Prescription Drug Misuse Research Articles

Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018

Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited. To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018). This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively. Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse. The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

Opioid misuse during late adolescence and its effects on risk behaviors, social functioning, health, and emerging adult roles

Opioid misuse has emerged in recent years as a major public health concern in the United States, particularly for adolescents and emerging young adults. We examined the association of opioid misuse from ages 18 to 20 with four domains at age 21–22: risk behaviors and consequences; health; social functioning; and emerging adult roles. Participants were surveyed annually from 2008 through 2019. The sample includes N = 2880 youth from waves 8–11. The sample was approximately 18 years old at wave 8; 54% female, 46% Hispanic, 20% white, 20% Asian, 2% Black, and 11% multiracial. Opioid misuse was low in this general sample of young adults, with about 4% reporting misuse from age 18–20. We used latent growth curve modeling to examine how misuse from ages 18–20 was associated with functioning at age 21–22. Adolescents who reported opioid misuse at age 18 also reported more negative consequences from alcohol and cannabis use and greater odds of other prescription drug misuse at age 21–22 than those with no misuse. Those reporting opioid misuse at age 18 were also more likely to engage in sexual risk behaviors, report delinquent behavior, and have a higher likelihood of experiencing sexual victimization and engaging in sexual perpetration at age 21–22 than those with no misuse. Neither the intercept nor slope of opioid misuse was associated with depression, anxiety, physical health or ailments, satisfaction with friends, romantic relationship functioning, or emerging adult roles at wave 11. Findings highlight the importance of screening and brief intervention for adolescents reporting opioid misuse.

Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study.

BackgroundPrescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts.ObjectiveThe objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey.MethodsAn EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred.ResultsRisk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study.ConclusionsThe novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.

Examining the influence school factors have on stimulant misuse among a national sample of adolescents

ABSTRACT Introduction Over the past decade, nonmedical prescription drug misuse has been a public health concern among adolescents in the United States. One of the main prescription drug classifications commonly used for nonmedical purposes is stimulants. The purpose of this study was to determine the relationship between negative school experiences (e.g., disliked going to school) and lifetime and past year stimulant misuse among US. high school students nationwide. Method The present study was a secondary analysis of the 2017 National Survey on Drug Use and Health (NSDUH) data. Participants included in the study were 9th-12th grade students (N = 8,337). Results A total of 9.7% high school students reported they had misused stimulants in their lifetime, and 8.5% reported they had misused stimulants during the past year. High school students who reported the following negative school experiences were at increased odds of reporting lifetime stimulant misuse: liked/hated going to school (adjusted OR [aOR] = 1.88, 95% confidence interval [CI] = 1.58–2.22); felt their coursework was somewhat/very boring (aOR = 1.56, 95%CI = 1.32–1.84), seldom/never meaningful (aOR = 1.69, 95%CI = 1.43–1.99), and would be somewhat/very unimportant to them later in life (aOR = 1.28, 95%CI = 1.07–1.52); and students with teachers who seldom/never let them know they were doing a good job (aOR = 1.44, 95%CI = 1.21–1.70). High school students who had a “D” grade average or lower (aOR = 2.48, 95%CI = 1.81–3.39) and skipped school on at least 1 day (aOR = 1.80, 95%CI = 1.51–2.16) were more likely to report lifetime misuse. Additionally, adolescents at increased risk for reporting stimulant misuse included males and those in higher grade levels. Conclusions Adolescents who reported having negative school experiences were at increased odds for reporting lifetime and past year stimulant misuse compared to their counterparts who reported positive school experiences. These findings should be considered when developing and implementing school-based prevention programs for stimulant misuse.

