Nonmedical Prescription Opioid Use Research Articles

“Drug Use with Racism…The Reason I Wanted to Do This Study”: Perceptions of Race and Racism’s Impact on Drug Use among Black Americans Using Opioids

Background: Several studies link racism with drug use disparities among systemically marginalized populations. However, few invite Black Americans to discuss how they perceive racism’s impact on their drug use. Objectives: To examine qualitative accounts from N=40 Black adults reporting non-medical prescription opioid use on their experiences of racism and drug use. Results: A deductive structural tabular thematic analysis informed by Jones’s (2000) levels of racism resulted in two themes: (a) Experiences of Racism (subthemes: Denying Experiences of Racism and Endorsing Experiences of Racism) and (b) Race, Racism, and Drug Use (subthemes: Rejecting Race and Racism’s Impact on Drugs and Rejecting Race and Racism’s Impact on Drugs). Conclusions: Participants provided examples of internalized, personally mediated, and institutionalized racism associated with their drug use. Implications for policy, practice, and research are discussed. Specifically, implications detail how to center Black Americans and demonstrate anti-racism when developing treatment strategies and drug policies.

The relations between impulsivity, opioid use, and nonmedical prescription opioid use motives: An examination within three large urban emergency departments.

Impulsivity is a transdiagnostic risk factor for multiple disorders, including opioid use disorders (OUDs). However, scant work has examined if impulsivity facets distinguish individuals reporting nonmedical opioid use from those who use opioids as prescribed, particularly in important settings such as emergency departments (EDs). Further, no studies, to our knowledge, have examined the relations between impulsivity facets and motives for nonmedical prescription opioid use (NMPOU). Using data from EDs, this study examined if impulsivity facets (assessed via the [negative] urgency, premeditation, perseverance, sensation seeking, and positive urgency) related to nonmedical opioid use and if these facets related to OUD severity among individuals reporting past-year opioid use. Among patients reporting past 3-month NMPOU, the relation between motives for use and impulsivity was examined. Results indicated all facets (except lack of perseverance) distinguished patients reporting nonmedical opioid use from individuals abstaining from opioid use and those who used opioids as prescribed, with particularly large effect sizes for positive and negative urgency. Similarly, among patients reporting past 12-month opioid use, all facets (except lack of perseverance) significantly distinguished individuals who were OUD negative from those with severe OUD, with positive and negative urgency showing the strongest relations. Multiple motives were associated with certain UPPS-P facets, particularly positive urgency, negative urgency, and sensation-seeking. Results suggest that the relation between impulsivity and opioid use characteristics varies across facets of impulsivity, with emotion-based impulsivity being the most relevant. Implications for screening and interventions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for The Relations Between Impulsivity, Opioid Use, and Nonmedical Prescription Opioid Use Motives: An Examination Within Three Large Urban Emergency Departments

Supplemental Material for The Relations Between Impulsivity, Opioid Use, and Nonmedical Prescription Opioid Use Motives: An Examination Within Three Large Urban Emergency Departments

Age-related Psychometric Dimensionality Using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Opioid Use Disorder Diagnostic Criteria.

Age-related psychometric differences in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) opioid use disorder (OUD) diagnostic criteria have been hypothesized, but not been tested. This study investigated DSM-5 OUD diagnostic criteria for age-related measurement noninvariance among younger adults (YAs) and middle/older adults (MOAs) with past 12-month nonmedical use of prescription opioids. People who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III and reported past 12-month nonmedical use of prescription opioids were included. YAs were 18-49 years old, and MOAs were 50+ years old. Item response theory, differential item functioning (DIF), and differential test functioning were used to assess for age-related measurement noninvariance. One in 5 people met the DSM-5 OUD diagnostic criteria for OUD within the past 12 months, with the most endorsed criteria being tolerance (17.96%). DIF was identified for 3 criteria, including (1) taking opioids for longer or in larger doses than intended, (2) long periods spent obtaining/using/recovering from use, and (3) withdrawal. DIF was associated with the latent OUD severity needed to correctly endorse the criteria, with criteria being correctly endorsed at less severe levels of latent OUD for MOAs when compared with YAs. Differential test functioning analyses showed collectively the criteria had improved detection in MOAs when compared with YAs (P < 0.01). These findings suggest that there may be age-related variations in the DSM-5 OUD diagnostic criteria's ability to detect latent OUD. Future research should identify contributing factors and the influence it has on the accuracy of age-specific surveillance estimations.

