Prescription Drug Use Research Articles

High-Throughput Computing to Automate Population-Based Studies to Detect the 30-Day Risk of Adverse Outcomes After New Outpatient Medication Use in Older Adults with Chronic Kidney Disease: A Clinical Research Protocol.

Safety issues are detected in about one third of prescription drugs in the years following regulatory agency approval. Older adults, especially those with chronic kidney disease, are at particular risk of adverse reactions to prescription drugs. This protocol describes a new approach that may identify credible drug-safety signals more efficiently using administrative health care data. To use high-throughput computing and automation to conduct 700+ drug-safety cohort studies in older adults in Ontario, Canada. Each study will compare 74 acute (30-day) outcomes in patients who start a new prescription drug (new users) to a group of nonusers with similar baseline health characteristics. Risks will be assessed within strata of baseline kidney function. The studies will be population-based, new-user cohort studies conducted using linked administrative health care databases in Ontario, Canada (January 1, 2008, to March 1, 2020). The source population for these studies will be residents of Ontario aged 66 years or older who filled at least one outpatient prescription through the Ontario Drug Benefit (ODB) program during the study period (all residents have universal health care, and those aged 65+ have universal prescription drug coverage through the ODB). We identified 3.2 million older adults in the source population during the study period and built 700+ initial medication cohorts, each containing mutually exclusive groups of new users and nonusers. Nonusers were randomly assigned cohort entry dates that followed the same distribution of prescription start dates as new users. Eligibility criteria included a baseline estimated glomerular filtration rate (eGFR) measurement within 12 months before the cohort entry date (median time was 71 days before cohort entry in the new user group), no prior receipt of maintenance dialysis or a kidney transplant, and no prior prescriptions for drugs in the same subclass as the study drug. New users and nonusers will be balanced on ~400 baseline health characteristics using inverse probability of treatment weighting on propensity scores within 3 strata of baseline eGFR: ≥60, 45 to <60, <45 mL/min per 1.73 m2. We will compare new user and nonuser groups on 74 clinically relevant outcomes (17 composites and 57 individual outcomes) in the 30 days after cohort entry. We used a prespecified approach to identify these 74 outcomes. In each cohort, we will obtain eGFR-stratum-specific weighted risk ratios and risk differences using modified Poisson regression and binomial regression, respectively. Additive and multiplicative interaction by eGFR category will be examined. Drug-outcome associations that meet prespecified criteria (identified signals) will be further examined in additional analyses (including survival, negative-control exposure, and E-value analyses) and visualizations. The initial medication cohorts had a median of 6120 new users per cohort (interquartile range: 1469-38 839) and a median of 1 088 301 nonusers (interquartile range: 751 697-1 267 009). Medications with the largest number of new users were amoxicillin trihydrate (n = 1 000 032), cephalexin (n = 571 566), prescription acetaminophen (n = 571 563), and ciprofloxacin (n = 504,374); 19% to 29% of new users in these cohorts had an eGFR <60 mL/min per 1.73 m2. Despite our use of robust techniques to balance baseline indicators and to control for confounding by indication, residual confounding will remain a possibility. Only acute (30-day) outcomes will be examined. Our data sources do not include nonprescription (over-the-counter) drugs or drugs prescribed in hospitals and do not include outpatient prescription drug use in children or adults <65 years. This accelerated approach to conducting postmarket drug-safety studies has the potential to more efficiently detect drug-safety signals in a vulnerable population. The results of this protocol may ultimately help improve medication safety.

Prevalence and Social Determinants of Non-medical use of prescription and Over-the-Counter Drugs among Secondary School Students

