Nonmedical Prescription Opioid Users Research Articles

Perceived risk of heroin use among nonmedical prescription opioid users

AimsThe prevalence of heroin use among nonmedical prescription opioid (NMPO) users has increased in recent years. Identifying characteristics associated with heroin use in this population can help inform efforts to prevent heroin initiation and maintenance. The aim of this study was to evaluate differences in perceived risk of heroin among NMPO users with and without histories of heroin use, and to examine temporal trends in perceived risk of heroin among this population. MethodsData are from the 2002–2013 National Survey on Drug Use and Health, and included all past-year NMPO users (N=49,045). Participants reported perceived risk of trying heroin once or twice and regular heroin use. Responses were coded dichotomously (great risk vs. other risk) and logistic regression analyses were used to evaluate the association between lifetime heroin use and perceived risk of heroin, and to determine temporal changes in perceived risk. ResultsResults indicated a significant association between lifetime heroin use and lower likelihood of reporting great risk of trying heroin (OR=0.38, 95% CI: 0.33, 0.44, p<0.001), and of regular use of heroin (OR=0.39, 95% CI: 0.32, 0.48, p<0.001). There was a significant, yet modest, trend toward decreasing perception of great risk from 2002 to 2013. ConclusionsFindings from this analysis of nationally representative data indicate that NMPO users with a history of heroin use perceive heroin to be less risky than those without heroin use. Perception of risk has decreased from 2002 to 2013 in this population, consistent with increasing rates of heroin initiation.

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

ABSTRACTBackground: Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex-risk behaviors. Objectives: This paper examines event-level associations between nonmedical prescription opioid use and sharing high dead space syringes (injection risk) and unprotected intercourse (sex risk) behaviors. Methods: We recruited 1,985 participants from two overlapping risk groups—drug users and men who have sex with men (MSM)—and their sex partners. Participants completed an interview that included event-level sex questions with recent sex partners and injection questions with recent injection partners. We used multivariable generalized estimating equations (GEE) to assess the associations between nonmedical prescription opioid use and unprotected intercourse during sexual encounters and sharing syringes during injection episodes, while adjusting for within-person correlations. Results: When both partners used nonmedical prescription opioids, its use was independently associated with unprotected intercourse in sexual encounters (OR = 2.24; 95% CI = 1.12, 4.49). The use of nonmedical prescription opioids was also associated with sharing high dead space syringes during injection episodes (OR = 6.57; 95% CI = 1.63, 26.51). Conclusion: Nonmedical prescription opioid use is associated with an increase in the risk of unprotected sex and sharing high dead space syringes. HIV and HCV prevention interventions for nonmedical prescription opioid users should address sex-risk behaviors and encourage the use of acceptable low dead space needles and syringes.

Exploring the latent trait of opioid use disorder criteria among frequent nonmedical prescription opioid users

BackgroundThere is a need to explore the dimensional and categorical phenotypes of criteria of opioid use disorder among frequent nonmedical users of prescription opioids (NMUPO) users. MethodsWe used pooled data of 2011–2012 National Survey on Drug Use and Health to examine reliability and phenotypic variability in the diagnosis of OUD secondary to NMUPO in a nationally-representative sample of 18+ years-old frequent past-year NMUPO users (120+ days, n = 806). Through exploratory factor analysis (EFA) and latent class analysis (LCA), we examined 10 past-year OUD criteria. We examined associations between the latent classes and sociodemographic/psychiatric/NMUPO correlates. ResultsOUD criteria were unidimensional, and a three-class model was the overall best fitting solution for characterizing individuals into phenotypes along this unidimensional continuum: a “non-symptomatic class” (40.7%), “Tolerance-Time spent class” (29.0%) with high probability of endorsing Tolerance/Time Spent criteria, and a “High-moderate symptomatic class” (30.1%). The last class was significantly associated with being male, having insurance and obtaining prescription opioids (PO) nonmedically via “doctor shopping” as compared to the non-symptomatic class. “Tolerance-Time spent class” was significantly associated with being younger (18–25 years) and obtaining PO nonmedically from family/friends as compared to the non-symptomatic class. ConclusionThis study revealed the different characteristics and routes of access to PO of different classes of frequent NMUPO users. It is possible that these groups may respond to different interventions, however such conclusions would require a clinical study.

