OxyContin Use Research Articles

May 2023 Medical Image of the Month: Methamphetamine Inhalation Leading to Cavitary Pneumonia and Pleural Complications

No abstract available. Article truncated after 150 words. A 31-year-old man with a self-reported history significant for active methamphetamine and OxyContin use (last use of methamphetamine the same day with confirmation on urine drug screen) presented to the hospital with several hours of dyspnea. Having gone into cardiac arrest shortly after, he received several rounds of epinephrine and CPR and was intubated before spontaneous circulation returned. Bedside ultrasound revealed global hypokinesis with left ventricular ejection fraction of 10 to 15%, trivial pericardial effusion, and a moderate left pleural effusion. Chest CT (Figure 1) revealed segmental to subsegmental pulmonary emboli in the left lower lobe and ground-glass opacities in the left upper and bilateral lower lobes. He was treated as septic shock with Vancomycin and Cefepime, eventually speciating methicillin-sensitive Staphylococcus aureus in respiratory culture. Due to difficulty liberating the patient from the ventilator, he underwent tracheostomy tube placement. Chest x-ray on hospital day 18 showed a large left partially …

An Evaluation of the Effect of the OxyContin Reformulation on Unintentional Fatal and Nonfatal Overdose.

Objectives:OxyContin was reformulated with a polyethylene oxide matrix in August 2010 to reduce the potential for intravenous abuse and for abuse by insufflation. The objective of this study was to evaluate the impact of OxyContin’s reformulation on overdose (OD) risk for individuals dispensed OxyContin in comparison to those dispensed other opioids under regular care.Materials and Methods:Three national insurance databases with National Death Index linkage identified OD in individuals with any dispensing of OxyContin or a primary comparator opioid (extended release morphine, transdermal fentanyl, or methadone) between July 2008 through September 2015. A difference-in-differences design was used to compare the pre-post reformulation changes in OD rates for OxyContin versus comparators.Results:A total of 297,836 individuals were dispensed OxyContin and 659,673 individuals were dispensed a primary comparator across the 3 databases. Overall, there was little or no difference in the temporal change in OD incidence in comparators versus OxyContin (Medicaid: adjusted ratio-of-rate-ratios (aRoRs) ranging from 0.90 to 1.05; MarketScan/HIRD: aRoR ranging from 1.10 to 1.22). However, restriction to person-time without concomitant opioid use revealed a modestly greater reduction in OD incidence over time during OxyContin use, as the aRoRs comparing the primary comparators to OxyContin ranged from 1.06 to 1.30 in Medicaid and from 1.64 to 1.85 in MarketScan/HIRD.Discussion:This study did not detect an overall effect of the OxyContin reformulation on OD in insured patients under regular medical care. There is a suggestion of a modestly reduced OxyContin-associated OD risk following the reformulation but only in commercially insured individuals receiving single-opioid regimens.

Opioid Misuse Among American Indian Adolescents.

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF).Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence.Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively.Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels.Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

THE EVOLVING CONSEQUENCES OF OXYCONTIN REFORMULATION ON DRUG OVERDOSES.

Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.

CN29 - Analysis on the implementation results of family sickbed for oncology patients in Dongshi Township Health Centers from 2015 to 2017

BackgroundCancer patients in good general condition can receive aggressive anti-cancer treatment, while palliative care is most appropriate for advanced cancer patients. In China, patients admit to 3A hospitals regardless of the disease stage. Given the limited number of 3A hospital beds, high price, low quality of life, family sickbed is emerging. With one-to-one help of The Second Affiliated Hospital of FMU, Dongshi Township Health Center (DTHC) established the first family sickbed project for oncology patients (FSOP) in China. MethodsA retrospective survey was adopted to analyze the general clinical data of patients, hospitalization days and expenses, the types of medical insurance and the opioid analgesics drugs used of 225 patients. And, we carried out telephone follow-up to collect the data concerning the patient’s survival and satisfaction with FSOP service. ResultsFrom 2015 to 2017, 225 patients were admitted to FSOP. Of 225 patients, 192 (85.3%) were males and 33 (14.7%) were females with ages from 24 to 91 years. The most common disease categories were lung cancer, esophagus cancer, liver cancer. 216 out of 225 patients purchased the NCMS Insurance. During those 3 years, the average total hospitalization expenses, the average personal expenses, the average personal expenses ratio, the average reimbursement ratio, and the average hospitalization days of all patients were 3824.24yuan, 1195.34yuan, 34.64%, 65.37% and 11.79 days, respectively. 51 out of 225 patients suffered pain and needed to eat painkillers. The use of Morphine tablets and OxyContin increased year by year, conforming to the principle of the WHO’s three-step analgesic ladder. Follow-up results showed that 37 (18.5%, 37/200) patients were survive, and 177 patients or family members (88.5%, 177/200) were fully satisfied with FSOP’s service. ConclusionsSince 2015, the DTHC has provided considerate home care, resulting in a high level of patient and family members satisfaction. Admitting to FSOP can lower the hospitalization expenses, decrease the burden of economy and life, improve the quality of life, and relieve the pain, both mental and physical. Moreover, FSOP will be a more appropriate place to spend the last days for advanced cancer patients. Legal entity responsible for the studyThe Second Affiliated Hospital of Fujian Medical University. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Incidence of nonmedical use of OxyContin and other prescription opioid pain relievers before and after the introduction of OxyContin with abuse deterrent properties