This study investigated the influence of gender and location on non-medical use of prescription and Over-the-counter (OTC) drugs among secondary school students in selected communities of Lagos and Adamawa states. A multi-stage sampling technique was adopted to select 196 participants from Lagos and 198 participants from Yola. 203 males and 191 females (mean ± SD age of 16.1 ±1.8 years) responded to the Prescription Medication Use Scale (PMUS) and a structured questionnaire. Prevalence of OTC drug use by categories was Analgesics 42.2%, Antibiotics 32.4% and dietary supplements 33.8%. Prevalence by individual OTC medications includes cough syrup 63.2%, Herbs 30.3%, Sleeping pills (tranquillizers) 22.1%, Slimming pills / Teas 20.6%, Indocid (indomethacin) 14.0%, Codeine 5.1%, and Tramadol 4.8%. Significant sex influence was observed on Analgesics (t = 2.52, p = .012), and on Tramadol in particular (t= 2.99, p =.003) with males manifesting higher mean scores. Sex has no significant influence on dietary supplements (t =1.68, p =.104), Antibiotics (t= 1.10, p = .271) and Codeine (t = .825, p=.410). Location had a significant influence on the use of Analgesics (t=2.50, p=.013) and Dietary supplements (t= 7.22, p = .000) and antibiotics use (t = 3.20, p = .001) with Lagos reporting higher mean scores. The location had no significant influence on Tramadol and Codeine use. Authors conclude that there is a high prevalence of non-medical use of prescription and OTC drugs among participants; sex, as well as location individually, has a significant influence on Prescription and OTC drugs among secondary school students.

Trends in drug poisoning hospitalizations over ten years in South Korea: mortality and length of hospital stay

Drug poisoning has evolved in South Korea, with changes in substance availability and a rise in non-lethal abuse among youth, necessitating an updated understanding of this public health concern. This study aims to investigate the shifts in toxicity-causing substances and their impacts over the past decade, providing a comprehensive overview to inform future interventions. This study were conducted as a retrospective observational study utilizing the Korea National Hospital Discharge In-depth Injury Survey, including data from January 2011–December 2020. Hospitalization patterns, durations and corresponding mortality rates were examined. The study, analyzing 10,017 patients hospitalized for drug poisoning, observed a decrease in average hospital stay (average decrease from 7.1 days in 2011 to 5.8 days in 2020) and mortality rate (7.7% in 2011 to 2.6% in 2020), with older adults having the longest stays and highest mortality. The use of prescription and non-prescription drugs as intoxicants increased, while pesticide use decreased, with older adults showing the highest frequency of pesticide poisoning. Factors affecting length of stay and mortality rate included age, sex and intent, with statistical analyses showing significant correlations. An increase in poisonings was caused by prescription and non-prescription drugs, whereas there was a decrease in poisonings caused by pesticides. Despite decreases in drug poisoning-related deaths in South Korea, largely attributed to national control for high-toxic agents and improved medical systems, the rising number of incidents involving prescription and over-the-counter medications highlights the urgent need for ongoing surveillance and focused interventions.

Prevalence of prescription drug abuse among patients with chronic pain attending in a pain clinic of a tertiary hospital

Background: Chronic pain and prescription drug abuse are extremely prevalent worldwide. Non-medical use of prescription drugs like opioids, central nervous system depressants and stimulants can lead to addiction, abuse or misuse, and diversion. It is not known what proportion of patients have already been exposed to prescription drug abuse presenting for chronic pain management. The main objective of the study was to assess the prevalence of prescription drug abuse among the patients presenting for chronic pain management.Method: The study was conducted at the out patient’s settings in the Pain Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka. Study population included patients suffering from chronic pain of at least 2 years duration and patients over 18 years of age. Both quantitative and qualitative methods of investigation were followed. The quantitative data was collected by face-to-face interview, clinical evaluation and recording of reports. Based on the patient information recorded 30 patients ( one-tenth of quantitative sample) were selected to find out the qualitative details through in-depth investigation of extent, trends, patterns and consequences of prescription drug abuse or misuse characteristics.Results: Quantitative data was collected from 305 patients. The average age of patients was 39.92 ± 9.61 years and male to female ratio was 2.2:1. Most of the patients were living in rural area 195 (64%). Chronic musculoskeletal pain was more prevalent among chronic pain patients 31% [95% CI: (26-36)]. The mean (±SD) duration of pain was 6.82 ± 3.45 years. Most commonly prescribed medications were NSAID 81% [95% CI: (76-85)], muscle relaxants 50% [95% CI: (45-56)] and opioids 41% [95% CI: (35-46)]. The prevalence of drug abuse was 64% [95% CI: (59-70)]. The specified ways of drug abuse revealed that 49% [95% CI: (42-56)] patients used medication without legal prescriptions, 21% [95% CI: (16-27)] used more than the prescribed dose and 30% [95% CI: (23-36)] used more than the prescribed duration for relieving pain. NSAID was the most common drug taken without legal prescription 72% [95% CI: (63-81)] and used more than the prescribed dose 57% [95% CI: (42-72)]. The most common cause of taking drugs more than prescribed dose and duration were initially relief of pain but gradually higher dose needed 79% [95% CI: (66-91)] and painful condition worsened after stopping medication 76% [95% CI: (65-87)], respectively. The common problems/complicationsrelated to drug abuse were mental disturbance 78 (26%), sleeplessness 69 (23%) and loss of memory 64 (21%).Conclusion: The prevalence of prescription drug abuse is high among chronic pain patients. Many patients suffer from abuse-related complications, which is a major concern for the healthcare system.

