have observed the effect of the opioid epidemic on families. The purpose of this study is to examine the relationship of adult non-medical prescription opioid use with psychological distress for families with children and adolescents. This study used data from the 2015 National Survey on Drug Use and Health (NSDUH). The sample in this analysis included 38,775 adults 18 and older. Multivariate regression analysis using survey design weights was used to examine the effect of past year non-medical prescription opioid use on psychological distress, measured by the Kessler Psychological Distress Scale (K6). Results indicated that adult opioid misuse was associated with increased psychological distress (b = 0.47, 95% CI [0.23, 0.71], β = 0.02, p < .001). Subgroup analysis revealed that for adult opioid users, having children or adolescents in the household was associated with higher psychological distress (b = 0.72, 95% CI [0.18, 1.25], β = 0.02, p < .05), while for non-users, it was associated with lower psychological distress (b = − 0.13, 95% CI [− 0.24, − 0.03], β = − 0.02, p < .05). Public policies targeting this health crisis must consider how resources should address opioid use within family systems. Social workers are on the front-line among providers that serve adults who live with children and adolescents affected by this crisis, and can play a critical role in screening, assessing, and delivering mental health services for this at-risk population.

The effects of state rules on opioid prescribing in Indiana

BackgroundPrescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP’s on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups.MethodsAn interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients’ gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied.ResultsAfter controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0–20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers’ comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply.ConclusionsAlthough the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules’ effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing.

Gender differences in trends for heroin use and nonmedical prescription opioid use, 2007–2014

BackgroundTrends in the current opioid epidemic in the United States show that use of heroin is increasing while nonmedical use of prescription opioids is slowing. Understanding gender differences in these trends is essential to efforts to address the opioid epidemic. This study compared gender difference in trends in heroin and nonmedical prescription opioid use in the U.S. between 2007 and 2014. MethodsData from the National Survey on Drug Use and Health (NSDUH) were used to trace prevalence and to estimate risk for heroin and nonmedical prescription opioid use in the last year for women and men. ResultsPrevalence rates in the total sample (N = 447,188) indicate a notable increase in heroin use and a steady decline in the nonmedical use of prescription opioids between 2007 and 2014 for both women and men. Women are increasing heroin use at a faster rate than men but decreasing nonmedical prescription opioid use at a slower rate than men. Overall, risk factors for both heroin use and nonmedical prescription opioid use are similar to other illicit substances, but the magnitude of associations indicates that women may be at greater risk for the nonmedical use of prescription opioids than for the use of heroin. ConclusionsTrend analyses reveal a linear increase in heroin use and a quadratic decline in nonmedical prescription opioid use at the population level. The differential rates of change between men and women in use of both opioids highlight the need for comprehensive, gender-sensitive approaches to prevention and treatment for both heroin and nonmedical prescription opioid use. Future research should continue to explore gender differences in treatment access, including access to medication-assisted treatments and treatments integrated with health and social services, especially for women.

Preparing Your Pediatric Patients and Their Families for the Operating Room: Reducing Fear of the Unknown.