ABSTRACTObjectives: There is an epidemic of nonmedical and extra-medical use opioid abuse, addiction, and overdose. Extended-release oxycodone (OxyContin®), a prescription opioid pain reliever, was reformulated in 2010 to deter its abuse. The aim of this study was to assess changes in the onset of abuse of OxyContin and other opioids among young people and adults after reformulation of OxyContin with abuse-deterrent properties.Methods: The study population was U.S. residents ≥ 12 years sampled in National Surveys on Drug Use and Health (NSDUH), 2004 to 2015, with subsample of 12–21-year-olds. Nonmedical and extra-medical use is the NSDUH proxy for abuse. Confidential audio-computer-assisted self-interviews were assessed. Age-specific incidence of nonmedical and extra-medical use of OxyContin and other prescription opioids were estimated year by year. Interrupted-time-series and age-period-cohort analyses were analyzed.Results: Interrupted-time-series analysis showed a lower incidence of OxyContin nonmedical and extra-medical use after 2010 reformulation compared to the counterfactual predicted by the trend before 2010. No such difference was seen for other prescription opioids for all ages, although a lower incidence was also observed for other prescription opioids among 12–21-year-olds. Among 12–21-year-olds, a robustly lower incidence was found in 2012 compared to 2010 for OxyContin after holding constant age and cohort effects, whereas no robust difference was observed for other prescription opioids. The results showed 137,500 fewer newly incident cases of OxyContin nonmedical and extra-medical use per year.Conclusions: This study provides evidence supporting the role of OxyContin reformulation in the reduction of onset of OxyContin nonmedical and extra-medical use.

Binge alcohol and substance use across birth cohorts and the global financial crisis in the United States.

BackgroundThe social and economic consequences of the global financial crisis (GFC) of 2007–9 has had serious impacts on population health, economic prospects, and overall wellbeing in all generations, particularly Millennials, Generation X, and Baby Boomers. The ways in which intergenerational inequality and global economic crises have affected population health, particularly with respect to excessive drinking and substance use in disadvantaged population groups has been understudied. Consequently, in this article, we seek to characterise the effects of the GFC on national trends in binge alcohol and substance use among Millennials, Generation X, and Baby Boomers. By doing so, we aim to contribute to a fuller understanding of the ways in which socioeconomic disadvantage engendered by the GFC has disparately affected the wellbeing of these generational cohorts.Methods and findingsWe present results from National Survey on Drug Use and Health from 2007–16 to characterise binge alcohol and substance use among different generational cohorts in the United States during and after the GFC. Bivariate descriptive analysis and maximum-likelihood logit regressions focused on: (a) individual substances and binge drinking, (b) poly-use and (c) any use to simultaneously model how socioeconomic, demographic, and health characteristics were related to past-month substance use and to report the social, economic, and demographic correlates of substance use. Socioeconomic vulnerability was captured on a five-point scale comprised of: (1) health insurance status, (2) government assistance, (3) income, (4) self rated health, and (5) employment status. Millennials showed generally higher risk of binge alcohol and substance use during 2007–16 than Generation X, while Baby Boomers generally exhibited lower risk. Comparison of individual and poly-use patterns for the birth cohorts before and after reveals: Millennials were at significantly increased risk of use of binge alcohol (AOR = 1.51; 95% CI = 1.46–1.56), cocaine (AOR = 1.19; 95% CI = 1.03–1.37), heroin (AOR = 1.39; 95% CI = 1.01–1.91), and oxycontin (AOR = 2.33; 95% CI = 1.74–3.12) than Gen X while Baby Boomers were at significantly reduced risk of all substances. Nevertheless, Millennials were at significantly reduced risk of crack use (AOR = 0.33; 95% CI = 0.25–0.43) and poly-use (AOR = 0.56; 95% CI = 0.45–0.70) compared to Gen X. These differences may be related to measures of austerity and socioeconomic vulnerability. Millennials exhibited the highest vulnerability related to austerity with an average vulnerability score of 0.97 (95% CI = 0.96–0.98) while Baby Boomers exhibited the lowest average vulnerability score of 0.65 (95% CI = 0.64–0.66) with Generation X in between with 0.72 (95% CI = 0.71–0.73). Increased social and economic vulnerability after the 2007 crisis is strongly associated with higher rates of substance use in all generations.ConclusionMillennials have been especially affected by socioeconomic changes associated with the GFC as reflected by their heightened vulnerability and increased use of binge alcohol and other substances compared to preceding generations. These findings suggest that attention is needed to address disparities in socioeconomic vulnerability, relationships to substance use and overall mental health of Millennials to mitigate the potential long term negative impacts of the GFC. In the context of a continuing international opioid and heroin crisis, the ways in which Millennials have been differentially affected warrants much greater attention both from policymakers and from researchers.