W151 - Heroin Use, Non-Medical Prescription Opioid Use, and Injection Drug Use Among Urban High School Students Across the US

W151 - Heroin Use, Non-Medical Prescription Opioid Use, and Injection Drug Use Among Urban High School Students Across the US

T40 - Trauma-Related Shame Predicts Daily Non-Medical Prescription Opioid Use and Motives for Use Among Individuals with PTSD

T40 - Trauma-Related Shame Predicts Daily Non-Medical Prescription Opioid Use and Motives for Use Among Individuals with PTSD

Adolescent oral oxycodone self-administration disrupts neurobehavioral and neurocognitive development

Nonmedical use of prescription opioids peaks during late adolescence, a developmental period associated with the maturation of higher-order cognitive processes. To date, however, how chronic adolescent oxycodone (OXY) self-administration alters neurobehavioral (i.e., locomotion, startle reactivity) and/or neurocognitive (i.e., preattentive processes, intrasession habituation, stimulus-reinforcement learning, sustained attention) function has not yet been systematically evaluated. Hence, the rationale was built for establishing the dose-dependency of adolescent OXY self-administration on the trajectory of neurobehavioral and neurocognitive development. From postnatal day (PD) 35 to PD 105, an age in rats that corresponds to the adolescent and young adult period in humans, male and female F344/N rats received access to either oral OXY (0, 2, 5, or 10 mg/kg) or water under a two-bottle choice experimental paradigm. Independent of biological sex or dose, rodents voluntarily escalated their OXY intake across ten weeks. A longitudinal experimental design revealed prominent OXY-induced impairments in neurobehavioral development, characterized by dose-dependent increases in locomotion and sex-dependent increases in startle reactivity. Systematic manipulation of the interstimulus interval in prepulse inhibition supports an OXY-induced impairment in preattentive processes. Despite the long-term cessation of OXY intake, rodents with a history of chronic adolescent oral OXY self-administration exhibited deficits in sustained attention; albeit no alterations in stimulus-reinforcement learning were observed. Taken together, adolescent oral OXY self-administration induces selective long-term alterations in neurobehavioral and neurocognitive development enjoining the implementation of safer prescribing guidelines for this population.

Substance Use–Related Alterations of Social Decision Making in a Longitudinal Cohort of Young Adults

BackgroundSubstance use disorders are associated with severe negative social and health-related outcomes. Evidence has accumulated that long-term substance use is associated with alterations in social interaction behavior, which likely contributes to the vicious cycle of substance use disorder. However, little is known about whether these social problems originate from contextual factors only or also from the substance use itself—in other words, if they are predisposed or substance induced. MethodsWe studied the causation behind behavioral alterations of substance users over a 9-year period (ages 11–20 years) in an urban age cohort (N = 1002) with a high prevalence of substance use at age 20. We identified common substance use patterns using toxicological hair analysis, examined behavioral alterations with incentivized games, and used teacher assessments across different ages to determine the causes and effects that underlie substance use–related impairments in social interaction. ResultsWe found that opioid and stimulant users showed reduced prosocial behavior compared with nonusers, particularly in interpersonal trust and perspective taking (e.g., they were approximately 50% less likely to trust others). Our longitudinal analyses suggest a causal relationship between the nonmedical use of prescription opioids and impaired social behavior, whereas impairments among stimulant users seem to be partially predisposed. Moreover, women tended to be more severely affected by opioid use than men. However, no behavioral alterations were found among young adult cannabis or ecstasy users. ConclusionsHighly addictive substances such as opioids can impair users’ social behavior by undermining fundamental human interaction, thereby fueling a vicious cycle of substance use and social isolation.

Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016-2021): gender differences and related factors.

The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021. The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14-18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics. In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94-1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08-1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only. This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents.