Exercise recommendations for patients with myositis: a narrative review of safety and efficacy.

Idiopathic inflammatory myopathies (IIM) are marked by progressive muscle weakness and lasting disability. Therapies targeting patient well-being include the use of prescription drugs as well as exercise. Maintaining or increasing muscular strength and endurance as well as cardiorespiratory fitness (CRF) improves quality of life (QoL) as well as functional status in IIM patients. This narrative review highlights exercise interventions in patients of different IIM subtypes with the intent to provide a summary table with exercise recommendations that will safely and effectively improve QoL in myositis patients.

Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents.

Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway. This is an ecological study using data from the 'Young in Oslo' surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14-17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021. We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, 'worried too much about things' and 'had sleep problems' were the two symptoms with the greatest changes. A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

Coming of age in recovery: The prevalence and correlates of substance use recovery status among adolescents and emerging adults.

To date, no epidemiological survey has estimated the prevalence of adolescents identifying as being in recovery. This is necessary for planning and identifying the needs of youth with current and remitted substance use disorders. This study estimated the prevalence of recovery status in a large statewide epidemiological survey administered between January and March 2020. Participants were high school students in 9th through 12th grades throughout Illinois. Youth were asked if they were in recovery and if they had resolved problems with substances. Youth who reported recovery and problem resolving dual status (DS), recovery only (RO), and problem resolution only (PRO) were compared to propensity score matched control groups who reported neither status (neither/nor; NN). Outcomes included alcohol use, binge alcohol use, cannabis use, and prescription drug use in the past 30 days. Prevalence estimates were 884 (1.4%) for DS, 1546 (2.5%) for PRO, and 1,811 (2.9%) for RO. Relative to propensity matched control samples, all three groups had significantly lower odds of prescription drug use. The PRO group had lower odds of past month cannabis use. There were no significant differences for either alcohol outcome. Prevalence estimates of youth in recovery are slightly lower than those of adults in recovery, and estimates should be replicated. Youth in recovery and those resolving problems have numerous behavioral health needs, and relative to matched controls, have even odds for past 30-day alcohol use. These findings compel us to further define recovery for adolescents and emerging adults to allow for improving treatments and epidemiological research.

Drug-related problems in hospitalized patients with chronic kidney diseases and clinical pharmacist interventions

BackgroundPatients with chronic kidney disease (CKD) are at high risk of drug-related problems (DRPs) because of extensive comorbidities and pharmacokinetic changes. This study aimed to identify DRPs and possible contributing factors in hospitalized patients with CKD, and evaluate the efficacy of the clinical pharmacist services in detection and intervention of DRPs in a large general hospital in Zhejiang Province, eastern China.MethodsWith the approval of the Ethics Committee, patients with CKD admitted to the nephrology ward from January to December 2020 were enrolled in this prospective study. The clinical pharmacist identified and intervened the DRPs during hospitalization. The DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) DRP classification system, and all data were statistically analyzed using Statistical Package for Social Science (SPSS) version 26.0.ResultsA total of 914 patients with CKD were included, with 463 DRPs observed among 420 (45.95%) participants; the average DRP per patient was 0.51 (standard deviation [SD], 0.60) before pharmacist intervention. Treatment safety accounted for the highest proportion of problems (43.84%), followed by treatment efficacy, accounting for 43.20%. Drug selection was the most common cause of DRPs (60.26%), and antibiotics and cardiovascular agents were the most common drugs associated with DRPs (32.84% and 28.66%, respectively). A total of 85.53% of pharmaceutical intervention recommendations were followed, and 84.23% of DRPs were completely resolved after intervention by the clinical pharmacist. The proportion of patients who experienced DRPs decreased to 7.77%, with an average of 0.08 (SD 0.28) DRPs during hospitalization after pharmacist’s intervention. Significant contributing factors for DRPs were CKD stage 4, number of comorbid diseases, number of prescribed medications, and hospitalization days in both the univariate and multivariate logistic regression models.ConclusionDRPs are common among hospitalized patients with CKD in China. CKD stage 4, the number of comorbidities, use of multiple prescription drugs, and extended length of hospital stay are contributing factors for DRPs. Even only one clinical nephrology pharmacist in the nephrology ward, clinical pharmacist can play an important role in facilitating the identification of DRPs in patients with CKD and assisting physicians resolve DRPs in this single center study in China.

