Rates Of Non-medical Use Research Articles

Patterns of ketamine use among people with substance use disorder in France: Multisource analysis of the data from the French Addictovigilance Network.

Due to its psychoactive effects, ketamine has become a drug used for non-medical purpose. To assess the latest trends in ketamine use among people with substance use disorder and to characterize its clinical complications using complementary health data sources of the French Addictovigilance Network. First, we extracted all reports involving ketamine from 2012 to 2021 from the database of the OPPIDUM program (i.e., a multicentric program conducted in collaboration with hundreds of substance abuse treatment facilities that collects data on drugs used by subjects with substance use disorders). We described the reports globally and the changes from 2012 to 2021. Second, we extracted all cases involving ketamine from July 2020 to December 2022 from the French National Pharmacovigilance Database (BNPV). We identified the cases related to ketamine use among people with substance use disorder and described them. There was a 2.5-fold increase in the number of ketamine users with substance use disorder in the OPPIDUM program, from 35 (0.7%) subjects in 2012 to 89 (1.7%) subjects in 2021. There was an increase in the proportion of subjects who were daily users, had distress upon discontinuation, and presented addiction. There were 238 cases related to ketamine use among people with substance use disorder in the French National Pharmacovigilance Database from July 2020 to December 2022. Among them, 94 (39.5%) cases involved ketamine use disorder, 20 (8.4%) cases involved urinary tract and kidney symptoms, and 13 (5.5%) cases involved hepatobiliary symptoms. The trend observed over 10years reflects the growth in ketamine use among people with substance use disorder, although it does not allow to estimate the rates of non-medical use of ketamine in the general population. Ketamine-induced uropathy and cholangiopathy are reported in ketamine users with substance use disorder, especially in case of repeated and/or prolonged use of high doses.

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries.

Background: Non-medical use (NMU) of prescription GABA analogs (pregabalin and gabapentin) has been reported especially in opiate dependent persons. However, by now the prevalence of NMU of gabapentinoids in the general population has not been sufficiently evaluated. The aim of this research paper is to determine the prevalence of prescription GABA analog NMU and associated demographics in five European countries with special detail of Spain.Methods: The RADARS Survey of Non-Medical Use of Prescription Drugs Program (NMURx) is a harmonized series of contemporaneous cross-sectional surveys of adults conducted in multiple countries. NMURx collects data from the general population in each participating country about NMU of prescription drugs, illicit drugs, and associated demographics. NMU was defined as “using a medication without a doctor's prescription or for any reason other than what was recommended by their doctor.” Responses from Spain (4Q2017, n=10,062) were analyzed in detail. Comparative data were available from France, Germany, Italy, and UK. Responses were collected using non-probability quota sampling and post-stratification population weighting was applied to reflect the national distributions of adults, based on age, gender, and census region. Rates of NMU and associated demographics were reported as rate of past 90-day NMU per 100,000 adult population with 95% confidence intervals.Results: Germany (1,197 per 100,000 adult population [95% CI: 1,004.3–1,379.1]) and United Kingdom (1,067 per 100,000 adult population [95% CI: 851.3–1,283.2]) presented the highest prevalence of gabapentinoids NMU. In Spain the prevalence of past 90 days GABA analog NMU was: 344.4, 95% (CI 204.8–484.0), with male predominance. Those who non-medically use GABA analogs had a higher prevalence of lifetime chronic pain, lifetime illicit drug use, and previous substance abuse treatment. In Spain, 20% of respondents who ever have used gabapentinoids, reported a lifetime NMU; the prevalence was higher for pregabalin 624 (6.2%) than for gabapentin 444 (4.4%). The main reasons for use were to self-treat pain and other medical conditions.Conclusions: The risk of NMU of gabapentinoids should not be neglected. Subjects with a history of chronic pain and lifetime substance use disorders had an increased risk of NMU of gabapentinoids.