Endocannabinoids and related lipids linked to social exclusion in individuals with chronic non-medical prescription opioid use

Opioid-related overdose deaths are still on the rise in North America, emphasizing the need to better understand the underlying neurobiological mechanisms regarding the development of opioid use disorder (OUD). Recent evidence from preclinical and clinical studies indicate that the endocannabinoid system (ECS) may play a crucial role in stress and reward, both involved in the development and maintenance of substance use disorders. Animal models demonstrate a specific crosstalk between the ECS and the endogenous opioid system. However, translational studies in humans are scarce. Here, we investigated basal plasma levels of the endocannabinoids anandamide (AEA) and 2-arachidonoyglycerol (2-AG), and eight endocannabinoid-related lipids, including oleoylethanolamide (OEA) and palmitoylethanolamide (PEA), as well as whole blood fatty acid amide hydrolase (FAAH) activity in chronic non-medical prescription opioid users (NMPOU; n = 21) compared to opioid-naïve healthy controls (n = 29) considering age, sex, and cannabis use as potential confounders. Additionally, the association of endocannabinoids and related lipids with the participants’ response to experimentally induced social exclusion was examined. We found significantly elevated basal AEA, OEA, and PEA levels in NMPOU compared to controls, but no differences in FAAH activity, 2-AG, or other endocannabinoid-related lipids. Within NMPOU, higher AEA levels were associated with lower perception of social exclusion. Robust positive correlations within N-acylethanolamines (i.e., AEA, OEA, and PEA) indicate strong metabolic associations. Together with our recent findings of elevated basal 2-AG levels in dependent cocaine users, present results indicate substance-specific alterations of the ECS that may have implications in the search for novel therapeutic interventions for these populations.

The Relationship of Opioid Misuse and Suicidality Among Adolescents With Disabilities

Adolescents experience higher risk for opioid misuse and suicide, and those with disabilities are disproportionately vulnerable to suicide risk. Using secondary data, this study presents findings on nonmedical prescription opioid use (NMPOU) and suicidality among adolescents with and without disabilities ( N = 10,676). Results indicated NMPOU was associated with higher odds for serious thoughts of suicide. Having a disability was associated with higher odds for having a plan for suicide and having a suicide attempt. Adolescents with disabilities who engaged in NMPOU had over 3 times the likelihood for serious thoughts of suicide. Social work services can be tailored for adolescents with disabilities within the context of the family unit to address the impact of the opioid epidemic using a disability-oriented framework.

Public Perceptions of Opioid Use for Chronic Non-Cancer Pain

Background: Chronic non-cancer pain affects 20% of Americans. This is significantly impacted by the ongoing opioid crisis and reduced opioid dispensing. Public perceptions additionally shape pain management strategies. Purpose: This study explores public attitudes toward prescription opioids for chronic non-cancer pain. We aim to understand how public attitudes are influenced by the evolving opioid crisis and shifting opioid use patterns. Methods: In Michigan, 823 adults participated in a Qualtrics survey on attitudes toward nonmedical and medical prescription opioid use. Multivariable logistic regression was performed to identify factors associated with beliefs that doctors prescribe opioids for too long (Model 1) and chronic pain patients should transition to alternative treatments (Model 2). Results: About half (49.4%) of respondents believed doctors keep patients on prescription opioids for too long, while two-thirds (65.7%) agreed chronic pain patients should be tapered off medications. Knowing someone who misused opioids and perceptions of substance use (e.g. perceived risk of prescription opioid misuse, stigma toward chronic pain patients, perceived prevalence of prescription opioid misuse, and awareness of fentanyl) were associated with greater odds of believing doctors keep patients on opioids too long. Demographics (age and education), substance use histories and perceptions (e.g. perceived risk and stigma) were associated with greater odds of believing patients should be tapered off their medication. Conclusions: These findings inform strategies to correct public misperceptions, emphasizing the importance of personal experience, perceived risks, and stigmatization of chronic pain patients. This insight can guide effective pain management for those with chronic non-cancer pain.

