Prescription Drug Misuse Research Articles

User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen.

Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community pharmacies in Aden city, from the users’ perspective. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. The majority of interviewees were male (n = 11/15) with an age range of 21–40 years. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor.

Peer Health Educators on Campus: Teaching Safe Medication Practices

Baylee Q. Bryan, Olga O. Vlashyn, Stephanie A. Deremiah, and Murphy K. O’Toole are advanced professional students in the Doctor of Pharmacy program at Purdue University, graduating in May 2019. Katherine M. Joseph is a senior in the School of Nursing, graduating in December 2018. Jane E. Krause (Clinical Associate Professor of Pharmacy Practice, Purdue College of Pharmacy) served as a faculty mentor for this project. In this article, the authors describe their service-learning project intended to increase awareness on campus regarding prescription drug abuse and misuse.

Correlates of Non-Medical Prescription Drug Misuse Among a Treatment-Seeking Population: A Comparison with Illicit Drug Users.

Prescription drugs (PD) undoubtedly help people with various physical or psychiatric ailments. Nevertheless, they are often diverted and misused (use without prescription or for purposes/in ways not intended by the prescriber). This study compared the sociodemographic and clinical correlates of those who misused PDs, used illegal drugs and co-ingested both, to identify those who were at a high risk of misusing these drugs. Retrospective analysis of the treatment outcome monitoring (TOM) data for the period of 2013–2017 identified 1369 subjects for the study; 295 patients presented with PD use disorder (PDUD alone), 811 with illegal drug use disorder (IDUD alone), and 263 had both PDUD and IDUD. The study sample included treatment seeking population (Singaporeans and permanent residents). TOM data included data collected through direct interviews (addiction severity, quality of life) and from the clinical case notes (diagnosis, co-morbidities, socio demographic information, etc.). The most commonly misused prescription and illegal drugs were benzodiazepines (63.1%) and heroin (63.4%), respectively. Those who co-ingested both PD and illegal drugs (PDUD+IDUD) had a significantly higher addiction severity score, lower quality of life and higher psychiatric co-morbidities than that of IDUD alone at baseline. When compared to Chinese patients, Malay and Indian patients had lower odds (p < 0.05) of PDUD alone and PDUD+IDUD than Chinese patients; divorcees had higher odds of PDUD+IDUD than those who were married. Those with primary and secondary qualifications had higher odds (2.1 and 2.9 times, respectively) of PDUD+IDUD than those with tertiary qualification and those in managerial or professional roles had higher odds of PDUD alone than those who were unemployed. Gender, ethnicity, marital status, education and occupational classes were associated with PDUD and IDUD. These characteristics can be helpful to identify those who are at the risk of PDUD and incorporate strict prescription monitoring to their care.

Alcohol, Prescription Drug Misuse, Sexual Violence, and Dating Violence Among High School Youth

PurposeSexual violence (SV), teen dating violence (TDV), and substance use are significant public health concerns among U.S. adolescents. This study examined whether latent classes of baseline alcohol and prescription drug misuse longitudinally predict SV and TDV victimization and perpetration (i.e., verbal,relational, physical/threatening, and sexual) 1 year later. MethodsStudents from six Midwestern high schools (n = 1,875; grades 9–11) completed surveys across two consecutive spring semesters. Latent class analysis was used to identify classes of individuals according to four substance use variables. A latent class regression and a manual three-step auxiliary approach were used to assess concurrent and distal relationships between identified classes and SV and TDV victimization and perpetration. ResultsThree classes of substance use were identified: low/no use (41% of sample), alcohol only use (45%), and alcohol and prescription drug misuse (APD) (14%). Youth in the APD class experienced greater SV and TDV victimization and perpetration than the alcohol only class at baseline. At Time 2 (one year later), youth in the baseline APD class experienced significantly higher SV and TDV victimization and perpetration outcomes than youth in the alcohol only class with the exception of sexual and physical TDV perpetration. ConclusionsThe misuse of both alcohol and prescription drugs emerged as a significant risk factor for later SV and TDV among adolescents. As such, it would be beneficial if future research continued to assess the nature of these associations and incorporate prescription drug use and misuse into heath education,substance use, and violence prevention programs.