Individual and Network Correlates of Antisocial Personality Disorder Among Rural Nonmedical Prescription Opioid Users.

Examination of the association of antisocial personality disorder (ASPD) with substance use and HIV risk behaviors within the social networks of rural people who use drugs. Interviewer-administered questionnaires were used to assess substance use, HIV risk behavior, and social network characteristics of drug users (n = 503) living in rural Appalachia. The MINI International Psychiatric Interview was used to determine whether participants met DSM-IV criteria for ASPD and Axis-I psychological comorbidities (eg, major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder). Participants were also tested for herpes simplex 2, hepatitis C, and HIV. Multivariate generalized linear mixed modeling was used to determine the association between ASPD and risk behaviors, substance use, and social network characteristics. Approximately one-third (31%) of participants met DSM-IV criteria for ASPD. In multivariate analysis, distrust and conflict within an individual's social networks, as well as past 30-day use of heroin and crack, male gender, younger age, lesser education, heterosexual orientation, and comorbid MDD were associated with meeting diagnostic criteria for ASPD. Participants meeting criteria for ASPD were more likely to report recent heroin and crack use, which are far less common drugs of abuse in this population in which the predominant drug of abuse is prescription opioids. Greater discord within relationships was also identified among those with ASPD symptomatology. Given the elevated risk for blood-borne infection (eg, HIV) and other negative social and health consequences conferred by this high-risk subgroup, exploration of tailored network-based interventions with mental health assessment is recommended.

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Opioid Use Found to Be Decreasing, While Opioid-Related Deaths Increase

To reverse adverse outcomes associated with the illicit use of prescription opiates, guidelines are needed to address prescription practices for such drugs, experts say.

Racial and ethnic trends and correlates of non-medical use of prescription opioids among adolescents in the United States 2004–2013

PurposeOur objective was to elucidate the trends in non-medical use of prescription opioids (NMUPO) among whites, African-Americans, and Hispanic adolescents in the United States. An additional aim was to examine the sociodemographic, behavioral, and psychosocial correlates of NMUPO across each of these aforementioned racial and ethnic groups. MethodsData was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic white, African American, and Hispanic respondents ages 12–17 (n = 164,028) and spanning the years 2004–2013. Consistent with prior NSDUH-based studies, respondents reporting use within the previous 12 months were classified as nonmedical prescription opioid users. Logistic regression was used to examine significance of trend year and correlates of NMUPO. ResultsNon-Hispanic white youth consistently reported higher levels of NMUPO as did older adolescents (ages 15–17) and females. However, there was a decrease in the prevalence of NMUPO overall driven largely by a significant decline (p < 0.001) in NMUPO among non-Hispanic whites of approximately 35% over the study period such that by 2013 no statistically significant differences across race/ethnicity remained. Further, logistic regression models found that externalizing behaviors such as comorbid drug use and fighting was associated with NMUPO and religiosity and parental involvement were identified as protective correlates. ConclusionsTo our knowledge, this is the first study to identify a declining trend in NMUPO among adolescents. Although the present study findings provide a source for optimism, there is still a relatively high prevalence of NMUPO and it remains to be seen whether our findings portend a long-term decline. Given the harm done by NMUPO, continued awareness and targeted prevention efforts should be implemented.

Sequences of substance use initiation among adolescent nonmedical users of prescription opioids and stimulants

Sequences of substance use initiation among adolescent nonmedical users of prescription opioids and stimulants

Abuse and Diversion of Gabapentin Among Nonmedical Prescription Opioid Users in Appalachian Kentucky

Gabapentin (Neurontin®) is FDA-approved as an adjunctive anti-epileptic for refractory partial seizures and as an analgesic for post-herpetic neuralgia. It is presumed to interact with calcium channels to regulate various neurotransmitter release (1) and is commonly prescribed off-label for other pain syndromes as well as mood and anxiety disorders (2), with few reports of abuse (2–5). However, with decreasing availability of commonly abused prescription opioids, it has been suggested that non-medical users of prescription opioids are substituting other licit (6) and illicit (7) drugs for abuse.