Conduct disorder and attention-deficit/hyperactivity disorder as risk factors for prescription opioid use

BackgroundExisting studies of attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use or substance use disorders have produced mixed results, with some identifying a direct link between ADHD and general or disordered substance use and others suggesting that comorbid CD may explain this relationship. Insufficient research has addressed the issue, which is particularly relevant in the context of the opioid crisis. This study examined the association of probable ADHD and childhood CD with self-reported opioid use in a general-population sample. MethodThe 2011–2013 cycles of the CAMH Monitor, a cross-sectional survey of adults (18+ years) from Ontario, Canada provided data from 6074 respondents. Binary logistic regressions were conducted of self-reported medical, non-medical, and any prescription opioid use in the previous 12 months, assessing demographic characteristics, perceived physical and mental health, and probable ADHD, childhood (before age 15 years) symptoms of CD, or their combination. ResultsAdjusting for potential covariates, probable ADHD alone was not associated with prescription opioid use. Childhood symptoms of CD significantly predicted non-medical use (OR = 2.10, 95% CI = 1.10, 4.03). ADHD and CD symptoms combined significantly predicted medical (OR = 3.27, 95% CI = 1.20, 8.91), non-medical (OR = 4.73, 95% CI = 1.05, 21.30), and any (OR = 3.02, 95% CI = 1.13, 8.11) prescription opioid use, although a low base rate of non-medical use may have negatively affected model fit. ConclusionsPrevious findings relating ADHD to opioid use could be explained, in part, by the high rate of comorbidity between ADHD and CD. These data support prevention and treatment programs targeting individuals with comorbid ADHD and CD symptoms.

Association between nonmedical use of opioids or sedatives and suicidal behavior among Chinese adolescents: An analysis of sex differences.

The rising rate of suicidal behavior among adolescents is a growing concern, and sex differences may induce differential exposure to prescription drug misuse or suicidal behavior. We estimated, among Chinese adolescents, (1) the prevalence of nonmedical use of prescription drugs, suicidal ideation and suicide attempts; (2) whether nonmedical use of prescription drugs was independently associated with suicidal ideation and suicide attempts; and (3) whether there were sex differences in the associations. This was a secondary analysis of the data drawn from the 2015 National School-based Chinese Adolescents Health Survey. A total of 94,911 students completed questionnaires and qualified for our survey (response rate: 93.7%). All analyses were conducted separately for boys and girls. There were significant sex differences in the prevalence of opioid or sedative misuse, and the sources and reasons for nonmedical use of prescription drugs ( p < 0.05). The prevalence of suicidal ideation or suicide attempts was significantly higher in girls than in boys (suicidal ideation: 17.9% among girls vs 14.1% among boys; suicide attempts: 3.5% among girls vs 2.7% among boys). Among girls, frequent use of opioids was associated with an increased risk of suicidal ideation (adjusted odds ratio = 1.84, 95% confidence interval = [1.57, 2.17]) and suicide attempts (adjusted odds ratio = 2.96, 95% confidence interval = [2.34, 3.74]), and frequent use of sedatives was also positively associated with suicidal ideation (adjusted odds ratio = 2.23, 95% confidence interval = [1.91, 2.60]) and suicide attempts (adjusted odds ratio = 4.02, 95% confidence interval = [3.25, 4.99]). These associations were also statistically significant in boys, but the magnitudes of adjusted odds ratios for the associations between frequent use of opioids and sedatives and suicidal behavior were greater in girls than boys. There exist significant sex differences in the prevalence rates of nonmedical use of prescription drugs and suicidal behavior, and the child's sex plays a role in the association between nonmedical use of prescription drugs and suicidal behavior. The significant sex differences found above may provide a basis for early identification of adolescents at high risk of suicidal behavior.

Pre-Incarceration Rates of Nonmedical Use of Prescription Drugs among Black Men from Urban Counties.