Women and Substance Use: An Overview for Nurses

Substance use is a major health concern among women, as approximately 15.8 million have used an illicit drug in the past year. Another 4.3 million have misused prescription drugs. Men are more likely to engage in illicit drug use than women, however, the gender gap is narrowing. The consequences of substance abuse not only negatively impact women, but may affect the cognitive and physical abilities of their children. For methodology, electronic searches were conducted using scholarly databases with various combinations of keywords related to women, substance abuse, addiction, nursing care, pregnancy, and gender difference. Research trends indicate that women often present with gender-specific needs, including physiologically, socially, and economically. This article gives an overview of some gender differences between men and women and how they influence treatment and outcomes for women. It also discusses special considerations for nurses caring for women with substance use disorders.

Personality and prescription drug use/misuse among first year undergraduates

Emerging adults (18–25 year olds) endorse the highest rates of prescription drug misuse. Attending college or university may confer additional risk. Previous research suggests that personality is an important predictor of many addictive behaviours. Four traits have been consistently implicated: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Published studies on personality as a predictor of prescription drug abuse are limited, however, by a primary focus on overall prescription drug use, inconsistent operationalisation of misuse, and failure to control for alcohol use. Sample sizes have been small and non-specific. We sought to better understand how personality predicted the overall use, the medically-sanctioned use, and the misuse of prescription sedatives/tranquilizers, opioids, and stimulants. A large (N = 1755) sample of first year Canadian undergraduate students (mean age = 18.6 years; 68.9% female) was used. We predicted that: anxiety sensitivity would be related to sedatives/tranquilizers, hopelessness to opioids, sensation seeking to stimulants, and impulsivity to all three. Save for the impulsivity to opioid use path, predictions were fully supported in our “any use” model. For medically-sanctioned use: anxiety sensitivity predicted sedative/tranquilizers, hopelessness predicted opioids, and impulsivity predicted stimulants. For misuse: anxiety sensitivity (marginally) predicted sedatives/tranquilizers, sensation seeking predicted stimulants, and impulsivity predicted all three. Our models support using personality-matched interventions. Specifically, results suggest targeting anxiety sensitivity for sedative/tranquilizer misuse, sensation seeking for stimulant misuse, and impulsivity for unconstrained prescription drug misuse. Interventions with early coping skills that pertain to all four traits might be useful for preventing prescription drug uptake and later misuse.

Anabolic steroid users' misuse of non-traditional prescription drugs.

Few anabolic-androgenic steroid (AAS) users disclose their performance enhancing drug (PED) use with their healthcare providers. AAS users practice polypharmacy with prescription medications to counter adverse effects of AAS, to further their muscular gains, or to lose weight. To compare and contrast AAS using and non-AAS using gym clients regarding PED use, in particular prescription drugs. The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey that took place at four gyms in San Francisco, California between August 2015 and January 2016. 40 AAS users and 179 non-AAS users completed the survey. The prevalence of AAS use in the study cohort was 18.3%. AAS users reported using a greater number of total PEDs (8.7 ± 4.2 vs. 3.7 ± 2.1, p < 0.001) than non-AAS users. AAS users were more likely to misuse the following prescription drugs: antiestrogens (tamoxifen, anastrazole), fertility agents (clomiphene, human chorionic gonadotropin), erectile dysfunction drugs (tadalafil, sildenafil), anabolic drugs (clenbuterol, recombinant human growth hormone), and weight loss drugs (liothyronine). AAS users practice polypharmacy and misuse multiple prescription drugs. These findings allow researchers and clinicians to be more knowledgeable and to anticipate potential misuse of prescription medications that traditionally are not thought to be abused.

Adolescent Suicide Cases: Toxicology Reports and Prescription Drugs

Abstract The use of nonmedical prescription drugs in adolescent suicide is a critical issue. This study examined the toxicology of drugs found in a sample of 134 medical examiner records. The majority of adolescents died at home of asphyxia, had a trauma history, psychiatric illness, and a history of child abuse. Thirty-seven types of prescription drugs were found on autopsy; most were not prescribed. Findings from this study suggest that prescription drug misuse has a potent impact on adolescent risk factors. Identifying neurobiological and contextual factors associated with suicidality is critical for prevention efforts by health providers.

Evaluating Emergency Department Opioid Prescribing Behaviors After Education About Mandated Use of the Pennsylvania Prescription Drug Monitoring Program.