Prescription opioid use in the rural Appalachia: A community-based study

The purpose of this study is to describe the sample characteristics and methods for a study of rural medical and nonmedical prescription opioid users with a history of OxyContin use. Snowball sampling was used to recruit 221 rural Appalachian residents. Participants included those under medical supervision for pain (n = 101) as well as those self-reporting nonmedical use of prescription opioids (n = 120). Participants were given an intervieuwer-administered questionnaire. Data relating to demographics, illicit and nonmedical prescription drug use, medical, legal, family, and psychiatric status, as well as pain history were collected. The primary outcomes of interest were differences in past 30 day prescription drug use between pain patients and nonmedical opioid users. A significantly greater proportion of those treated for pain reported using oxycodone and hydrocodone prescribed by a physician in the prior 30 days (p < 0.001); however, more than third of pain participants also reported nonmedical use of OxyContin, methadone, hydrocodone, benzodiazepines, and marijuana in the prior 30 days. A large proportion of rural opioid users who reported being treated for pain also reported nonmedical use ofprescription drugs. Similarly, among the nonmedical users, half of those reported experiencing pain that interfered with their daily life. These results suggest that many rural prescription drug users are being either incorrectly or perhaps inadequately treated for chronic nonmalignant pain. Therefore, developing educational materials and training for rural physicians about pain treatment (including drug seeking behavior) is proposed.

Energy drinks and energy shot use associated with non- medical prescription opioid use among adolescents

We investigated the relationship between energy drinks (ED), energy shot (ES) and non-medicalopioid use among high school students. Logistic regression indicated ED use was a significant predictor ofnon-medical Vicodin (OR = 1.314, P &lt; 0.05) use but not non-medical Oxycontin use (OR = 1.050 P= 0.073) and ES use was a statistically significant predictor of non-medical use of Vicodin (OR = 1.545,P &lt; 0.01) and Oxycontin use (OR = 1.590 P &lt; 0.001). Mann-Whitney U tests indicated significantlygreater non-medical opioid use among students who used ED and ES than those who did not.

Changes in drug use patterns reported on the web after the introduction of ADF OxyContin: findings from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System Web Monitoring Program.

The primary objective was to study online posts that endorsed continued use of OxyContin or a switch from OxyContin to another formulation of oxycodone or another substance altogether following the introduction of the ADF. A secondary objective was to determine whether posts revealed that the ADF led to cessation of OxyContin use. Data were collected with the Researched Abuse, Diversion, and Addiction-Related Surveillance System Web Monitoring Program, an online surveillance system that collects and organizes posts about prescription drugs from social media websites, blogs, and forums from 3Q2009 to 4Q2014 using a commercially available web platform. Posts were categorized by whether they conveyed a switch to drugs other than reformulated OxyContin or a continuation of reformulated OxyContin abuse. "Switch posts" primarily discussed switching to immediate-release opioids. "Continue abusing" posts identified tampering strategies for alternate routes of administration, oral use, and continued use although post authors were generally unhappy with the experience. No reference to OxyContin cessation as a function of the introduction of the ADF was found; however, discontinued use was discussed. Web Monitoring data are useful for capturing cross sections of Internet conversation reflecting reactions to new drug formulations. These data support the notion that users will gravitate to non-ADFs generally, and to immediate-release non-ADF opioid formulations, specifically, as long as these options remain on the market.