Allostatic load and risk of invasive breast cancer among postmenopausal women in the U.S.

ObjectiveAllostatic load can reflect the body's response to chronic stress. However, little is known about the association between allostatic load and risk of breast cancer in postmenopausal women. This study used a large prospective cohort in the United States to examine the relationship between allostatic load and invasive breast cancer risk, and to evaluate the relationship by racial and ethnic identity and breast cancer subtypes. MethodsAmong 161,808 postmenopausal participants in Women's Health Initiative, eligible were a subsample of 27,393 postmenopausal women aged 50–79 years old, who enrolled from 1993 to 1998, had serum test biomarkers, and were followed for breast cancer incidence through February 2022. Allostatic load at enrollment was computed based on eight biomarkers from lab serum tests and a questionnaire about participants' prescription drug use. The associations between allostatic scores and risk of breast cancer (overall and by subtypes) were assessed using Cox proportional hazards models. The race and ethnic differences were examined. ResultsOver a median follow-up time of 17.24 years, 1722 invasive breast cancer cases were identified. High allostatic load was associated with an increased risk of breast cancer (HR = 1.36, 95%CI: 1.20, 1.54 for third tertile vs first tertile, Ptrend < 0.0001). Similar trends were found in White women and non-Hispanic women. Higher allostatic load was associated with hormone receptor-positive and HER2/Neu-negative breast cancer (HR = 1.54, 95%CI: 1.30, 1.80 for third tertile vs first tertile, Ptrend < 0.0001). ConclusionIn this study, we found that higher allostatic load was significantly associated with an increased risk of breast cancer in postmenopausal women.

P56 Trends in Prescription Drug Use Among Adults With Diabetes in the United States From 1999-2018

P56 Trends in Prescription Drug Use Among Adults With Diabetes in the United States From 1999-2018

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BackgroundSubstance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics. MethodsFrom June 2016 to July 2017, 1,426 YEH (aged 18–26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership. ResultsFour latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH. ConclusionsThese findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Involuntary temporary work and mental health medications: A longitudinal study in Denmark.

Since the 1970s, most western countries have experienced an increase in jobs characterized by temporary employment working arrangements. Research links temporary employment to negative health outcomes. Yet, no study has analysed the effects on the mental health of workers in involuntary temporary employment. This study analyses the consequences of involuntary temporary employment for mental health. We distinguish between different lengths of exposure to involuntary temporary employment and assess the effects separately for women and men. We use a cohort design that combines data from the Danish version of the longitudinal European Labour Force Survey with administrative data about use of prescription drugs for anxiety and stress. Using a fixed effects approach, we identify the effects of involuntary full-time temporary employment on mental health over time. To further investigate causal effects, we also compare the outcomes of workers in involuntary full-time temporary employment with a control group that consists of workers who become employed in involuntarily full-time temporary job at a later point of time. For women in involuntary full-time temporary employment (for six quarters or more) the results show a deterioration in mental health as indicated by a 12.8 percentage point increase in drug use. Involuntary full-time temporary employment for one quarter results in a decrease in drug use by 1.1 percentage points, but no lasting effects. For men, we find no mental health consequences of involuntary full-time temporary employment. We conclude that involuntary full-time temporary employment for six quarters or more is likely to be harmful for women's mental health, while shorter periods of involuntary full-time temporary employment may have a minor positive impact. The implications suggest that it is advisable for labour market policy to make it easy for those in involuntary temporary employment to find permanent jobs, and that policy makers should consider adverse mental health problems when addressing policies affecting the prevalence of temporary employment.

Generating synthetic data from administrative health records for drug safety and effectiveness studies.