HPTLC–MS method for the determination of benzodiazepines in urine samples

Misuse and abuse of prescription drugs has become a global health problem in the last few years as the illicit drug cartels have grown exponentially. The non-medical use of prescribed medications, such as benzodiazepines, synthetic opioids, stimulants and tranquilizers, has increased rapidly due to their easy availability. Nowadays benzodiazepines are not only misused/abused, but also play a significant part in facilitating various crimes such as robbery, date rapes, sexual harassment, which has made its forensic examination important and critical. Considering the gravity of these crimes, an attempt has been made to develop and validate simultaneous quantification method for seven benzodiazepines (clonazepam, lorazepam, alprazolam, diazepam, flurazepam, oxazepam and nitrazepam) using high-performance thin-layer chromatography–mass spectrometry (HPTLC–MS) from urine. Quantitative analysis of clonazepam, lorazepam, alprazolam, diazepam, flurazepam, oxazepam and nitrazepam was carried out using HPTLC–MS. MS operating in selective ion-monitoring mode was attempted for the accurate identification of the drugs under study. Small-volume liquid extraction technique using diethyl ether–chloroform (80:20, v/v) was used for the extraction of urine. Pre-coated HPTLC (silica gel G 60 F254) plates were developed using the mobile-phase chloroform–glacial acetic acid (9:1, v/v). The screening of HPTLC plates was carried out by ultraviolet light, and the m/z ratio of drugs was obtained by extracting spots from plates using a TLC–MS interface. Method validation was carried out according to the International Council for Harmonisation guidelines. The current HPTLC–MS method is simple, sensitive, precise and accurate, and it can be used for the detection and quantitative estimation of benzodiazepines in urine.

Longitudinal Associations Between Sexual Victimization and Substance Misuse Among High School Youth in Colorado.

There are consistently high rates of sexual victimization and substance misuse among youth in the United States. Although there is a known relation between sexual victimization and substance use, there is a gap in the research regarding the magnitude and temporality of these associations. This study examined whether latent classes of sexual victimization and help-seeking attitudes longitudinally predict intentions of future substance misuse 7-10 months later. Students from nine Colorado high schools (N = 533; M = age 16 years) completed surveys across two consecutive school semesters. Latent class analysis was used to identify classes of students who experienced at least one form of sexual victimization (e.g., sexual harassment, unwanted sexual contact) according to 13 sexual victimization items, and level of positive attitudes regarding help-seeking for sexual victimization. Classes were compared on demographic characteristics and for distal outcomes of likelihood of future substance misuse (cigarettes, alcohol, cannabis, prescription drugs, and electronic vaping products) using latent class regression, controlling for previous intentions to use. At Time 1, four classes of sexual victimization were identified with two main classes for comparison: low odds of experiencing sexual victimization (60.1% of sample) and high odds of endorsing all forms of sexual victimization (7.7% of sample). The high sexual victimization class had higher proportions of male and transgender students, compared to other classes. At Time 2 (7-10 months later), students in the high sexual victimization class reported a significantly greater likelihood of future cigarette (p = .017) and prescription drug misuse (p = .007) when compared to the low sexual victimization class. There was no evidence that having higher positive attitudes towards help-seeking resulted in lower intentions to use substances in the future. These findings highlight that addressing sexual violence in prevention programming may have crossover effects of reducing substance misuse and other forms of violence among youth.

Typologies of illicit drug use in mid-adulthood: a quasi-longitudinal latent class analysis in a community-based sample of twins.

To identify drug use typologies based on substances used and persistence of use over two time points, use a genetically informed design to explore twin concordance of and genetic influence on the use typologies and compare patterns of declined/discontinued ("desistant") and persistent drug use on drug use correlates. Latent class analysis was applied to data from a cross-sectional self-report survey on current and past drug use. Use characteristics, use disorder, and psychiatric problems were compared across classes. Computer-assisted telephone interview in respondents' homes. A total of 3785 individual twins and siblings (1365 men, 2420 women; Mage =32) from the Australian Twin Registry Cohort III. A comprehensive interview assessed prior to past year and past year use of cannabis, stimulants, cocaine/crack, hallucinogens, opioids, sedatives, inhalants, dissociatives, and solvents; age of first use; opportunity to use; peer drug use; attention deficit/hyperactivity, conduct, antisocial personality, depressive, and substance use disorders; and suicidality. A five-class solution emerged: no/low use (50%), desistant cannabis use (23%), desistant party drug use (18%), persistent prescription drug misuse (4%), and persistent polydrug use (5%). Twin concordances were higher among monozygotic (k =0.30-0.35) than dizygotic pairs (same-sex k =0.19-0.20; opposite sex k =0.07), and biometric modeling suggested that the persistent polydrug use class, in particular, was highly heritable (a2 =0.94). Conduct disorder (OR=2.40), antisocial personality disorder (OR=3.27), and suicidal ideation (OR=1.98) increased persistent polydrug use risk; depression (OR=2.38) and lifetime suicide attempt (OR=2.31) increased persistent prescription misuse risk. Relative to persistent prescription drug misuse, persistent polydrug use was associated with higher rates of cannabis and stimulant use disorder (OR=6.14-28.01), younger first substance use (OR=0.82-0.83), more drug use opportunity (OR=10.66-66.06), and more drug-using peers (OR=4.66-9.20). Unique patterns of declined/discontinued ("desistant") and persistent drug use are differentially heritable and differentially associated with risk factors, psychiatric symptoms, and substance use disorder outcomes.