Racial/ethnic differences in trends in heroin use and heroin-related risk behaviors among nonmedical prescription opioid users

BackgroundThis study examines changing patterns of past-year heroin use and heroin-related risk behaviors among individuals with nonmedical use of prescription opioids (NMUPO) by racial/ethnic groups in the United States. MethodsWe used data from the National Survey on Drug Use and Health (NSDUH) from 2002 to 2005 and 2008 to 2011, resulting in a total sample of N=448,597. ResultsPast-year heroin use increased among individuals with NMUPO and increases varied by frequency of past year NMUPO and race/ethnicity. Those with NMUPO in the 2008–2011 period had almost twice the odds of heroin use as those with NMUPO in the 2002–2005 period (OR=1.89, 95%CI: 1.50, 2.39), with higher increases in non-Hispanic (NH) Whites and Hispanics. In 2008–2011, the risk of past year heroin use, ever injecting heroin, past-year heroin abuse or dependence, and the perception of availability of heroin increased as the frequency of NMUPO increased across respondents of all race/ethnicities. ConclusionIndividuals with NMUPO, particularly non-Hispanic Whites, are at high risk of heroin use and heroin-related risk behaviors. These results suggest that frequent nonmedical users of prescription opioids, regardless of race/ethnicity, should be the focus of novel public health efforts to prevent and mitigate the harms of heroin use.

The Prevalence of Common Infectious Diseases among Nonmedical Prescription Opioid Users: Preliminary Findings from the National Prescription Opioid Misuse, Abuse, and Diversion (NOMAD) Study

Background: Little population data exist on the lifetime prevalence of risk-based infectious diseases, both those that are sexually transmitted and blood-borne via needle sharing among persons using prescription opioids for nonmedical purposes, such as those using for euphoria and/or to self-treat medical conditions. Objective: This study examined the lifetime prevalence and characteristics of persons reporting Common Infectious Diseases (CID) related to sexual risk and drug use in a national study of persons engaging in past-year nonmedical prescription opioid use (NMPOU) in the United States. Methods: The Nonmedical Prescription Opioid Misuse, Abuse, and Diversion (NOMAD) study collected selfreported survey assessments via an online questionnaire (ages 18+). Participants were recruited from online advertisements as well as referrals from ongoing research studies of prescription drug abusers in the United States. Participants were asked to self-report prior medically confirmed diagnoses of blood borne infectious diseases like HIV/AIDS, hepatitis (Hep A, Hep B, Hep C), and sexually transmitted infections like Syphilis. Risk behaviors, such as unprotected sex and needle sharing, were ascertained via standardized survey items drafted from the Composite International Diagnostic Interview. Results: Of the 344 past-year nonmedical prescription opioid users, 72.5% reported at least one lifetime CID. The most common were Hep B (18.8%), Hep A (8.9%), and Hep C (8.4%). Over 5% reported an HIV/AIDS diagnosis. The risk of onset for a CID was between 18 and 35, with 80% of the risk of a first STD in this window. Injection practices were associated with CIDs, and in particular Hep C and Hep A. The characteristics significantly associated with a lifetime CID were having bipolar disorder (O.R.=16.3), an opioid use disorder (O.R.=8.3), and a lifetime mood disorder (O.R.=6.83). Jail/prison and drug treatment were associated with a lower risk of disease risk. Most (95.4%) of the infectious diseases onsets prior to initiation of the NMPOU. Conclusion: This study highlights that common infectious diseases, both STDs and injection-based (e.g., Hep- A,B,C) are very common among NMPOUs, though the risk onset is largely in early adulthood prior to the initiation of NMPOU.

Trends in racial/ethnic differences in heroin use and heroin risk behaviors among nonmedical users of prescription opioids from 2002 to 2011

Trends in racial/ethnic differences in heroin use and heroin risk behaviors among nonmedical users of prescription opioids from 2002 to 2011

Nonmedical prescription drug use among US young adults by educational attainment.