Administrative health records (AHRs) are used to conduct population-based post-market drug safety and comparative effectiveness studies to inform healthcare decision making. However, the cost of data extraction, and the challenges associated with privacy and securing approvals can make it challenging for researchers to conduct methodological research in a timely manner using real data. Generating synthetic AHRs that reasonably represent the real-world data are beneficial for developing analytic methods and training analysts to rapidly implement study protocols. We generated synthetic AHRs using two methods and compared these synthetic AHRs to real-world AHRs. We described the challenges associated with using synthetic AHRs for real-world study. The real-world AHRs comprised prescription drug records for individuals with healthcare insurance coverage in the Population Research Data Repository (PRDR) from Manitoba, Canada for the 10-year period from 2008 to 2017. Synthetic data were generated using the Observational Medical Dataset Simulator II (OSIM2) and a modification (ModOSIM). Synthetic and real-world data were described using frequencies and percentages. Agreement of prescription drug use measures in PRDR, OSIM2 and ModOSIM was estimated with the concordance coefficient. The PRDR cohort included 169,586,633 drug records and 1,395 drug types for 1,604,734 individuals. Synthetic data for 1,000,000 individuals were generated using OSIM2 and ModOSIM. Sex and age group distributions were similar in the real-world and synthetic AHRs. However, there were significant differences in the number of drug records and number of unique drugs per person for OSIM2 and ModOSIM when compared with PRDR. For the average number of days of drug use, concordance with the PRDR was 16% (95% confidence interval [CI]: 12%-19%) for OSIM2 and 88% (95% CI: 87%-90%) for ModOSIM. ModOSIM data were more similar to PRDR than OSIM2 data on many measures. Synthetic AHRs consistent with those found in real-world settings can be generated using ModOSIM. Synthetic data will benefit rapid implementation of methodological studies and data analyst training.

“Death by a Thousand Cuts”: Agriculture Producer Resiliency in the Western United States

ABSTRACT Objective Agricultural producers face a wide array of stress triggers, shocks, and long-term pressures such as drought, flooding, fire, government policies, financial insecurity, and physical injuries. Extant research has revealed that mental health stigma, lack of access to care in rural areas, and negative coping responses (alcohol abuse, suicide, prescription drugs use) exacerbate the challenge of producer responses to short and long-term adversity. Resilience, the traits, processes, and capacities of producers to adapt and transform their approach to farming or ranching, when necessary, in response to stress triggers or long-term pressures, has received less research attention, particularly in the Western United States. The purpose of the study was to apply an interactionist occupational resilience theoretical perspective to the investigation of contextual factors contributing to resilience in Western United States agricultural producers. Methods Qualitative interviews (45 to 90 minutes) were conducted with agricultural producers (n=51) from Western states and territories. Applied thematic analysis with a phenomenological lens was utilized to analyze interview transcriptions. First and second level coding were conducted to derive themes. Results The analysis revealed that resilience is based upon the interactions between traits of producers and the context of agriculture. Four themes were generated (Agricultural Life, External Stressors, Traits and Adaptations, and Supports and Resources), supported by subthemes. The themes and subthemes are depicted in an agricultural producer resiliency model. The findings shed light on the equivocal role of neighbors in providing support for each other and the double-edged sword of co-working with family. Conclusions The findings underscore that social capital is an important mechanism for supporting farmers and ranchers, as those with stronger social resources are more resilient. We recommend more funding to tailor stress and mental health programming to the specifics of agriculture, integration of behavioral health in primary care as a mechanism to increase access to care, and more intentional technical assistance for farmers and ranchers on strategic planning and problem solving.

The burden of drug abuse: Predictors of prescription drug abuse among women in Northern Nigeria. A systematic review