Prescription drug monitoring programs (PDMPs) are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk for prescription drug misuse, overdose, and death. In 2016, Pennsylvania launched an initiative mandating all prescribers to search the PDMP for each patient when the patient is prescribed controlled substances. The primary aim of this project was to support the Pennsylvania PDMP mandate by educating emergency department (ED) providers regarding the opioid epidemic and use of the PDMP and measure opioid prescriptions posteducation. Secondary aims were to evaluate provider knowledge and identify barriers to PDMP use. This quality improvement project was conducted through a retrospective chart review of patients 18-85 years old discharged from the ED with a chief complaint of pain. A pretest and a posttest measured provider knowledge change after an education program and assessed barriers to PDMP use. Numbers of opioid prescriptions written at discharge were examined. Provider knowledge scores increased significantly (p = .000). Barriers to PDMP use focused on access and process issues. A statistically significant decrease was observed in opioid prescriptions written (p = .002) during the project. An education program increased ED providers' knowledge of the opioid epidemic and the Pennsylvania PDMP mandate and identified barriers to use. A decrease in opioid prescriptions written may have been associated with improved knowledge and suggests that providers can change prescribing behaviors. More research is needed in this area, and future projects may want to focus on prescriber attitudes toward PDMP usefulness.

Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults

BackgroundPrescription drug misuse (PDM) rates are highest in adolescents and young adults. Little research in these high-risk groups has examined PDM differences by educational status or attainment. This investigation attempted to further our understanding of adolescent and young adult prescription drug use and misuse through examining PDM type (i.e., nonmedical misuse, medical misuse and mixed misuse) and substance use disorder (SUD) symptoms from PDM by educational status/attainment. MethodsData were from the 2015 National Survey on Drug Use and Health, with 13,585 adolescent and 14,553 young adult respondents. Participants were categorized by educational status separately in adolescents and young adults. Outcomes were rates of past-year prescription drug use, PDM, PDM type, and SUD symptoms, with analyses performed separately by age group and for opioids, stimulants and sedatives/tranquilizers. Analyses used logistic regression and controlled for age, race/ethnicity and sex. ResultsIn adolescents and across medication classes, the highest rates of any use, PDM, medical misuse, nonmedical misuse and presence of two or more SUD symptoms were seen in those with poor school adjustment or not in school. In young adults, opioid-PDM and related outcomes were more prevalent in those not in school, especially high school dropouts. For stimulants, rates were highest in full-time college students and college graduates. ConclusionsThese results further suggest the importance of assessing educational status in adolescent and educational attainment in young adult PDM investigations. Adolescents poorly engaged in school or not in school appear especially in need of interventions to limit PDM and associated SUD symptoms.

Disability status and prescription drug misuse among U.S. adults

BackgroundThe U.S. is in the midst of a public health crisis related to drug overdose deaths. Largely responsible for the dramatic increase in overdose deaths is the misuse of prescription drugs such as opioids and benzodiazepines. While much research attention has focused on correlates of prescription drug misuse in recent years, notable gaps in the literature remain. The current research addresses one of these gaps by examining the relationship between disability status and prescription drug misuse. MethodWe examine data from the 2015 National Survey on Drug use and Health, a leading source of epidemiological data on drug use in the United States that added questions related to disability status to the 2015 survey. The current research assessed the relationship between disability status (i.e. activities of daily living and instrumental activities of daily living) and prescription drug misuse (i.e. opioids and benzodiazepines) among adults. ResultsFindings from multinomial logistic regression analysis showed that a disability related to activities of daily living was correlated with opioid misuse, while a disability associated with instrumental activities of daily living was associated with benzodiazepine misuse and misuse of both. In addition, health related measures had a greater impact on the relationship between disability status and prescription drug misuse than did the social engagement/isolation measures. ConclusionFindings indicated that disability status is a significant correlate of prescription drug misuse. However, this relationship was largely mediated by measures associated with poor health and social engagement/isolation.