1. Adam C. Adler, MS, MD*,‡ 2. Stephanie Leung, BS, CCLS† 3. Benjamin H. Lee, MD*,‡ 4. Scott R. Dubow, MD§ 1. *Department of Anesthesiology, Perioperative and Pain Medicine and 2. †Department of Child Life, Texas Children’s Hospital, Houston, TX 3. ‡Baylor College of Medicine, Houston, TX 4. §Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA * Abbreviations: BiPAP: : bilevel positive airway pressure CLS: : child life specialist CPAP: : continuous positive airway pressure DEA: : Drug Enforcement Administration IV: : intravenous MRI: : magnetic resonance imaging OSA: : obstructive sleep apnea Clinicians should: identify the resources available to patients and families to allow for a smooth perioperative experience; understand the long-term effects and potential maladaptive changes associated with an anxiety-provoking perioperative period; understand the most common parental and patient concerns and misconceptions regarding surgery; understand the most common and up-to-date perioperative anesthesia practices; understand the indication for referral to the preoperative anesthesia clinic for patient evaluation to avoid unnecessary cancellation. Pediatricians are often tasked with preparing children and their families for the preoperative period and dealing with questions related to postoperative issues and concerns. Instruction based on current practice and new research and techniques may help patients and families cope with the stressors of surgery. Determining which patients may benefit from a medical or child life preoperative visit is of crucial importance. After completing this article, the reader should be able to: 1. Describe common preoperative anesthesia practice. 2. Recognize the role of a child life specialist in preparing children for surgery. 3. Differentiate children who would benefit from a preoperative anesthesia and/or child life evaluation. 4. Instruct patients and families on issues related to the perioperative period. 5. Address a wide array of parental concerns regarding surgery, anesthesia, and postoperative pain management. The period of time surrounding a planned surgical procedure can be tumultuous and anxiety provoking for both pediatric patients and their parents. The “mysterious place” that is the operating room often remains a mystery to many health care providers, including those tasked with caring for patients both before and after a procedure. As the health care provider most familiar to patients and their families, the pediatrician is in a …

Intersection of Stress and Gender in Association With Transitions in Past Year DSM-5 Substance Use Disorder Diagnoses in the United States

Background Stress contributes to the development and maintenance of substance use disorders, with some research suggesting that the impact of stress on substance use disorders is greater in women. However, this has yet to be evaluated in a national dataset, across major substances of abuse. Methods Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n = 36,309), we evaluated relationships among past year stressful life events (0 or 1 vs. 2+ events, range 0–16) and gender, and their association with transitions (new vs. absent cases; ongoing vs. remitted cases) in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alcohol use disorder, tobacco use disorder, cannabis use disorder, and nonmedical prescription opioid use disorder diagnoses. Results Having two or more stressful life events in the past year increased the odds of having a new alcohol use disorder, tobacco use disorder, cannabis use disorder, and opioid use disorder (OR = 3.14, 2.15, 5.52, and 3.06, respectively) or ongoing alcohol use disorder, tobacco use disorder, and cannabis use disorder (OR = 2.39, 2.62, and 2.95, respectively) compared to zero or one stressful life event. A stress by gender interaction for new vs. absent alcohol use disorder demonstrated that having two or more stressful life events was associated with increased odds of new alcohol use disorder in men (OR = 2.51) and even greater odds of new alcohol use disorder in women (OR = 3.94). Conclusions Results highlight that stress is a robust factor in both men and women with new or ongoing substance use disorders, and that effective treatments for substance use should consider the role of stress in addiction etiology and maintenance. There was little evidence for gender differences in the role of stress on transitions in substance use disorders, except for the onset of alcohol use disorders. Given that rates of alcohol use disorders are increasing in women, the impact of stress needs to be considered.

Sports involvement, injury history, and non-medical use of prescription opioids among college students: An analysis with a national sample.

The United States is in the midst of a prescription drug epidemic, particularly related to opioids. To more effectively deal with the devastating outcomes associated with non-medical use of prescription opioids (NUPO), research is needed to identify populations at increased risk. The current research builds on a small number of studies that have shown that adolescents involved in competitive sports are more likely to report NUPO. Specifically, we examine the relationship between athlete status, injury history, and NUPO among college students. Using data from the National College Health Assessment (NCHA II from 2008 to 2011), we estimated several logistic regression models to examine the individual, and combined, effects of sex, athlete status, and injury history on NUPO. In the NCHA II 8.3% of students reported NUPO, 8.0% identified as a varsity athlete, and 17.4% reported an injury. Looking at factors individually, having an injury, being a varsity athlete, and being male were all significantly associated with NUPO. By combining these factors together we were able to determine that male athletes, athletes with injuries, and male athletes with injuries were at the greatest risk for NUPO, after controlling for relevant covariates. To create effective prevention and intervention programs that target the health and wellness of college students, it is important to understand which groups of students are most likely to report NUPO. This study advances our understanding of the relationship between sports involvement and NUPO. (Am J Addict 2018;27:15-22).

Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.

Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p < 0.05 for both). PDMPs may be helpful in identifying patients with certain aberrant drug-related behavior, but are unable to detect many patients with opioid use disorder. The majority of ED patients with opioid use disorder were not captured by the PDMP, highlighting the importance of using additional methods such as screening and clinical history to identify opioid use disorders in ED patients and the limitations of PDMPs to detect opioid use disorders.

Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs

BackgroundHistorical shifts have taken place in the last twenty years in marijuana policy. The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking. MethodsPre-post MML difference-in-difference analyses were performed on a nationally representative sample of adolescents in 48 contiguous U.S. states. Participants were 1,179,372U.S. 8th, 10th, and 12th graders in the national Monitoring the Future annual surveys conducted in 1991–2015. Measurements were any self-reported past-30-day use of marijuana, cigarettes, non-medical use of opioids, amphetamines and tranquilizers, other illicit substances, and any past-two-week binge drinking (5+ drinks per occasion). ResultsAmong 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment (0.2–2.4% decrease; p-values:<0.0001–0.0293). Among 10th graders, the prevalence of substance use did not change after MML enactment (p-values: 0.177–0.938). Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment (0.9–2.7% increase; p-values: <0.0001–0.0026). ConclusionsMML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states. Mechanisms that explain the increase in non-medical prescription opioid and cigarette use among 12th graders following MML enactment deserve further study.

Prevalence and correlates of benzodiazepine use and misuse among young adults who use prescription opioids non-medically

BackgroundBenzodiazepine use dramatically increases the risk of unintentional overdose among people who use opioids non-medically. However, little is known about the patterns of co-occurring benzodiazepine and opioid use among young adults in the United States. MethodsThe Rhode Island Young Adult Prescription Drug Study (RAPiDS) was a cross-sectional study from January 2015—February 2016. RAPiDS recruited 200 young adults aged 18–29 who reported past 30-day non-medical prescription opioid (NMPO) use. Using Wilcoxon rank sum test and Fisher’s exact test, we examined correlates associated with regular prescribed and non-medical use (defined as at least monthly) of benzodiazepines among NMPO users in Rhode Island. ResultsAmong participants, 171 (85.5%) reported lifetime benzodiazepine use and 125 (62.5%) reported regular benzodiazepine use. Nearly all (n=121, 96.8%) reported non-medical use and 43 (34.4%) reported prescribed use. Compared to the 75 participants who did not regularly use benzodiazepines, participants who reported regular use were more likely to be white (66.3% vs. 58.0%, p=0.03), have ever been incarcerated (52.8% vs. 37.3%, p=0.04), and have ever been diagnosed with a psychiatric disorder (bipolar: 29.6% vs. 16.0%, p=0.04; anxiety: 56.8 vs. 36.0%, p=0.01). Although the association was marginally significant, accidental overdose was higher among those who were prescribed the benzodiazepine they used most frequently compared to those who were not (41.9% vs. 24.4%, p=0.06). ConclusionBenzodiazepine use and misuse are highly prevalent among young adult NMPO users. Harm reduction and prevention programs for this population are urgently needed.

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge.

The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. Median number of opioid doses dispensed was 43 (interquartile range, 30-85 doses), and median duration of therapy was 4 days (interquartile range, 1-8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16-31.68) more doses than those who underwent other types of surgery (P < .001), and number of doses consumed was positively associated with higher discharge pain scores (P = .032). Overall, 58% (95% confidence interval, 54%-63%) of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (P < .001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8 of 211) did so. Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of nonmedical use of prescription opioids. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

Nonmedical prescription opioids and pathways of drug involvement in the US: Generational differences