MisuMedPT - Morbi-mortality consequences of misuse of psychoactive prescription drugs in Portugal

Abstract Background In Portugal, there are no published data on the health-related consequences of prescription drug misuse, which is therefore a public health issue of unknown dimension in our country. Poison control centres and other pharmacoepidemiological sources can be part of a surveillance system for monitoring medicine's use and misuse. Methods Retrospective observational study of intentional exposures to opioid analgesics, antiepileptics, antidepressants, anxiolytics, hypnotics and sedatives reported to the Portuguese Poison Information Centre (CIAV) between 2014 and 2018. Variables studied were demographic characteristics of individuals, geographic distribution of calls, co-exposure to alcohol or illicit drugs, call origin, case evaluation and guidance. Results CIAV received 24624 calls reporting 34203 intentional exposures to any medicine, 31169 (91.1%) of which involving one of the studied psychoactive medicines and 20906 exposures having emergency room advice or effective hospitalisation. The most frequently involved medicines were benzodiazepines (62.0%) - alprazolam (15.4%) and diazepam (12.0%) - with trazodone ranking fifth (6.0%). Combination with non-medicinal products was seen in 2169 calls (9.4%), 2052 (94.6%) of which with alcohol. Conclusions There is female predominance in the poisonings reported involving any of the medicines studied. Benzodiazepines and antidepressants are the top classes reported. The rate of intentional exposures to psychoactive medicines is higher in Coimbra district, whose significant university student population requires further analysis of data. To adjust for the variability in the level of medicines' use in the population, work is undergoing to include rates of intentional poisonings in patients prescribed the studied medicines. To better characterise the potential consequences of misuse of psychoactive prescription drugs in Portugal, additional data on deaths involving these medicines will also be included in the project. Key messages First published Portuguese data on prescription drug poisoning reported to CIAV. First Portuguese project to analyse prescription drug poisoning, forensic and hospitalisation data.

Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life.

Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Shared correlates of prescription drug misuse and severe suicide ideation among clinical patients at risk for suicide.

ObjectiveUnintentional drug overdose and suicide have emerged as public health problems. Prescription drug misuse can elevate risk of overdose. Severe suicidal ideation increases risk of suicide. We identified shared correlates of both risk factors to inform cross‐cutting prevention efforts.MethodsWe conducted a cross‐sectional study using the Military Suicide Research Consortium's Common Data Elements survey; 2012–2017 baseline data collected from 10 research sites were analyzed. The sample included 3962 clinical patients at risk of suicide. Factors examined in relation to the outcomes, prescription drug misuse and severe suicidal ideation, included demographic characteristics and symptoms of: hopelessness; anxiety; post‐traumatic stress disorder; alcohol use; other substance use; prior head/neck injury; insomnia; and belongingness. Poisson regression models with robust estimates provided adjusted prevalence ratios (aPRs) and 97.5% confidence intervals (CIs).ResultsMedium and high (vs. low) levels of insomnia were positively associated with prescription drug misuse (aPRs p < 0.025). Medium (vs. low) level of insomnia was positively associated with severe suicidal ideation (aPR: 1.09; CI: 1.01–1.18). Medium and high (vs. low) levels of perceived belongingness were inversely associated with both outcomes (aPRs p < 0.025).ConclusionsResearch should evaluate whether addressing sleep problems and improving belongingness can reduce prescription drug misuse and suicidal ideation simultaneously.