A process model of health consciousness: Its application to the prevention of workplace prescription drug misuse

The concept of health consciousness (HC), previously studied as a dispositional construct, holds promise for brief prevention training in work settings. The current study developed a more process‐oriented model of HC. Employer’s increasing concerns about worker prescription drug (Rx) misuse represents an opportunity to study and improve HC. Two pilot studies delivered a brief training program and assessed short‐term, pre‐ to post–self‐reports of factors related to HC. The first pilot (n = 162) attempted to evaluate a stress/resilience program (“Raw Coping Power”) that sought to improve worker ability to recognize and correct unhealthy coping behaviors. A second pilot (n = 114) attempted to evaluate an Rx misuse prevention program that sought to enhance awareness of HC as a protective factor. Both pilots used a driver analysis to examine correlates of improved HC. These correlates included increased confidence in one’s ability to evaluate risks, and awareness of healthy alternatives. Many employees also found the concept of HC useful. Previous writings about HC, in combination with current results, informed the design of a new, process‐oriented model of HC. The current paper offers this model and a driver analysis methodology that future researchers can use to further explore and more fully evaluate brief HC interventions in work settings.

Evaluating Behavioral Health Surveillance Systems.

In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health–related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems.

PMH59 - College Students' Beliefs About Prescription Drug Misuse Among Peers

PMH59 - College Students' Beliefs About Prescription Drug Misuse Among Peers

Prescription Drug Misuse and Child Maltreatment Among High-Risk Families

Prescription drug misuse is increasingly common in the United States. To date, little is known about how prescription drug misuse relates to negative parenting behaviors like child maltreatment, even though use of illicit drugs increases rates of both child neglect and physical abuse. This study used secondary data from the Fragile Families and Child Well-Being Study (FFCWS), a clustered national sample of families at high risk for both prescription drug misuse and child maltreatment (n = 2,917). Data from mothers who participated in the 9-year follow-up of this study were used to create logistic regression models examining prescription drug misuse and physically aggressive and neglectful parenting, while controlling for demographic and psychosocial variables. Black, non-Hispanic mothers and mothers in worse health had higher odds of physically aggressive parenting. Mothers in worse health and those who used other illicit drugs had greater odds of neglectful parenting. There were no relationships between prescription drug misuse and either parenting outcome. The findings do not provide evidence that prescription drug misuse is a risk factor for child maltreatment. Further research examining this issue and potential progression from prescription drug misuse to other illicit drug use could help clarify whether this behavior is related to negative outcomes for children.

Sources of Prescription Medication Misuse Among Young Adults in the United States: The Role of Educational Status.

This study examined prescription drug misuse (PDM), sources of PDM, and substance use disorder (SUD) symptoms as a function of educational status among US young adults based on a large nationally representative sample. Data from the 2009-2014 National Survey on Drug Use and Health came from a sample of 106,845 young adults aged 18-25 years. Respondents were categorized by educational status and PDM, sources of PDM, other substance use, and SUD symptoms, with analyses performed separately for prescription opioids, stimulants, and sedatives/tranquilizers. Prescription opioid (past-year: 11.9%) and sedative/tranquilizer (past-year: 5.8%) misuse were most prevalent among young adults not attending college, especially among high school dropouts. In contrast, full-time college students and college graduates had the highest rates of prescription stimulant misuse (past-year: 4.3% and 3.9%, respectively). Obtaining prescription medications from friends/relatives for free was the most common source of PDM, especially among college students/graduates. Prescription drug misusers who obtained medications from theft/fake prescriptions, purchases, or multiple sources were more likely to report past-year SUDs and had the most severe overall risk profile of concurrent substance use and SUD. More than 70% of past-month prescription drug misusers who reported multiple sources for PDM had at least 1 past-year SUD. Sources of PDM vary by educational status among US young adults, and the college environment is associated with sharing prescription medications. Clinicians can help assess an individual's risk for SUD by determining whether the individual engaged in PDM and the source of prescription medication the individual is misusing.

Stimulant Use Among Undergraduate Nursing Students.