IntroductionThe North-Eastern, North-Western, and North-Central cities in Nigeria comprise of 19 states, each with its own governor. With over 400 ethnicities in the country, Northern Nigeria is home to many ethnic groups nearly half of whom are the Hausa-Fulani whose main religion is Islam. Practices in Northern Nigeria has favoured polygamy, early child marriage, and a lack of desire for western education while encouraging the strictly Islamic studies especially among the Hausa/Fulanis. Northern Nigeria is also known for its gender inequality and poverty. Prescription drug abuse has become more common in recent years even among women in Northern Nigeria. ObjectivesThis study's objectives include finding out the predicting factors to entry into prescription drug use among women in Northern Nigeria. Highlighting the causes of growing numbers in prescription drug abuse as well as recommending solutions in form of preventative measures. MethodsEight articles were selected after being critically appraised for this study following a set of inclusion and exclusion criteria. For this mixed method Systematic Review (SR), a thematic analysis was used for the results and findings. ResultsThis research shows that some of the factors in the rise of prescription drug abuse among women in Northern Nigeria include: unemployment, insurgency due to the activities of violent extremist organization—Boko Haram—in the Northern region, as well as family dynamics which involves family history of drug misuse, early marriage, and a lack of education. ConclusionUnderstanding the factors influencing women into drug use in Northern Nigeria can help end the cycle. This study suggests recommendations to prompt a decline in the rising numbers of prescription drug use among women in Northern Nigeria.

Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study.

Nonmedical use of prescription drugs can cause overdose; this represents a serious public health crisis globally. In this digital era, social networking services serve as viable platforms for illegal acquisition of excessive amounts of medications, including prescription medications. In Japan, such illegal drug transactions have been conducted through popular flea market applications, social media, and auction websites, with most of the trades being over-the-counter (OTC) medications. Recently, an emerging unique black market, where individuals trade prescription medications-predominantly nervous system drugs-using a specific keyword ("Okusuri Mogu Mogu"), has emerged on X (formerly Twitter). Hence, these dynamic methods of illicit trading should routinely be monitored to encourage the appropriate use of medications. This study aimed to specify the characteristics of medications traded on X using the search term "Okusuri Mogu Mogu" and analyze individual behaviors associated with X posts, including the types of medications traded and hashtag usage. We conducted a cross-sectional study with publicly available posts on X between September 18 and October 1, 2022. Posts that included the term "Okusuri Mogu Mogu" during this period were scrutinized. Posts were categorized on the basis of their contents: buying, selling, self-administration, heads-up, and others. Among posts categorized as buying, selling, and self-administration, medication names were systematically enumerated and categorized using the Anatomical Therapeutic Chemical (ATC) classification. Additionally, hashtags in all the analyzed posts were counted and classified into 6 categories: medication name, mental disorder, self-harm, buying and selling, community formation, and others. Out of 961 identified posts, 549 were included for analysis. Of these posts, 119 (21.7%) referenced self-administration, and 237 (43.2%; buying: n=67, 12.2%; selling: n=170, 31.0%) referenced transactions. Among these 237 posts, 1041 medication names were mentioned, exhibiting a >5-fold increase from the study in March 2021. Categorization based on the ATC classification predominantly revealed nervous system drugs, representing 82.1% (n=855) of the mentioned medications, consistent with the previous survey. Of note, the diversity of medications has expanded to include medications that have not been approved by the Japanese government. Interestingly, OTC medications were frequently mentioned in self-administration posts (odds ratio 23.6, 95% CI 6.93-80.15). Analysis of hashtags (n=866) revealed efforts to foster community connections among users. This study highlighted the escalating complexity of trading of illegal prescription medication facilitated by X posts. Regulatory measures to enhance public awareness should be considered to prevent illegal transactions, which may ultimately lead to misuse or abuse such as overdose. Along with such pharmacovigilance measures, social approaches that could direct individuals to appropriate medical or psychiatric resources would also be beneficial as our hashtag analysis shed light on the formation of a cohesive or closed community among users.

The effect of prescription drug insurance on the incidence of potentially inappropriate prescribing: Evidence from Medicare Part D.

The Medicare Part D program has been documented to increase the affordability and accessibility of drugs and improve the quality of prescription drug use; however, less is known about the equity impact of the Part D program on potentially inappropriate prescribing-specifically, incidences of polypharmacy and potentially inappropriate medication (PIM) use based on different racial/ethnic groups. Using a difference in the regression discontinuity design, we found that among Whites, Part D was associated with increases in polypharmacy and "broadly defined" PIM use, while the use of "always avoid" PIM remained unchanged. Conversely, Blacks and Hispanics reported no changes in such drug utilization patterns.