Trends in the Nonmedical Use of OxyContin, United States, 2006 to 2013.

The role of the opioid OxyContin in the opioid abuse epidemic has been well documented. In 2010, OxyContin was reformulated to make it more difficult to abuse. We assessed past-year OxyContin nonmedical use among a nationally representative population and among nonmedical users of opioid pain relievers in the United States between 2006 and 2013. Data are from the National Survey on Drug Use and Health. Prevalence estimates of past-year OxyContin nonmedical use overall and by sociodemographic, geographic, and substance use characteristics were calculated for each year, 2006 through 2013. Multivariable logistic regression was used to identify individual characteristics associated with past-year OxyContin nonmedical use before and after reformulation. In 2013, the of past-year nonmedical use of OxyContin among people 12 years and older in the United States was 0.5%. This was significantly lower than the prevalence in 2010 (0.7%; P<0.05), but was similar to that in 2006 to 2009 and 2011 to 2012. Among past-year nonmedical users of pain relievers in 2013, the prevalence of OxyContin nonmedical use was 13.0%. This was significantly higher than the prevalence in 2006 (10.5%; P<0.05), and was similar to that in 2007 through 2012. Groups with increased odds of using OxyContin nonmedically in the past-year were similar before and after reformulation (2009-2010 and 2012-2013, respectively). For 2012-2013, odds for past-year OxyContin nonmedical use after reformulation were greatest for: people reporting ≥200 days of pain reliever nonmedical use, adjusted odds ratio (aOR)=3.61 (95% confidence interval [CI], 2.47-5.28); past-year heroin users, aOR=3.45 (95% CI, 2.22-5.37); and people with past-year pain reliever abuse or dependence, aOR=2.57 (95% CI, 1.88-3.51). The prevalence of past-year OxyContin nonmedical use in 2013, 3 years after reformulation, was significantly lower than the prevalence in the reformulation year, but similar to other years before and after reformulation. The prevalence of OxyContin nonmedical use among nonmedical users of pain relievers was higher than or similar to historical prevalence rates before reformulation. Groups with increased odds of OxyContin nonmedical use were similar before and after reformulation.

Changes in nonmedical use of OxyContin after reformulation with abuse deterrent properties

Changes in nonmedical use of OxyContin after reformulation with abuse deterrent properties

Discordant reporting of nonmedical opioid use in a nationally representative sample of US high school seniors

ABSTRACTBackground: Nonmedical opioid use has become a major public health concern due to increases in treatment admissions, overdoses, and deaths. Use has also been linked to heroin initiation. Reliable data on nonmedical opioid use are needed to continue to inform prevention. Objective: To determine the prevalence and correlates of discordant self-report of nonmedical use of opioids in a national sample. Methods: Utilizing a nationally representative sample of 31,149 American high school seniors in the Monitoring the Future study (2009–2013), discordant responses between self-reported 12-month nonmedical opioid use and self-reported 12-month nonmedical Vicodin and OxyContin use (reporting Vicodin/OxyContin use, but not reporting “opioid” use) were assessed. We also used multivariable logistic regression to determine the characteristics of students who were most likely to provide a discordant response. Results: 37.1% of those reporting nonmedical Vicodin use and 28.2% of those reporting nonmedical OxyContin use did not report overall nonmedical opioid use. Prevalence of nonmedical opioid use (8.3%) would increase when factoring in Vicodin, OxyContin, or both, by 2.8%, 1.3%, and 3.3%, respectively. Females were more likely to provide a discordant response to Vicodin and highly religious students were more likely to provide a discordant response regarding OxyContin use. Those who reported cocaine or nonmedical tranquilizer use were at consistently low odds for discordant responses. Nonmedical amphetamine users were at low odds for providing a discordant Vicodin response. Conclusion: Prevalence of nonmedical opioid use may be underreported on some surveys, particularly among specific subpopulations. Further research on the effect of question order and skip-patterns (e.g., “gate” questions) is needed. Reliable data on nonmedical opioid use are needed to continue to accurately inform prevention.