‘Codeine crazy:’ a content analysis of prescription drug references in popular music

ABSTRACT Prescription drug misuse (PDM) is a national problem in the U.S., particularly effecting youth ages 16–25. Drug-related messages in music are one known predictor of substance use for this population. Research suggests that racial/ethnic minority youth are less likely to engage in PDM; however, the prevalence of PDM references in rap music may better reflect emerging drug trends. This study examined changes in the frequency of references to PDM in rap lyrics in the top 25 songs in 2007 and 2017, using targets identified from a generated list of 235 slang terms for PDM. The lyrics for each song were obtained from Genius, a social media site with lyric annotations. Coders independently identified the target stanzas and a third member of the research team corroborated the selections. Results of the General Linear Model using a Negative Binomial distribution indicated that the number of songs referencing PDM was estimated to be 18.80 times higher in 2017 than in 2007. Implications for healthcare providers are provided.

Is Medical Marijuana Legalization Associated With Prescription Drug Misuse, Illicit Drug Use, or Combination of Both Among Adults in the United States?

This research focuses on associations of medical marijuana legalization with prescription drug misuse, illicit drug use, and a combination of both behaviors. Using three waves of the National Survey of Drug Use and Health (NSDUH, 2016–2018), adult participants (age ≥ 18) were selected for the final study sample ( n = 127,438). Multinomial logistic regression was adjusted for biological, socioeconomic, and substance use measurements. Results from multinomial regression demonstrated that medical marijuana legalization was positively associated with illicit drug use (relative risk ratio [RRR] = 1.33, 95% confidence interval [CI] = [1.17, 1.51]; p &lt; .01) and both prescription drug misuse and illicit drug use (RRR = 1.14, 95% CI = [1.05, 1.25]; p &lt; .01) among U.S. adults. It is recommended to design policy interventions to counter illicit drug use and a combination of both prescription drug misuse and illicit drug use as the result of medical marijuana legalization.

Sense of Purpose in Life and Likelihood of Future Illicit Drug Use or Prescription Medication Misuse.

In the United States, 28.6 million people used illicit drugs or misused prescription drugs in the last 30 days. Thus, identifying factors linked with lower likelihood of future drug misuse is an important target for research and practice. Sense of purpose in life has been linked with better behavioral and physical health outcomes. Furthermore, a higher sense of purpose may reduce the likelihood of drug misuse because it has been linked with several protective factors including enhanced ability to handle stress, higher pain tolerance, and lower impulsivity. However, the association between sense of purpose and drug misuse has been understudied. Thus, we tested whether people with a higher sense of purpose at baseline had a lower likelihood of future drug misuse 9 to 10 years later. This study included 3535 middle-aged adults from the Midlife in the United States Study who were not misusing drugs at baseline. Using multiple logistic regression models, we assessed whether baseline purpose in life was associated with risk of misusing drugs 9 to 10 years later. Among respondents not misusing drugs at baseline, people in the highest quartile of purpose (versus lowest quartile) had a substantially lower likelihood of future drug misuse in a model adjusting for demographic variables (odds ratio = 0.50, 95% confidence interval = 0.31-0.83). Associations remained evident after additionally adjusting for psychological distress, baseline health, and health behaviors. A growing knowledge base suggests that a sense of purpose can be increased. Additional research is needed to evaluate sense of purpose as a novel target in the prevention and reduction of drug misuse.

Nightlife scene involvement and patterns of prescription drug misuse.