Research reveals a decade-long increase in prescription drug misuse (PDM) of stimulant medication used to treat attention deficit hyperactivity disorder, and college students in particular are at the highest risk for these behaviors. However, PDM has not been specifically studied in undergraduate nursing students, and thus, this study fills a gap in our knowledge of PDM of stimulants. This descriptive study used a cross-sectional, convenience sample of undergraduate nursing students (N = 249) attending a large midwestern university. The purpose of this study was to examine the medical use, medical misuse, nonmedical use, and diversion of attention deficit hyperactivity disorder stimulant medications as well as to compare CRAFFT scores among these four groups of stimulant users. A 28-item, Web-based survey was sent via email to all registered undergraduate nursing students during the winter semester of 2017. Results showed that 10.4% of respondents used prescription stimulants nonmedically in the past 12 months, and over half (51.5%) of respondents screened positive on the CRAFFT, an indication of possible alcohol and drug misuse behaviors. In addition, there was a strong association between medical misuse and nonmedical use and positive CRAFFT scores. The high percentage of positive CRAFFT scores is a concern and indicates a pressing need for nursing faculty to evaluate and address substance use by nursing students.

Psychosocial Correlates of Clinicians’ Prescription Drug Monitoring Program Utilization

The purpose of this study is to extend prior research on barriers to use of a prescription drug monitoring program by examining psychosocial correlates of intended use among physicians and pharmacists. Overall, 1,904 California physicians and pharmacists responded to a statewide survey (24.1% response rate) from August 2016 to January 2017. Participants completed an online survey examining attitudes toward prescription drug misuse and abuse, prescribing practices, prescription drug monitoring program design and ease of use, professional obligations, and normative beliefs regarding prescription drug monitoring program use. Data were analyzed in 2017. Perceived prescription drug monitoring program usefulness and normative beliefs fully mediated the relationship between concern about prescription drug abuse and intentions to use the prescription drug monitoring program. Clinicians' sense of professional and moral obligation to use the prescription drug monitoring program was unrelated to intention to use the prescription drug monitoring program despite a positive relationship with concern about misuse and abuse. Compared with physicians, pharmacists reported greater concern about prescription drug misuse, greater professional and moral obligation to use prescription drug monitoring program, and greater rating of prescription drug monitoring program usefulness. Interventions that target normative beliefs surrounding prescription drug monitoring program use and how to use prescription drug monitoring programs effectively are likely to be more effective than those that target professional obligations or moralize to the medical community.

Religious Involvement and Substance Use Among Urban Mothers

AbstractAlthough numerous cross‐sectional studies suggest that religious involvement is associated with lower rates of substance use, it is unclear whether these protective effects can be observed over time with more rigorous longitudinal designs. In this study, we use longitudinal data from the U.S. Fragile Families and Child Wellbeing Study (n = 3,176) to test whether indicators of religious involvement are protective against illicit drug use and prescription drug misuse among mothers who are primarily single and of low socioeconomic status. Our results show that religious involvement at baseline is unrelated to prescription drug misuse at follow‐up. We also find that religious attendance at baseline reduces the odds of illicit drug use at follow‐up. Respondents who increased their level of religious attendance over the study period also tended to exhibit a concurrent reduction in the odds of illicit drug use. Although prior substance use was unrelated to changes in religious attendance, prior illicit drug use and prescription drug misuse were associated with a reduction in religious salience over the study period.

Correlates of prescription opioid misuse among Black adults: Findings from the 2015 National Survey on Drug Use and Health

BackgroundPrescription drug misuse, especially opioid misuse, has become a public health crisis in the US. While much research attention has been focused on prescription drug misuse, a number of notable gaps in the literature remain. The current research addresses one of these gaps by examining racial/ethnic variation in prescription opioid misuse among adults. MethodsWe use data from the 2015 NSDUH to identify correlates of prescription opioid misuse among Black respondents aged 18 and older. The NSDUH defines prescription drug misuse as the use of prescription drugs in any way a doctor did not direct respondents to use them, including (a) without a prescription of their own; (b) in greater amounts, more often, or longer than told to use; or (c) in any other way a doctor did not tell respondents to use the drug. ResultsFindings indicate that Black respondents have a very similar prevalence rate of prescription opioid misuse compared to White respondents. A number of factors (i.e., gender, socioeconomic status, educational attainment) were significantly correlated with prescription opioid misuse only among Black respondents. In addition, many factors (i.e., depression, general health, other illicit drug use, being approached by a drug dealer) were significantly associated with prescription opioid misuse among both Black and White respondents. ConclusionsThe current research identified a number of unique correlates of prescription opioid misuse among Black adults. To more effectively deal with the current public health crisis, research must identify risk factors among various groups within the population.