Little is known about nonmedical use of prescription drugs among non-college-attending young adults in the United States. Data were drawn from 36,781 young adults (ages 18-22 years) from the 2008-2010 National Survey on Drug Use and Health public use files. The adjusted main effects for current educational attainment, along with its interaction with gender and race/ethnicity, were considered. Compared to those attending college, non-college-attending young adults with at least and less than a HS degree had a higher prevalence of past-year nonmedical use of prescription opioids [NMUPO 13.1 and 13.2 %, respectively, vs. 11.3 %, adjusted odds ratios (aORs) 1.21 (1.11-1.33) and 1.25 (1.12-1.40)], yet lower prevalence of prescription stimulant use. Among users, regardless of drug type, non-college-attending youth were more likely to have past-year disorder secondary to use [e.g., NMUPO 17.4 and 19.1 %, respectively, vs. 11.7 %, aORs 1.55 (1.22-1.98) and 1.75 (1.35-2.28)]. Educational attainment interacted with gender and race: (1) among nonmedical users of prescription opioids, females who completed high school but were not enrolled in college had a significantly greater risk of opioid disorder (compared to female college students) than the same comparison for men; and (2) the risk for nonmedical use of prescription opioids was negligible across educational attainment groups for Hispanics, which was significantly different than the increased risk shown for non-Hispanic whites. There is a need for young adult prevention and intervention programs to target nonmedical prescription drug use beyond college campuses.

High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users

BackgroundOpioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Yet few studies have examined the overdose knowledge and experience of nonmedical PO users. MethodsIn depth, semi-structured, audio-recorded interviews were conducted with 46 New York City young adults (ages 18–32) who reported using POs nonmedically within the past 30 days. Verbatim interview transcripts were coded for key themes in an analytic process informed by grounded theory. ResultsDespite significant experience with overdose (including overdose deaths), either personally or within opioid-using networks, participants were relatively uninformed about overdose awareness, avoidance and response strategies, in particular the use of naloxone. Overdose experiences typically occurred when multiple pharmaceuticals were used (often in combination with alcohol) or after participants had transitioned to heroin injection. Participants tended to see themselves as distinct from traditional heroin users, and were often outside of the networks reached by traditional opioid safety/overdose prevention services. Consequently, they were unlikely to utilize harm reduction services, such as syringe exchange programs (SEPs), that address drug users’ health and safety. ConclusionsThese findings suggest that many young adult nonmedical PO users are at high risk of both fatal and non-fatal overdose. There is a pressing need to develop innovative outreach strategies and overdose prevention programs to better reach and serve young PO users and their network contacts. Prevention efforts addressing risk for accidental overdose, including opioid safety/overdose reversal education and naloxone distribution, should be tailored for and targeted to this vulnerable group.

Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18–32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed “clean” (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users.

Participatory Research With an Online Drug Forum: A Survey of User Characteristics, Information Sharing, and Harm Reduction Views

Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample (N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The study's implications and limitations are noted and future research is suggested.

Alcohol and Illegal Drug Use Behaviors and Prescription Opioids Use: How Do Nonmedical and Medical Users Compare, and Does Motive to Use Really Matter?

Background/Aims: This study compares illegal drug and alcohol use behaviors between medical and nonmedical users of prescription opioids (PO) and nonmedical users with distinct motives to use. Method: An ethically approved cross-sectional study (2010) was conducted on a representative sample of private university students (n = 570), using a self-filled anonymous questionnaire. Results: About 25% reported using PO only medically and 15% nonmedically. The prevalence of alcohol and illegal drug use was consistently higher among nonmedical than medical PO users. Adjusting for age and gender, lifetime medical users of PO were more likely to use marijuana only (OR = 1.8, 95% CI: 1.1, 2.8), while nonmedical users were at higher odds of using marijuana, ecstasy, cocaine/crack, and alcohol problematically. Compared to nonusers, students who took PO nonmedically for nontherapeutic reasons were more likely to use various illegal drugs, but nonmedical users who took PO to relieve pain/help in sleep were only more likely to use marijuana (OR = 2.5, 95% CI: 1.1, 5.4) and alcohol (e.g. alcohol abuse; OR = 3.8, 95% CI: = 1.4, 10.1). Conclusion: Youth who use PO nonmedically to self-treat have a different alcohol and illegal drug-using profile than those who take it for nontherapeutic reasons.