Participation in nightlife influences a range of health behaviours. Participants in various nightlife scenes have increasingly adopted prescription drug misuse into their substance use repertoires. With 404 young adults recruited via time-space sampling in New York, we examine the relationship of nightlife participation-measured by number of scenes and the number of nights out in nightlife scenes-to prescription drug misuse during the past 3 months. Outcomes included frequency of misuse, escalation to non-oral consumption, polydrug use, social problems and symptoms of dependence. Negative binomial regressions indicate nightlife participation is associated with increased frequency of misuse measured by number of scenes (incidence rate ratio = 1.114, P < 0.05) and number of nights out (incidence rate ratio = 1.009, P < 0.001). Logistic regression models show nightlife participation is associated with increased odds of non-oral use (adjusted odds ratio; AOR = 1.334, P < 0.01) and polydrug use (AOR = 1.776, P < 0.001) measured by number of scenes, and non-oral use (AOR = 1.021, P < 0.001) and polydrug use (AOR = 1.023, P < 0.001) as measured by number of nights out. Nightlife participation is not associated with prescription drug problems or symptoms of dependence. Frequency of participation is associated with peer norms favourable to prescription drugs (B = 0.003, P < 0.01). Nightlife participation has implications for prescription drug misuse. While shaping how often and in what manner young people consume prescription drugs, nightlife participation is not associated with harms experienced. Given the significance of the prescription drug trend in many world regions, these results suggest that increasing participation in nightlife shapes patterns of drug use, but in ways that do not lead to reported problems.

Early onset of cannabis use and alcohol intoxication predicts prescription drug misuse in American Indian and non-American Indian adolescents living on or near reservations

ABSTRACT Background Prescription drug misuse (PDM) is a growing issue within the American Indian (AI) population, especially in younger populations. Objectives This study estimates relationships between PDM and early initiation (prior to 14 yrs) of cannabis use and alcohol intoxication for a national sample of AI and non-AI adolescents attending schools on or near reservations. Method Participants were 2580 students (50.2% female; 58.1% AI), ages 15–18, attending schools located on or near an AI reservation. Four models of PDM were estimated: 1) demographic variables; 2) demographics plus cannabis use initiation status; 3) demographics plus alcohol intoxication initiation status; and 4) all variables. All analyses were conducted using multilevel modeling. Results Results indicated that early onset of cannabis use and alcohol intoxication were individually significant predictors of PDM for AI and non-AI adolescents, with odds ratios (OR) of 47.00 for cannabis (p <.01) and 35.73 (p <.01) for intoxication and with no significant differences by race (AI vs. non-AI). Results also indicated a greater likelihood of PDM when a student was an early initiator of both cannabis use and intoxication than when they were one or the other. Finally, there was a significantly greater association between cannabis use and PDM (ORearlycannabis = 24.95, p <.01) than between intoxication and PDM (ORearlyintoxication = 3.98, p <.01) when both predictors were in the model. Conclusions These findings suggest that for AI and non-AI youth who have some shared living experience, early initiation of cannabis use and alcohol intoxication are risk factors that are similarly related to PDM and that targeting early initiation for both groups of adolescents is critical in prevention of PDM.

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees.

This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.

Online Conversation Monitoring to Understand the Opioid Epidemic: Epidemiological Surveillance Study.

BackgroundBetween 2016 and 2017, the national mortality rate involving opioids continued its escalation; opioid deaths rose from 42,249 to 47,600, bringing the public health crisis to a new height. Considering that 69% of adults in the United States use online social media sites, a resource that builds a more complete understanding of prescription drug misuse and abuse could supplement traditional surveillance instruments. The Food and Drug Administration has identified 5 key risks and consequences of opioid drugs—misuse, abuse, addiction, overdose, and death. Identifying posts that discuss these key risks could lead to novel information that is not typically captured by traditional surveillance systems.ObjectiveThe goal of this study was to describe the trends of online posts (frequency over time) involving abuse, misuse, addiction, overdose, and death in the United States and to describe the types of websites that host these discussions. Internet posts that mentioned fentanyl, hydrocodone, oxycodone, or oxymorphone were examined.MethodsPosts that did not refer to personal experiences were removed, after which 3.1 million posts remained. A stratified sample of 61,000 was selected. Unstructured data were classified into 5 key risks by manually coding for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of the coded posts were used to estimate the total post volume for each key risk.ResultsAddiction and misuse were the two most commonly discussed key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed key risks. Fentanyl had the highest estimated number of misuse-, overdose-, and death-related mentions (41,808, 42,659, and 94,169, respectively). Oxycodone had the highest estimated number of abuse- and addiction-related mentions (3548 and 12,679, respectively). The estimated volume of online posts for fentanyl increased by more than 10-fold in late 2017 and 2018. The odds of discussing fentanyl overdose (odds ratios [OR] 4.32, 95% CI 2.43-7.66) and death (OR 5.05, 95% CI 3.10-8.21) were higher for social media, while the odds of discussing fentanyl abuse (OR 0.10, 95% CI 0.04-0.22) and addiction (OR 0.24, 95% CI 0.15-0.38) were higher for blogs and forums.ConclusionsOf the 5 FDA-defined key risks, fentanyl overdose and death has dominated discussion in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone has decreased. As drug-related deaths continue to increase, an understanding of the motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Furthermore, content was notably different based on media origin, and studies that exclusively use either social media sites (such as Twitter) or blogs and forums could miss important content. This study sets out sustainable, ongoing methodology for surveilling internet postings regarding these drugs.