There are inconsistent findings regarding the rates of nonmedical prescription drug use (NMPDU) among Black Americans. The majority of previous studies used pharmaceutical names of drugs and relied on national data that excludes incarcerated populations, in which Black men are overrepresented. Therefore, the current study aimed to describe pre-incarceration rates of NMPDU among Black men in prison using culturally relevant alternative drug names. We recruited 208 incarcerated (adult age 18 or older) Black men nearing community reentry to urban counties from four state prisons in Kentucky. Results indicated the majority of participants engaged in lifetime NMPDU. The most commonly endorsed class of prescription drug was, "Other Sedatives, Hypnotics, and Tranquilizers" and the most commonly endorsed specific prescription drugs were "Syrup," Lortab/Hydrocodone, and Xanax. There were significant age differences in the number of days that drugs were used in the year prior to incarceration. The current study contributes to the dearth of literature on NMPDU among Black Americans. These findings have implications for disease transmission, overdose risk, and culturally relevant data collection methods and interventions aimed at reducing NMPDU among Black men.

The Impact of Individual-Level Social Capital in Non-Medical use of Pain Medications Among Individuals 50 Years or Older from Diverse Racial/Ethnic Backgrounds

ABSTRACTObjectives: In 2014, there were 21.5 million Americans (12 years old or older) that had a substance abuse disorder and almost 2 million of them had a substance use disorder involving prescription pain relievers (SAMHSA, 2014). The misuse of non-medical pain medication (NMPM) is a significant public health problem. This study examines the impact of individual-level social capital in non-medical use of pain medications (NMPM) among individuals 50 years or older. Methods: Data from the 2003 National Survey on Drug Use and Health (n = 11,146) was analyzed using bivariate analysis and logistic regression analysis. Results: Perception of social capital varied by race/ethnicity; White respondents reported the highest rates of non-medical use of pain medications (NMPM) in the past year and lifetime. Social capital was associated with a decrease in the likelihood of NMPM across the various groups in the sample. Discussion: Features of social capital were associated with likelihood of non-medical use of pain medications. Future research should focus on understanding the mechanisms by which these features of social capital impact NMPM among diverse groups.

Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995.

Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e.g., survey, monitoring, government reports) data published in 1995-2015. Two reviewers conducted data screening and extraction; results were categorized and narratively summarized by key sub-topics. Levels of benzodiazepine use in the general population have been relatively stable in recent years; medical use is generally highest among older adults. Rates of non-medical use are fairly low in general but higher in marginalized (e.g., street drug use) populations; high and/or inappropriate prescribing appears common in older adults. Benzodiazepines are associated with various morbidity outcomes (e.g., accidents/injuries, cognitive decline, sleep disturbances, or psychiatric issues), again commonly observed in older adults; moreover, benzodiazepines are identified as a contributing factor in suicides and poisoning deaths. Overall there is a substantial benzodiazepine-related health problem burden-although lower than that for other psycho-medications (e.g., opioids)-in Canada, mainly as a result of overuse and/or morbidity. National benzodiazepine prescription guidelines are lacking, and few evaluated interventions to reduce benzodiazepine-related problems exist. There is a clear need for reducing inappropriate benzodiazepine use and related harm in Canada through improved evidence-based practice as well as monitoring and control.

Sexual orientation and first-year college students' nonmedical use of prescription drugs

ABSTRACTObjective: To examine differences between heterosexual and lesbian, gay, bisexual, and questioning students' nonmedical use of prescription drugs (NMUPD). Participants: First-year university students between October 2009 and October 2013 who self-identified as heterosexual, lesbian, gay, bisexual, or questioning. Methods: Students completed questionnaires on demographic variables and NMUPD. Any NMUPD was examined, as were stimulants, anxiolytics, and painkillers. Hierarchical regression was used to examine differential NMUPD based on sexual orientation, gender, and race. Results: For any NMUPD and painkillers, bisexual and questioning students reported higher rates of nonmedical use than heterosexual students and gay men. When compared with heterosexual females, lesbian, bisexual, and questioning females reported higher any NMUPD and nonmedical painkiller use. For stimulants and anxiolytics, bisexual students reported the highest nonmedical use, followed by gay and lesbian students. Conclusions: There may be particular risk for NMUPD associated with membership in marginalized groups in terms of both sexual orientation and gender.