Prescription Opioid Misuse: Effective Methods for Reducing the Epidemic

Prescription opioid misuse has been a significant epidemic during the past decade. Formulations of prescription opioids with different mechanisms of abuse-deterrence have been developed or are currently under development. Given that these medications are substantially more difficult to use in an illicit fashion and minimize the potential for euphoria and/or create an aversive experience when over-ingested, they represent an important next step in pharmacological innovation. Immediate decreases in nonmedical use and in associated overdose mortality and adverse events have been observed after a highly abused opioid, OxyContin, was changed into an abuse-deterrent formulation. However, this reduction in OxyContin use may have simply shifted the drug of choice towards other more easily misused opioids, suggesting that a change in formulation alone will not be sufficient in controlling the epidemic. To control prescription opioid misuse requires treating populations with opioid use disorder and preventing the development of opioid abuse or dependence in unaffected populations. Buprenorphine with naloxone has been designed as an abuse-deterrent formulation, while also demonstrating significant efficacy in treating opioid use disorder. Thus, the dissemination of buprenorphine treatment can be a helpful step in reducing the current epidemic. Other strategies to reduce the epidemic include limiting the availability of leftover prescription opioids through drug take back programs, monitoring physician prescriptions through state prescription monitoring programs, and implementing evidence-based practices in pain management. Increased referral of patients with chronic nonmalignant pain to comprehensive pain rehabilitation programs can also reduce healthcare utilization while improving patient outcomes. Also, routine screening for prescription misuse and referral for addictions treatment must become a standard practice in order to ensure patient safety and create early opportunities for intervention.

Impact of abuse-deterrent OxyContin on prescription opioid utilization.

We quantified the degree to which the August 2010 reformulation of abuse-deterrent OxyContin affected its use, as well as the use of alternative extended-release and immediate-release opioids. We used the IMS Health National Prescription Audit, a nationally representative source of prescription activity in the USA, to conduct a segmented time-series analysis of the use of OxyContin and other prescription opioids. Our primary time period of interest was 12 months prior to and following August 2010. We performed model checks and sensitivity analyses, such as adjusting for marketing and promotion, using alternative lag periods, and adding extra observation points. OxyContin sales were similar before and after the August 2010 reformulation, with approximately 550 000 monthly prescriptions. After adjusting for declines in the generic extended-release oxycodone market, the formulation change was associated with a reduction of approximately 18 000 OxyContin prescription sales per month (p = 0.02). This decline corresponded to a change in the annual growth rate of OxyContin use, from 4.9% prior to the reformulation to -23.8% during the year after the reformulation. There were no statistically significant changes associated with the sales of alternative extended-release (p = 0.42) or immediate-release (p = 0.70) opioids. Multiple sensitivity analyses supported these findings and their substantive interpretation. The market debut of abuse-deterrent OxyContin was associated with declines in its use after accounting for the simultaneous contraction of the generic extended-release oxycodone market. Further scrutiny into the effect of abuse-deterrent formulations on medication use and health outcomes is vital given their popularity in opioid drug development.

Evaluating the potential impact of a reformulated version of oxycodone upon tampering, non-adherence and diversion of opioids: the National Opioid Medications Abuse Deterrence (NOMAD) study protocol.

A new oxycodone formulation (Reformulated OxyContin® was released in Australia, early 2014. It was developed as a tamper-resistant ('abuse-deterrent') formulation of the drug. We summarize methods used in the National Opioid Medication Abuse Deterrence (NOMAD) study, which will examine: (i) whether there is a reduction in extra-medical use (including via tampering) of OxyContin® following the introduction of Reformulated OxyContin®; (ii) potential changes in extra-medical use of non-abuse-deterrent forms of oxycodone, other pharmaceutical opioids and illicit drugs; (iii) whether methods of tampering with Reformulated OxyContin® become widespread over time; (iv) Reformulated OxyContin®'s attractiveness on the illicit market; and (v) sales, prescriptions and harms related to OxyContin® and other drugs. There are three major components. First, analyses of existing routine data sources such as: pharmaceutical sales; prescribing data; data on drug overdose deaths; and survey data on drug use in the general population and among people who inject drugs; secondly, specific data on OxyContin® collected through the Illicit Drug Reporting System; and thirdly, a prospective cohort of n = 606 people who regularly misuse or tamper with pharmaceutical opioids was formed prior to the introduction of Reformulated OxyContin®, followed-up twice post-release to examine potential changes after Reformulated OxyContin®'s introduction. The study's strengths lie in varied data collections; interrupted time-series analysis; and prospective cohort. To our knowledge, this is one of the most comprehensive and transparently conducted studies conducted to date of the potential impact of an opioid medication upon use, tampering and diversion. Results have the potential to inform policymakers, clinicians, consumers and researchers alike.