Predictors of Prescription Drug Misuse among High School Students in the United States

ABSTRACT The misuse of prescription medication is a prominent public health concern in the United States. The current study examines prescription drug misuse among adolescents under age 18, a segment of the population that is particularly vulnerable to this issue. The study further explores the correlates of prescription drug misuse among adolescents through analysis of the Youth Risk Behavior Survey results. The analysis is framed through Routine Activities Theory. Results indicate that aspects of the theory are moderate to strong predictors of youth prescription drug misuse.

Prevalence of Opioid and Benzodiazepine Prescriptions for Osteoarthritis.

Opioids and benzodiazepines are commonly used for management of osteoarthritis, despite evidence-based recommendations to the contrary. This study aimed to quantify the prevalence of opioid and benzodiazepine prescribing for osteoarthritis. Additionally, we aimed to characterize risk factors for prescription drug misuse, abuse, and diversion among this population. We conducted a descriptive analysis of adult outpatient encounters with a primary diagnosis of osteoarthritis during a 1-year period at a large health care system, excluding cancer and outpatient procedures. Demographic data, prescription data, and patient-specific risk factors were collected. Descriptive analysis was conducted to characterize arthritis patients who received and did not receive prescription opioids. During 1 year, our system had 31,123 outpatient encounters for osteoarthritis. Opioids and benzodiazepines were prescribed for nearly 27% of the encounters (n = 8,420). In all, 43% of the encounters involved patients age ≥65 years. Hydrocodone-acetaminophen was the most common medication prescribed (34.3%). Most prescriptions were written by pain specialists (53%). A total of 35.5% of patients had a risk factor for prescription misuse, the most prevalent being early refill and a history of receiving ≥3 prescriptions in the past month. Prescriptions for opioids and benzodiazepines continue to be written for osteoarthritis. These prescriptions may pose a risk for adverse outcomes since >1 in 5 patients receiving prescriptions had a risk factor for misuse. Continued efforts to improve compliance with evidence-based guidelines as well as multimodal and alternative pain management pathways are critical to help curb the use of opioids for management of osteoarthritis-related pain. level IV.

Treatment Needs and Service Utilization in Older U.S. Adults Evidencing High-Risk Substance Use.

Objectives: Because substance misuse by older adults poses clinical risks and has not been recently assessed, we examined substance use patterns, treatment needs, and service utilization in those evidencing high-risk use. Methods: We identified National Survey on Drug Use and Health respondents (2015-2018) aged ≥50years reporting multiple-occasion binge drinking, illicit drug use, prescription drug misuse, or substance dependence. Past-year psychological symptoms were assessed using validated scales. Results: The sample, representing 10.2% of community-dwelling older U.S. adults, evidenced clinically important risks: 65.2% past-month binge drinking, 27.3% mental illness, 14.3% psychological distress, 10.6% combined alcohol/drug use, and 6.5% suicidality. Treatment receipt was uncommon (27.7%), positively associated with distress, and negatively associated with binge drinking. Of those not receiving treatment, 3.8% perceived treatment need. Discussion: Findings highlight the value of substance misuse screening and brief interventions, suggesting potential treatment referral opportunities for those evidencing psychological distress.