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

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

Positive subjective measures in abuse liability studies and real-world nonmedical use: Potential impact of abuse-deterrent opioids on rates of nonmedical use and associated healthcare costs

To quantify the potential impact of reductions in positive subjective measures from human abuse liability studies on real-world rates of nonmedical use of prescription drugs and associated healthcare resource utilization and costs. Positive subjective endpoints "overall drug liking," in-the-moment "drug liking," and "drug high" Emaxs (peak effects) were recorded from published studies. Nonmedical use data were obtained from the 2010 National Survey on Drug Use and Health (NSDUH) and Drug Abuse Warning Network surveys. Multivariate regressions evaluated the association between the positive subjective endpoints and nonmedical use rates, controlling for prescription volume, whether the drug is an opioid, and controlled substance schedule. A published budget-impact model was used to assess healthcare resource utilization and cost impacts of abuse-deterrent opioid formulations. A five-point reduction in overall drug liking/drug liking/drug high Emax was associated with a 0.25/0.10/0.05 (standard errors: 0.11/0.12/0.07) percentage point decrease in the NSDUH lifetime nonmedical use rates. Those decreases yielded a 11.3/4.2/2.1 percent reduction compared to the samples' lifetime nonmedical use rates of 2.21/2.38/2.36 percent. On the basis of a number of assumptions, these reductions were associated with private payer cost reductions for a morphine and oxycodone abuse-deterrent formulation in the ranges of $147.9-324.1 million and $230.7-958.7 million, respectively. Reductions in overall drug liking were significantly associated with reduced real-world nonmedical use, healthcare utilization, and costs. Associations using drug high and drug liking were directionally consistent with this finding though not statistically significant. A reduction in positive subjective measures associated with an abuse-deterrent formulation has potential to reduce abuse and associated healthcare utilization and costs.

SY01-4 * SITUATION AND COUNTERMEASURES FOR PRESCRIPTION DRUG ABUSE IN THAILAND

The non-medical use of therapeutic drugs, such as tranquilizers/hypnotics, analgesics and cough/cold remedies has become a growing public health problem in Thailand. The purposes of abuse include recreation, replacement for other addictive substances, to achieve a more intoxicated feeling from other substance, and crime. Misusers of these drugs are able to obtain supplies on the black market especially via the internet. Some come from indiscriminate prescribing due to physicians' unawareness of the dangers. The drugs may also be obtained by theft or from the corrupt sale of legal supplies. The highest rate of indictment in 2011-2012 was for cold remedies (i.e. ephedrine, pseudoephedrine and phenylpropanolamine), followed by benzodiazepines and codeine-cough syrup. Based on the latest national survey in 2011, the rates of non-medical use of analgesics, tranquilizers/ hypnotics and antitussive in the past year among Thais aged 12-65 years were 3.69, 0.94 and 0.93 per 1000 populations. The rate of analgesic use was higher among men while tranquilizer/ hypnotic use was higher among women. Whereas there is a need for increased enforcement of illegal supply, there is also need for intensified public health measures and education of physicians and people to increase awareness of the dangers of misusing these drugs. Language: en

Nonmedical Use of Tapentadol Immediate Release by College Students

Prescription opioid analgesics play an important role in managing moderate to severe pain. An unintended consequence of the availability of these drugs is nonmedical use. We report rates and methods of nonmedical use of the analgesic tapentadol immediate release (IR) and other commonly prescribed opioid analgesics among US college students following the launch of tapentadol IR in June 2009. The Researched Abuse, Diversion and Addiction-Related Surveillance System College Survey Program collects data from approximately 2000 self-identified college students throughout the United States during fall, spring, and summer terms using a web-based questionnaire. Responses from July 2009 through September 2011 were analyzed for the rate of nonmedical use of tapentadol IR. Nonmedical use of prescription opioids was reported by 1626 of 13,514 respondents (12.0%); tapentadol IR use was reported by 101 respondents (0.7%). The rate of nonmedical tapentadol IR use per 100,000 population was highest in 4Q2009 (0.013 per 100,000 population) and decreased over the subsequent 2 years to 0.004 per 100,000 population. Similarly, the rate per 1000 unique recipients of dispensed drug (URDD) was highest in 4Q2009 (0.66 per 1000 URDD) and decreased to 0.06 per 1000 URDD. The primary route of administration endorsed for nonmedical tapentadol IR use was intact swallow (49.5%), chewed and swallowed (41.6%), followed by inhalation (20.8). Since its launch, rates of nonmedical tapentadol IR use by college students have been low and have decreased over time. The initial levels of reported nonmedical use may represent a brief period of experimentation after introduction.