OxyContin Use on a Rural Midwest American Indian Reservation: Demographic Correlates and Reasons for Using

In 2009 we surveyed 400 tribal members of a midwestern American Indian reservation to assess the prevalence of OxyContin use. Thirty percent of tribal participants reported nonmedical use of OxyContin ever, 18.9% in the past year, and 13.4% in the past month. Participants aged 18 to 25 years were most likely to have used OxyContin. Reasons given for use of the drug included pain relief (59.3%) and getting high (52.2%), indicating a need for opioid treatment programs.

Toward primary prevention of extra-medical OxyContin® use among young people

ObjectiveThe prevention research context includes current epidemic levels of hazards associated with extra-medical use of OxyContin® (to get high or otherwise outside prescribed boundaries) among teenagers and young adults, and a recent OxyContin® re-formulation with an intent to reduce these hazards, plus hope for possibly beneficial primary prevention impact. The aim is to create a benchmark of risk estimates for the years just prior to OxyContin® re-formulation in anticipation of potential public health benefit in future years, with a focus on teens and the youngest adults in the United States, and to compare two methods for estimating peak risk. MethodThe data are from nationally representative probability sample surveys of 12–21year olds, yielding estimates for incidence of extra-medical OxyContin® use. Samples are of the non-institutionalized United States population, recruited and assessed in National Surveys on Drug Use and Health (NSDUH), each year from 2004 through 2008. In aggregate, the sample includes 135,552 young people who had not used OxyContin® extra-medically prior to their year of survey assessment. ResultsThe main outcome was the estimated population-level age-specific incidence of extra-medical OxyContin® use, 2004–2008. We found that during the 2004–2008 interval the estimated risk accelerated from age 12years, reached a peak value in mid-adolescence at roughly five newly incident users per 1000 persons per year (95% confidence intervals, 0.3%, 0.7%), and then declined. A meta-analysis approach to year-by-year data differentiated age patterns more clearly than a pooled estimation approach. ConclusionStudying young people in the United States, we have discovered that the risk of starting to use OxyContin® extra-medically rises to a peak by mid-adolescence and then declines. From a methods standpoint, the meta-analysis serves well in this context; there is no advantage to pooling survey data across years. We also discovered that during any given year a pediatrician might rarely see even one patient who has just started to use OxyContin® to get high or for other extra-medical purposes. Implications for screening are discussed.

Service Provider Views of Oxycontin Use on an Indian Reservation: Traumatic Effects on the Tribal Community

This qualitative research study on a Great Lakes Indian reservation used semistructured interviews of American Indian (n = 8) and non-American Indian (n = 2) providers of behavioral and physical health services to elicit views of Oxycontin use. We gathered data on existing substance abuse services including accessibility, cultural appropriateness, service strengths and weaknesses, barriers to treatment, and treatment needs. Results indicated a high prevalence of the use of Oxycontin, with traumatic effects on families and the tribal community such that the providers were overburdened with their dual role as service providers and caretakers in their own community. Implications for social work practice are discussed.

Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine

BackgroundAs buprenorphine prescribing has increased in the United States so have reports of its diversion. The study purpose was to examine frequency and source of and risk factors for diverted buprenorphine use over a 6-month period in an Appalachian community sample of prescription opioid abusers. MethodsThere were 503 participants at baseline; 471 completed the 6-month follow-up assessment. Psychiatric disorders and demographic, drug use, and social network characteristics were ascertained at baseline and follow-up. Multivariable logistic regression was used to determine the predictors of diverted buprenorphine use over the 6-month period. ResultsLifetime buprenorphine use “to get high” was 70.1%. Nearly half (46.5%) used diverted buprenorphine over the 6-month follow-up period; among these persons, 9.6% and 50.6% were daily and sporadic (1–2 uses over the 6-months) users, respectively. The most common sources were dealers (58.7%) and friends (31.6%). Predictors of increased risk of use of diverted buprenorphine during the 6-month follow-up included inability to access buprenorphine treatment (AOR: 7.31, 95% CI: 2.07, 25.8), meeting criteria for generalized anxiety disorder, and past 30day use of OxyContin, methamphetamine and/or alcohol. ConclusionsThese results suggest that improving, rather than limiting, access to good quality affordable buprenorphine treatment may be an effective public health strategy to mitigate buprenorphine abuse. Future work should evaluate why more persons did not attempt to access treatment, determine how motivations change over time, and how different motivations affect diversion of the different buprenorphine formulations.