BackgroundThis study sought to specify (1) the position of nonmedical prescription opioids (NMPO) in drug initiation sequences among Millennials (1979–96), Generation X (1964–79), and Baby Boomers (1949–64) and (2) gender and racial/ethnic differences in sequences among Millennials. MethodsData are from the 2013–2014 National Surveys on Drug Use and Health (n = 73,026). We identified statistically significant drug initiation sequences involving alcohol/cigarettes, marijuana, NMPO, cocaine, and heroin using a novel method distinguishing significant sequences from patterns expected only due to correlations induced by common liability among drugs. ResultsAlcohol/cigarettes followed by marijuana was the most common sequence. NMPO or cocaine use after marijuana, and heroin use after NMPO or cocaine, differed by generation. Among successively younger generations, NMPO after marijuana and heroin after NMPO increased. Millennials were more likely to initiate NMPO than cocaine after marijuana; Generation X and Baby Boomers were less likely (odds ratios = 1.4;0.3;0.2). Millennials were more likely than Generation X and Baby Boomers to use heroin after NMPO (hazards ratios = 7.1;3.4;2.5). In each generation, heroin users were far more likely to start heroin after both NMPO and cocaine than either alone. Sequences were similar by gender. Fewer paths were significant among African-Americans. ConclusionsNMPOs play a more prominent role in drug initiation sequences among Millennials than prior generations. Among Millennials, NMPO use is more likely than cocaine to follow marijuana use. In all generations, transition to heroin from NMPO significantly occurs only when both NMPO and cocaine have been used. Delineation of drug sequences suggests optimal points in development for prevention and treatment efforts.

Prevalence of Nonmedical Use of Prescription Opioids and Association With Co-occurring Substance Use Disorders Among Adolescents in Substance Use Treatment

PurposeWe sought to describe the prevalence of the nonmedical use of prescription opioids (NMUPO) and its association with co-occurring substance use disorders in a sample of adolescents in substance treatment. MethodsAdolescents in two substance treatment programs were recruited for participation between 2009 and 2013. The Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM) was administered to assess substance use patterns and lifetime abuse or dependence. ResultsA total of 378 adolescents completed the CIDI-SAM (mean age 16.1 [standard deviation = 1.1], 78% male, 50% white, non-Hispanic). Of the 378 adolescents, 62 (16.4%) reported NMUPO and 59 (15.6%) were diagnosed with opioid/heroin abuse or dependence. The mean age at first NMUPO was 14.3 (standard deviation = 1.4). NMUPO was associated with a 3.31-fold (95% confidence interval: 2.83–3.79) increase in having three or more co-occurring substance use diagnoses. ConclusionsNMUPO is quite prevalent among adolescents in substance use treatment. Intervention to interrupt NMUPO from progressing to heroin use or developing into a disorder is critical.

Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial

BackgroundOverdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations’ efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to concerns regarding reimbursement. Throughout the USA, the prevalence of OUD far exceeds the capacity of the OUD pharmacotherapy treatment system. Poor access to OUD pharmacotherapy prescribers has become a workforce development need for the addiction treatment field and a significant health issue.MethodsThis cluster randomized controlled trial (RCT) is designed to increase buprenorphine and extended-release naltrexone treatment capacity for OUD. The implementation intervention to be tested is a bundle of OUD pharmacotherapy capacity building practices called the Prescriber Recruitment Bundle (PRB), which was developed and piloted in a previous statewide buprenorphine implementation study. For this cluster RCT, organizational sites will be recruited and then randomized into one of two arms: (1) control, with treatment as usual and access to a website with PRB resources, or (2) intervention, with organizations implementing the PRB using the Network for the Improvement of Addiction Treatment organizational change model over a 24-month intervention period and a 10-month sustainability period. The primary treatment outcomes for each organizational site are self-reported monthly counts of buprenorphine slots, extended-release naltrexone capacity, number of buprenorphine patients, and number of extended-release naltrexone patients.This trial will be conducted in Florida, Ohio, and Wisconsin, resulting in 35 sites in each arm, for a total sample size of 70 organizations.DiscussionThis study addresses three issues of substantial public health significance: (1) the pressing opioid misuse epidemic, (2) the low uptake of OUD treatment pharmacotherapies, and (3) the need to increase prescriber participation in the addiction treatment workforce.Trial registrationClinicalTrials.gov NCT02926482,

Prevalence of Hepatitis C Screening, Testing, and Care Experience Among Young Adults Who Use Prescription Opioids Nonmedically