A systematic review of the safety of lisdexamfetamine dimesylate.

BackgroundHere we review the safety and tolerability profile of lisdexamfetamine dimesylate (LDX), the first long-acting prodrug stimulant for the treatment of attention-deficit/hyperactivity disorder (ADHD).MethodsA PubMed search was conducted for English-language articles published up to 16 September 2013 using the following search terms: (lisdexamfetamine OR lisdexamphetamine OR SPD489 OR Vyvanse OR Venvanse OR NRP104 NOT review [publication type]).ResultsIn short-term, parallel-group, placebo-controlled, phase III trials, treatment-emergent adverse events (TEAEs) in children, adolescents, and adults receiving LDX were typical for those reported for stimulants in general. Decreased appetite was reported by 25–39 % of patients and insomnia by 11–19 %. The most frequently reported TEAEs in long-term studies were similar to those reported in the short-term trials. Most TEAEs were mild or moderate in severity. Literature relating to four specific safety concerns associated with stimulant medications was evaluated in detail in patients receiving LDX. Gains in weight, height, and body mass index were smaller in children and adolescents receiving LDX than in placebo controls or untreated norms. Insomnia was a frequently reported TEAE in patients with ADHD of all ages receiving LDX, although the available data indicated no overall worsening of sleep quality in adults. Post-marketing survey data suggest that the rate of non-medical use of LDX was lower than that for short-acting stimulants and lower than or equivalent to long-acting stimulant formulations. Small mean increases were seen in blood pressure and pulse rate in patients receiving LDX.ConclusionsThe safety and tolerability profile of LDX in individuals with ADHD is similar to that of other stimulants.

(465) Trends and characteristics of individuals who abuse ER morphine: data from the RADARS System

The goal of abuse-deterrent formulations (ADFs) of opioids is reduction of misuse and abuse that can lead to hospitalization or death. As novel ADFs become available, epidemiologic studies must be carefully designed and conducted to help assess if their introduction effectively reduces misuse and abuse. ADFs of extended release morphine (ER-M) are in late stages of development, thus we sought to understand ‘baseline’ trends and characteristics of ER-M abusers. Data from 5 programs from RADARS® (Researched Abuse, Diversion, and Addiction-Related Surveillance) System were evaluated between 1st-quarter of 2010 through 2nd-quarter of 2013: College Survey (CS), Drug Diversion (DD), Poison Center (PC), Street Prescription Program (SPP), and Treatment Programs (TP). Comparison of intentional-abuse exposure, diversion, past 3-month nonmedical use, past 30-day abuse, and street-price of ER-M compared to other prescription opioids were calculated using the total US population (TUP) and unique recipients of dispensed drug (URDD). ER-M was abused mainly through oral administration (∼80%[PC] and ∼76%[CS]) and IV (∼33%[TP]). Rates and trends of abuse varied by database; indicating that opioid preferences may be based on type of abuser and experience level. ER-M URDD-adjusted abuse rates were higher than IR-oxycodone and hydrocodone but similar or significantly lower than other opioids when compared using TUP rates (PC, TP). Diversion rates were 92% higher than hydrocodone but similar or lower compared to other opioids when adjusted for URDD. In 2012, 3 month nonmedical use (CS) for ER-M was significantly higher than hydrocodone (69% [PC], and 33%[CS]) and IR-oxycodone (30% [PC] and CS[33%]) but significantly lower than other opioids when adjusted for URDD. Although ER-M is prescribed less than other opioids, the high rates of nonmedical use and diversion among those filling a prescription suggests that ER-M has a particularly high abuse potential. The goal of abuse-deterrent formulations (ADFs) of opioids is reduction of misuse and abuse that can lead to hospitalization or death. As novel ADFs become available, epidemiologic studies must be carefully designed and conducted to help assess if their introduction effectively reduces misuse and abuse. ADFs of extended release morphine (ER-M) are in late stages of development, thus we sought to understand ‘baseline’ trends and characteristics of ER-M abusers. Data from 5 programs from RADARS® (Researched Abuse, Diversion, and Addiction-Related Surveillance) System were evaluated between 1st-quarter of 2010 through 2nd-quarter of 2013: College Survey (CS), Drug Diversion (DD), Poison Center (PC), Street Prescription Program (SPP), and Treatment Programs (TP). Comparison of intentional-abuse exposure, diversion, past 3-month nonmedical use, past 30-day abuse, and street-price of ER-M compared to other prescription opioids were calculated using the total US population (TUP) and unique recipients of dispensed drug (URDD). ER-M was abused mainly through oral administration (∼80%[PC] and ∼76%[CS]) and IV (∼33%[TP]). Rates and trends of abuse varied by database; indicating that opioid preferences may be based on type of abuser and experience level. ER-M URDD-adjusted abuse rates were higher than IR-oxycodone and hydrocodone but similar or significantly lower than other opioids when compared using TUP rates (PC, TP). Diversion rates were 92% higher than hydrocodone but similar or lower compared to other opioids when adjusted for URDD. In 2012, 3 month nonmedical use (CS) for ER-M was significantly higher than hydrocodone (69% [PC], and 33%[CS]) and IR-oxycodone (30% [PC] and CS[33%]) but significantly lower than other opioids when adjusted for URDD. Although ER-M is prescribed less than other opioids, the high rates of nonmedical use and diversion among those filling a prescription suggests that ER-M has a particularly high abuse potential.