Leftover Prescription Opioids and Nonmedical Use Among High School Seniors: A Multi-Cohort National Study

To (1) estimate the proportion of nonmedical users of prescription opioids (i.e., used prescription opioids in the past year without a doctor's orders) who used leftover medications from their own previous prescriptions; (2) assess substance use behaviors as a function of diversion source; and (3) identify the sources for these prescribed opioids. We analyzed data collected via self-administered questionnaires from nationally representative samples of high school seniors (modal age, 18 years) as a part of the Monitoring the Future (MTF) study. The sample consisted of four cohorts (senior years of 2007-2010, n= 8,888), including 647 high school seniors who reported past-year nonmedical use of prescription opioids, of whom 53% were estimated to be women. An estimated 36.9% of past-year nonmedical users of prescription opioids obtained these opioid medications from their own previous prescriptions. Logistic regression analyses indicated that nonmedical users who used leftover medications from their previous prescriptions were primarily motivated to relieve physical pain, whereas nonmedical users who obtained medications from other sources had significantly higher odds of prescription opioid abuse and other substance use behaviors. Based on a subanalysis of nonmedical users who obtained prescription opioids from their previous prescriptions in 2010 (n= 51), approximately 27.1% obtained them from a dentist, 45.0% obtained them from an emergency room physician, and 38.3% obtained them from another physician. Leftover prescription opioids from previous prescriptions represent a major source of nonmedical use of prescription opioids among high school seniors. These findings indicate that enhanced vigilance is needed when prescribing and monitoring prescription opioids among adolescents, to reduce leftover medications and nonmedical use.

Nonmedical Use of Prescription Opioids Among Adolescents: Subtypes Based on Motivation for Use

The purpose of this study was to advance our understanding of nonmedical use of prescription medications by identifying the distinguishing characteristics of 2 subtypes of adolescent nonmedical users of prescription opioids that have been previously described. A Web-based, self-administered survey was completed by 2,597 7th–12th grade students. Sensation-seeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self-treating users were best characterized by somatic complaints, anxiety and depressive symptoms, and history of sexual victimization.

Co-ingestion of prescription opioids and other drugs among high school seniors: Results from a national study

BackgroundThe objective of this study was to determine the past-year prevalence rates and behavioral correlates of co-ingestion of prescription opioids and other drugs among high school seniors in the United States. MethodsNationally representative probability samples of high school seniors in the United States were surveyed as a part of the Monitoring the Future (MTF) study. Data were collected in schools via self-administered paper-and-pencil questionnaires during the spring of each cohort's senior year. The sample consisted of five cohorts (senior years of 2002–2006) made up of 12,441 high school seniors (modal age 18), of which 53% were women. ResultsThe estimated prevalence of any past-year co-ingestion of prescription opioids and other drugs for these cohorts was 4.4%, and 69.8% among nonmedical users of prescription opioids. The substances most commonly co-ingested with prescription opioids included marijuana (58.5%), alcohol (52.1%), cocaine (10.6%), tranquilizers (10.3%), and amphetamines (9.5%). Nonmedical users who co-ingested prescription opioids with other drugs were more likely to report intranasal administration, recreational motives, oxycodone use, and greater subjective high when using prescription opioids than nonmedical users who did not co-ingest prescription opioids and other drugs. ConclusionsNearly 7 out of every 10 nonmedical users of prescription opioids reported co-ingestion of prescription opioids and other drugs in the past year. The findings indicate that the co-ingestion of prescription opioids and other drugs by high school seniors in the United States serves as a marker for substance abuse and represents a significant public health concern.