Assessment of prescription completeness and drug use pattern using WHO prescribing indicators in private community pharmacies in Addis Ababa: a cross-sectional study

BackgroundHealthcare systems in both developing and developed countries were not free from prescription errors. One of the effects of prescription errors is irrational prescribing. According to the estimation of the World Health Organization (WHO), greater than 50% of medicines are prescribed and dispensed irrationally. On the other hand, research on drug use patterns in the private healthcare sector is scarce. This study aimed to assess prescription Completeness and Drug use Pattern using WHO prescribing indicators in Private Community Pharmacies in Lemi-Kura sub-city.MethodsBased on the WHO prescribing indicators, a retrospective cross-sectional technique was employed to examine the completeness and drug-prescription patterns. The study was conducted from April to May 2021. Prescriptions, kept for 1 year that was prescribed from March 2020 to March 2021, by private healthcare sectors, were analyzed. A systematic random sampling technique was employed to select prescriptions obtained from private health facilities. Data were analyzed using SPSS® version 26.0 software.ResultsOf a total of 1000 prescriptions, 1770 drugs were prescribed and the average number of drugs per prescription was 1.77. Prescriptions for two drugs account for 38% of these, while prescriptions for three drugs account for 15%. Age, sex, and card number were written on 99.0%, 99.2%, and 41.8% of prescriptions, respectively. The patient's name was written on every prescription. Even though the availability of other therapeutic information on the prescription made it appear greater, only 44.2% of prescriptions included the dosage form of medications. The generic name was used for the majority of the medications (67.8%). Furthermore, assuming that each prescription was for a single patient, 71% of patients received antibiotics, and 2% received injectable medicines. The National List of Essential Medicines-Ethiopia was used in 99.6% of the prescriptions.ConclusionsOn the basis of the finding of this study, the prescribing and prescription completeness indicator showed deviation from the standard recommended by WHO. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing prescription errors in Ethiopia. Hence, in-service training for prescribers should be provided to improve adherence to basic prescription writing.

Gender and substance use among Latinx college students: An application of social structure social learning theory

Social structure social learning theory (SSSL) is a theoretical framework that has been used to understand gender differences in substance use. However, the Latinx community remains understudied in this body of research. Drawing on a Latinx college student sample, we tested the extent to which four social learning mechanisms specified by SSSL theory (positive definitions, neutralizing definitions, differential association, and differential reinforcement) explained gender differences in three substance use outcomes: alcohol intoxication, marijuana use, and illicit prescription drug use. We found that men reported greater levels of all three substance use outcomes, and that the social learning mechanisms mediated between 24% to 44% of these gender effects. We also found some evidence that the effects of differential association and differential reinforcement were stronger for men than women, suggesting that women may exhibit greater resilience when exposed to peer influence. We discuss the implications for SSSL theory and the study of substance use and gender differences in substance use among Latinx populations.

Moral injury and substance use among United States healthcare workers.

Moral injury (i.e., perpetrating, witnessing, failing to prevent, or being a victim of acts that transgress one's moral beliefs, values, or ethics) has largely been studied in military-connected populations and is associated with a range of adverse psychological sequelae. Emerging literature suggests that healthcare workers also experience moral injury, particularly in the context of the ongoing COVID-19 pandemic. However, it is not known if moral injury contributes to substance use among healthcare workers or whether these effects might differ by gender, race/ethnicity, or occupational level. In March 2022, we collected self-reported pilot data from a diverse sample of US healthcare workers (N=200) We examined the cross-sectional relationships between moral injury and several measures of substance use (i.e., current non-medical use of prescription drugs [NMUPD], current cannabis use, current use of other illicit drugs, and hazardous drinking) using separate logistic regression models. Next, we used separate interaction models to examine if any of these relations differed by gender, race/ethnicity, or occupational level. In main effects models, healthcare workers reporting greater moral injury had greater odds of current NMUPD (adjusted odds ratio (aOR)=1.07; p<0.001), current use of other illicit drugs (aOR=1.09; p<0.01), and hazardous drinking (aOR=1.07; p<0.01). These relations did not differ by race/ethnicity or occupational level (ps>0.05); however, men were more likely to report current NMUPD and hazardous drinking (ps<0.05) in the presence of high moral injury than women healthcare workers. Our findings suggest that healthcare workers experience substantial distress related to morally injurious events, which may affect their likelihood of NMUPD, cannabis use, use of other illicit drugs, and hazardous drinking, and that men in healthcare may be particularly at risk. Healthcare organizations should address systemic issues driving moral injury (e.g., resource shortages, lack of psychosocial support) to prevent substance-related harms among healthcare workers.