Surveillance of Diversion and Nonmedical Use of Extended-Release PrescriptionAmphetamine and Oral Methylphenidate in the United States

This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Nonmedical use data were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Drug Diversion Program and Poison Center Program. Drug diversion trends nearly overlapped for extended-release amphetamine and extended-release oral methylphenidate. Calls to poison centers were generally similar; however, calls regarding extended-release amphetamine trended slightly lower than those for extended-release oral methylphenidate. Data suggest similar diversion and poison center call rates for extended-release amphetamine and extended-release oral methylphenidate.

Nonmedical Use and Diversion of ADHD Stimulants Among U.S. Adults Ages 18-49

Objective: Evaluate nonmedical use (NMU) of ADHD prescription stimulants (Ritalin®, Adderall®, Adderall® XR, Concerta®, and Vyvanse®) in a U.S. adult general population sample. Method: In all, 10,000 adults (aged 18-49) from an online, opt-in panel, proximity matched to U.S. Census demographics, were surveyed to assess NMU prevalence, routes of administration (ROA), reasons for NMU, and diversion source. Results: Lifetime NMU of any prescription drug was 35.1%, pain medications (24.6%), sedatives/tranquilizers (15.6%), sleep medications (9.9%), and prescription stimulants (8.1%). Within the prescription stimulants, rates of NMU (per 100,000 prescriptions dispensed) were 1.62 for Ritalin and 1.61 for Adderall followed by Adderall XR (0.62), Concerta (0.19), and Vyvanse (0.13). Respondents used stimulants mostly for wakefulness and performance enhancement, obtained the drugs from family/friends, and used oral ROA. Conclusion: NMU of ADHD prescription stimulants were low compared with other prescription medications. While prevalence of NMU was higher for immediate-release than extended-release ADHD medications, absolute rates for prescription stimulants were low.

Prevalence and correlates of nonmedical use of prescription opioids in patients seen in a residential drug and alcohol treatment program

Population-based data indicate that rates of nonmedical use of prescription opioids (POs) have increased dramatically over the past decade. However, data are lacking on nonmedical use of POs in individuals seeking treatment for substance use disorders. Patients ( N = 351) seeking treatment from a residential drug and alcohol treatment program were assessed for nonmedical use of POs prior to treatment entry. Approximately 68% (65% men and 78% women) of patients reported at least some nonmedical PO use in the 30 days prior to treatment. Our results indicate that nonmedical PO use was more common in those with higher levels of depressive symptoms and pain intensity and in those with lower physical functioning. Treatment programs should consider actively screening participants for nonmedical PO use and consider how nonmedical use of pain medications might influence their treatment planning for patients.