Trauma-related shame predicts daily non-medical prescription opioid use among individuals with PTSD symptoms

Non-medical prescription opioid use (NMPOU) is the use of opioids without a prescription or in a way different from how they were prescribed and is the fourth most common type of drug use in the United States. Separate research has shown that trauma-related shame is linked to posttraumatic stress disorder (PTSD) and, respectively, opioid use. However, no study to date has empirically examined the association between trauma-related shame and NMPOU among individuals with PTSD symptoms. Forty adults with clinical or subclinical PTSD who reported engaging in NMPOU at least one day in the prior month before the study completed 28 days of daily surveys. Trauma-related shame was measured at baseline. NMPOU and underlying motives to engage in NMPOU were assessed once daily via a smartphone app. Twenty-four participants (60 %) reported NMPOU over the 28-day period. After controlling for PTSD symptoms and covariates, mixed models showed that higher trauma-related shame significantly predicted higher risk of daily NMPOU (B = 0.06, SE = 0.03, t = 2.14, p=.03). After controlling for false discovery rates, trauma-related shame also significantly predicted NMPOU due to the following motives (p's < 0.031): to manage depression/sadness, to manage anxiety, to manage other stress/worry, and to get high. Among individuals with PTSD, higher baseline trauma-related shame prospectively and positively predicted greater NMPOU over a four-week daily monitoring period. Findings suggest a need to attend to trauma-related shame and its impact on subsequent motivations to engage in NMPOU. Future research should examine how treatments may effectively target trauma-related shame to reduce NMPOU and more severe PTSD symptoms.

Predicting first use of heroin from prescription opioid use subtypes: Insights from the Monitoring the Future longitudinal panel

BackgroundOnly a small proportion of individuals who initiate nonmedical use of prescription opioids (NUPO) transition to heroin, suggesting that more nuanced aspects of NUPO may be better indicators of risk for escalating opioid use trajectories. This study leveraged panel data to identify NUPO typologies based on NUPO characteristics associated with opioid risk trajectories (route of administration, motives) and compared rates of heroin initiation at follow-up across typologies. MethodsLatent class analyses were run among respondents with no history of heroin use from the Monitoring the Future Panel Study (base year N=10,408) at modal ages 18, 19/20, 21/22, 23/24, and 25/26. Indicators included oral NUPO, nonoral NUPO, and NUPO motives to experiment, have a good time with friends, get high, escape problems, manage pain, relax, and sleep. Heroin initiation at follow-ups through modal age 29/30 was predicted from class membership. ResultsNo NUPO, self-medication (oral, manage pain), recreational (oral, nonoral, experiment, get high, have a good time with friends), and mixed-motive (all routes, all motives) classes emerged. Heroin initiation rates did not differ across no NUPO and self-medication classes; recreational and mixed-motives classes initiated heroin at higher rates than the other classes and comparable rates to each other. Non-NUPO drug use prior to heroin initiation was prevalent in recreational and mixed-motive classes. ConclusionsNUPO does not uniformly or uniquely increase risk for heroin initiation. Leveraging more nuanced indicators of risk for heroin use and targeting polysubstance use in addition to opioid-specific programming may enhance the efficacy of public health efforts.

Associations between cannabis use, opioid misuse and severe psychological distress in adolescents: A cross-sectional school-based study

BackgroundCannabis use and nonmedical use of prescription opioids are consumed by a small to moderate number of adolescents. However, little is known about their combined influence on mental health in this age group. This study examined the association between cannabis use, nonmedical use of prescription opioids, or both with serious psychological distress among adolescents and tested if sex could moderate these associations. MethodsWe based our analyses on cross-sectional data from the 2019 Ontario Student Drug Use and Health Survey, a provincially representative sample of students in grades 7 through 12 (aged 11–20 years or older) across Ontario, Canada (n= 7097; mean age: 15.2 ± 1.2 years). Logistic regression analyses were adjusted for important covariates. ResultsWe found that 20.5% reported cannabis use only, 5.8% reported opioid use only, and 5% reported both cannabis and opioid use. Cannabis use only (odds ratio [OR]:1.91; 95% confidence interval [CI]:1.53–2.37), opioid use only (OR: 2.21; 95% CI: 1.63–3.00), and both cannabis and opioid use (OR: 3.24; 95% CI: 2.25–4.66) were associated with greater odds of serious psychological distress after adjustment for covariates. Associations were similar for males and females. ConclusionThe use of both cannabis and opioids is significantly associated with serious psychological distress among adolescents. Adolescents who use both cannabis and opioids represent a small and vulnerable group that should be targeted in future interventions against mental health problems. Health professionals should consider screening for polysubstance use, especially when working with adolescents who use cannabis.

The Opioid Industry Documents Archive: Advancing Public Health Through Industry Document Disclosure.