PurposeExamine the prevalence of hepatitis C virus (HCV) screening, confirmatory testing, and care experiences among young adult nonmedical prescription opioid (NMPO) users. MethodsWe examined self-reported HCV screening history in a sample of 18- to 29-year-olds reporting past-month NMPO use, and we used modified Poisson regression to identify associated sociodemographic and drug use patterns. ResultsAmong 196 participants, 154 (78.6%) reported prior HCV screening, among whom 18 (11.7%) reported positive results. Of these, 13 (72.2%) reported receiving a confirmatory test; 12 (66.7%) were referred for specialty HCV care. Screening was associated with injection drug use (adjusted prevalence ratio [APR] = 1.19; 95% confidence interval [CI] = 1.05–1.33) and history of hospitalization for psychiatric illness (APR = 1.23; 95% CI = 1.09–1.39). Younger participants (18–23 years) were less likely to have been screened (APR = .69; 95% CI = .57–.85). ConclusionAmong young adult NMPO users, post-HCV screening support and referral to care were inadequate.

Age of initiation, psychopathology, and other substance use are associated with time to use disorder diagnosis in persons using opioids nonmedically

ABSTRACTBackground: Nonmedical use of prescription opioids (NMUPO) is an ongoing public health challenge, as NMUPO is associated with psychopathology, other drug use, and fatal overdose. These concomitant risks are greatest in those with opioid use disorder (OUD), but the development of NMUPO-related use disorder is poorly understood. The primary aim of this study was to establish factors associated with the development of and time to OUD among persons engaged in NMUPO. Methods: Data were from wave 1 of the National Epidemiologic Study on Alcohol and Related Conditions, with 1755 participants endorsing lifetime NMUPO. Analyses used sequential design-based logistic regression for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) opioid dependence correlates, followed by Cox regression of proportional hazards for correlates (e.g., sociodemographics, age of NMUPO initiation, and psychopathology) of time to dependence in those who developed DSM-IV dependence. Results: Earlier age of NMUPO initiation increased OUD odds (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = 0.94–0.96) but slowed OUD development (adjusted hazard ratio [AHR] = 1.05, 95% CI = 1.04–1.06) in those who developed OUD (n = 118), after controlling for sociodemographics, psychopathology, and ages of other drug use initiation. Psychopathology and earlier other drug use initiation were associated with higher OUD odds, but only having an alcohol use disorder was associated with shorter time to OUD. Conclusions: Earlier NMUPO initiation is associated with increased odds of OUD, although those with early initiation had a slower progression to OUD. Programs that prevent early NMUPO initiation, which might lower rates of OUD, and/or identify the later initiators at highest risk for rapid OUD development could have great public health benefits.

Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation

ABSTRACTBackground: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. Methods: Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20. Results: Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ2 = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ2 = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minority of students reported nonmedical use of prescription stimulants and prescription opioids. In addition, 3.3% of male students (n = 12) compared with 0.6% of female students (n = 3) reported problematic drug use. Further, almost 2/3 of respondents reported decreased psychological health since beginning medical school, with women noting greater reductions (χ2 = 12.39, P = .05) and higher levels of stress (χ2 = 16.30, P = .003). Over 10% of students (n = 102) endorsed “thoughts of committing suicide” during medical school, and 70.1% felt they would benefit from mental healthcare (79.3% of women vs. 59.6% of men; χ2 = 41.94, P < .001), although only 39.8% accessed help. Conclusions: Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use. More work is needed to effectively address medical student mental health and well-being.

Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States.

The authors sought to determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3-year follow-up. The authors used logistic regression models to assess prospective associations between cannabis use at wave 1 (2001-2002) and nonmedical prescription opioid use and prescription opioid use disorder at wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at wave 1. Cannabis and prescription opioid use were measured with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and, in opioid use disorder analyses, nonmedical opioid use. In logistic regression models, cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23-7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95-12.16) at wave 2. These associations remained significant after adjustment for background characteristics (nonmedical opioid use: adjusted odds ratio=2.62, 95% CI=1.86-3.69; opioid use disorder: adjusted odds ratio=2.18, 95% CI=1.14-4.14). Among adults with pain at wave 1, cannabis use was also associated with increased incident nonmedical opioid use (adjusted odds ratio=2.99, 95% CI=1.63-5.47) at wave 2; it was also associated with increased incident prescription opioid use disorder, although the association fell short of significance (adjusted odds ratio=2.14, 95% CI=0.95-4.83). Among adults with nonmedical opioid use at wave 1, cannabis use was also associated with an increase in nonmedical opioid use (adjusted odds ratio=3.13, 95% CI=1.19-8.23). Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.