Nonmedical use of Prescription Opioids by Adolescents: A Review of the Literature

Concomitant with increases in prescriptions for controlled opioids, rates of nonmedical use of prescription opioids (NMUPO) have increased, including among adolescents aged 12-19 years. Adolescent NMUPO poses particular problems for clinicians, as prescribing physicians and dentists serve as the primary source of opioids for NMUPO in the majority of cases. Furthermore, early initiation of NMUPO appears to increase the risk of developing opioid dependence in adulthood. Given the significant morbidity and mortality associated with adolescent NMUPO, steps taken by clinicians to limit the scope of this phenomenon are needed. This article aims to aid clinicians by reviewing the literature on adolescent NMUPO and making specific recommendations to limit the scope of adolescent NMUPO.

P02-30 - Current trends in nonmedical use of prescription extended-release amphetamines and methylphenidate

ObjectiveTo examine rates of nonmedical use (NMU) of prescription extended-release (ER) amphetamines and ER methylphenidate, relative to availability.MethodsPrescribing data were acquired from IMS Health. Data relevant to ER amphetamine and ER methylphenidate were collected from two studies in the RADARS® (Researched Abuse, Diversion and Addiction-Related Surveillance) System (Q3 2007-Q2 2009). First, the Drug Diversion System provides a law enforcement perspective based on surveys of diversion investigators throughout the US. Second, the Poison Center System provides data on exposures to prescription drugs based on spontaneous calls. RADARS System data are presented as rates per 1,000 Unique Recipients of Dispensed Drug (URDD) to account for drug availability.ResultsFrom July 2007-June 2009, 18,315,404 prescriptions were filled for ER amphetamines, 26,674,152 for ER methylphenidate. RADARS System Drug Diversion trends nearly overlap for ER amphetamine and ER methylphenidate, relative to URDD (running average of 0.042 vs. 0.024 drug diversion reports per 1,000 URDD). Similarly, trends in RADARS System Poison Center calls are generally similar for ER amphetamine and ER methylphenidate, although ER amphetamine trends slightly lower (running average of 0.15 vs. 0.22 intentional exposures per 1,000 URDD).ConclusionsTrends from the US RADARS System, which controls for utilization rates, suggest diversion and poison center call rates are similar for ER amphetamine and ER methylphenidate.Supported by funding from Shire Development Inc.

Nonmedical use of prescription opioids and stimulants among student pharmacists

To examine the prevalence and patterns of nonmedical use of prescription opioid analgesics and stimulants among student pharmacists. Descriptive, nonexperimental, cross-sectional study. Private urban college of pharmacy in the United States in fall 2006. 1,538 PharmD students. Online survey. Lifetime and past-year nonmedical prescription opioid and stimulant use. Response rate for the survey was 62%. Lifetime prevalence of opioid misuse was 8%, and 5% of students had misused in the past year. Lifetime prevalence of stimulant misuse was 7%, and 5% had misused in the past year. Whites and fraternity or sorority members were more likely than their peers to have ever misused opioids. Past-year opioid misuse was more likely among whites, men, and low academic achievers compared with their peers. Lifetime stimulant misuse was more likely among students who were white, older, and fraternity or sorority members, while past-year misuse was more likely among whites and low academic achievers. Common motives for opioid misuse were to have fun, to relax, and to deal with chronic pain. Stimulants were used to improve concentration and academic performance. Friends were the most common source of prescription opioids and stimulants. Nonmedical prescription use was associated with greater likelihood of alcohol and other illicit substance use. The prevalence of prescription medication misuse among student pharmacists was lower than (opioids) or comparable with (stimulants) reported rates in college populations. Subgroups of students demonstrated higher rates of nonmedical use, including whites, students involved with fraternities or sororities, and low academic achievers. That friends were the primary source of misused medications indicates that diversion of prescription-only controlled substances likely occurs among student pharmacists. Nonmedical prescription medication use should be considered in the context of other substance use.