More than twenty-five years after the first signs of potential harm, the US remains locked in the grip of an opioid epidemic, with more Americans dying from overdoses than ever before.1 Diversion of prescription opioids plays an important role in opioid-related harms. Much of the scientific and public health focus on diversion has been on end-users, given how commonly non-medical prescription opioid use occurs, as well as the proportion of individuals who report that their source of non-medical opioids was friends or family. However, diversion of opioids, as well as their rampant oversupply, can be discerned higher up the supply chain, including among wholesalers, pharmacies and rogue prescribers whose behavior may trigger well-described "flags" warranting further evaluation and action.

Identifying patterns of pain, depression, anxiety, interpersonal trauma exposure, and nonmedical prescription opioid use: Latent class analysis among patients with chronic pain.

Chronic pain in the context of certain factors may be associated with potential for nonmedical prescription opioid use; however, identifying this risk can be challenging and complex. Several variables alone have been associated with non-prescribed opioid use, including depression, anxiety, pain interference, and trauma exposure. Prior research has often failed to integrate these assessments together, which is important as these factors may cluster together in important and complex ways. The current study aimed to identify classes of patients with chronic pain who have differential risk for use of nonmedical prescription opioid use, depression and anxiety, and pain severity, interference, and catastrophizing, and interpersonal violence exposure. Self-report and medical record data from patients (N = 211; Mage = 48, 69.0% women, 69.0% white) at a pain management center were collected. Latent class analysis revealed 3 classes with (1) low probability of clinically significant depression, anxiety, pain, and nonmedical prescription opioid use (44.7%), (2) high probability of clinically significant depression, anxiety, pain, pain catastrophizing, trauma, and nonmedical prescription opioid use (41.3%), and (3) high probability of severe pain and nonmedical prescription opioid use (14.0%). High-risk classes had either high levels of depression and anxiety, pain catastrophizing, and interpersonal violence exposure, or pain severity and interference. Future research should continue to explore these classes in large, diverse samples, and prospective study designs. Finally, results underscore that opioid use is complex, not easily identified by a single factor, and may be motivated by complex unmet clinical needs.

Proportion of Non-Medical Opioid Use of Prescription Opioids among Cancer Patients in Korea

Proportion of Non-Medical Opioid Use of Prescription Opioids among Cancer Patients in Korea

Prevalence and correlates of DSM-5 opioid withdrawal syndrome in U.S. adults with non-medical use of prescription opioids: results from a national sample

ABSTRACTBackground: In the U.S. non-medical use of prescription opioids (NMOU) is prevalent and often accompanied by opioid withdrawal syndrome (OWS). OWS has not been studied using nationally representative data.Objectives: We examined the prevalence and clinical correlates of OWS among U.S. adults with NMOU.Methods: We used data from 36,309 U.S. adult participants in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, 1,527 of whom reported past 12-month NMOU. Adjusted linear and logistic regression models examined associations between OWS and its clinical correlates, including psychiatric disorders, opioid use disorder (OUD; excluding the withdrawal criterion), medical conditions, and healthcare utilization among people with regular (i.e. ≥3 days/week) NMOU (n = 534).Results: Over half (50.4%) of the sample was male. Approximately 9% of people with NMOU met criteria for DSM-5 OWS, with greater prevalence of OWS (∼20%) among people with regular NMOU. Individuals with bipolar disorder, dysthymia, panic disorder, and borderline personality disorder had greater odds of OWS (aOR range = 2.71–4.63). People with OWS had lower mental health-related quality of life (β=-8.32, p < .001). Individuals with OUD also had greater odds of OWS (aOR range = 26.02–27.77), an association that increased with more severe OUD. People using substance use-related healthcare services also had greater odds of OWS (aOR range = 6.93–7.69).Conclusion: OWS was prevalent among people with OUD and some psychiatric disorders. These findings support screening for OWS in people with NMOU and suggest that providing medication- assisted treatments and behavioral interventions could help to reduce the burden of withdrawal in this patient population.

Association Between Legal Access to Medical Cannabis and Frequency of Non-Medical Prescription Opioid Use Among U.S. Adults

Association Between Legal Access to Medical Cannabis and Frequency of Non-Medical Prescription Opioid Use Among U.S. Adults