Most nonmedical users of Rx drugs started with medical use, use them for pain relief: Study

Both medical and nonmedical (misuse or abuse) use of prescription opioids have been declining among adolescents, according to a study published in the April 2017 issue of Pediatrics. However, prescription opioid exposure is still common, with adolescents who reported both medical and nonmedical use more likely to have started with medical use. Medical use of prescription opioids among teens peaked in 1989 and 2002 and stayed level until a decline that began in 2013.

The relationship between treatment accessibility and preference amongst out-of-treatment individuals who engage in non-medical prescription opioid use

BackgroundRelatively little is known regarding the perception of medication-assisted treatments (MATs) and other treatment options amongst individuals that engage in non-medical prescription opioid use. This study surveyed out-of-treatment individuals that misuse opioids to better understand how perceived access to treatment shapes treatment preference. MethodsParticipants (n=357) were out-of-treatment adults registered as workers on the Amazon Mechanical Turk platform who reported current non-medical prescription opioid use. Participants were surveyed regarding demographics, insurance status, attitudes toward opioid use disorder (OUD) treatments, and self-reported symptoms of OUD. ResultsParticipants who were male, did not have health insurance, and knew that counseling-type services were locally available were most likely to first attempt counseling/detox treatments (χ2(6)=30.19, p<0.001). Participants who met criteria for severe OUD, used heroin in the last 30days, knew their insurance covered MAT, and knew of locally available MAT providers were most likely to first attempt MAT (χ2(4)=26.85, p<0.001). Participants with insurance and who knew of locally available physicians were most likely to attempt physician visits without the expressed purpose of MAT (χ2(3)=24.75, p<0.001). ConclusionOut-of-treatment opioid users were particularly interested in counseling-based services and medical care that could be attained from a primary-care physician. Results suggest that insurance coverage and perceived access to OUD treatment modalities influences where out-of-treatment opioid users might first seek treatment; understanding the factors that shape treatment preference is critical in designing early interventions to effectively reach this population.

Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain

ObjectiveState-level prescription drug monitoring programs (PDMPs) have been implemented in most states. PDMPs enable registered prescribers to obtain real-time information on patients' prescription history to reduce non-medical use of controlled drugs. This study examined whether PDMP implementation and different levels of PDMP requirements were associated with physicians' patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. MethodsThis is a secondary analysis study using cross-sectional national data. Patients with non-cancer chronic pain from the 2012 National Ambulatory Medical Care Survey were included (weighted N=81,018,131; unweighted N=3295). Heckman two-step selection procedure employing two logistic regressions was used to explore the associations between PDMP requirements and physicians' prescribing behaviors, controlling for physician characteristics, patient characteristics, physician-healthcare system interaction, and physician-patient relationship, guided by the Eisenberg's model of physician decision making. ResultsState PDMP implementation status and requirement levels were not associated with physician opioid prescribing for non-cancer chronic pain treatment (p's ranged 0.30–0.32). Patients with Medicare coverage were more likely to be prescribed opioid analgesics than those with private health insurance (OR=1.55, p<0.01). Hispanic patients were less likely to be prescribed opioid analgesics than non-Hispanic white patients (OR=0.61, p<0.05). ConclusionsFindings indicated that the effectiveness of PDMPs on physicians' opioid prescribing tendency for non-cancer chronic pain treatment could not be supported. Policy makers should be aware of the need for redesigning PDMPs regarding requirements and enforcement for prescribers and related stakeholders. Future studies also are needed to identify characteristics contributing to PDMP effectiveness in reducing non-medical use of prescription opioids.