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Lape EC, Powers JM, LaRowe LR, Ditre JW. Initial validation of the expectancies for Benzodiazepine Analgesia Scale. Exp Clin Psychopharmacol 2024; 32:369-378. [PMID: 38010761 PMCID: PMC11098706 DOI: 10.1037/pha0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Chronic pain populations exhibit greater prevalence of benzodiazepine (BZD) prescription (vs. the general population) and greater likelihood of BZD use not as prescribed and dependence symptoms. Individuals report taking BZDs for pain relief, potentially contributing to maintenance/escalation of BZD use and hazardous couse with prescription opioids. Identifying cognitive factors underlying pain-BZD use relations represents a critical step toward understanding the role of pain in BZD use trajectories. Outcome expectancies for substance-related analgesia have been implicated in pain-substance use comorbidity (e.g., alcohol), and there is reason to believe these processes may extend to BZD use. The present study aimed to examine psychometric properties of a newly adapted Expectancies for Benzodiazepine Analgesia (EBA) scale and probe associations between EBA scores and prescription opioid use behaviors. Participants were 306 adults (38.9% females) endorsing chronic pain and current BZD prescription who completed an online survey. Results provided initial support for psychometric validity of the EBA: evidence of single-factor structure with good model fit (Bollen-Stine bootstrap p = .101), excellent internal consistency (α = .93), and evidence of concurrent validity via correlations with pain variables, likelihood of BZD use not as prescribed, BZD dependence symptoms, and self-reported BZD use for pain relief. Exploratory findings among participants prescribed opioids indicated positive covariation between EBA scores and behaviors associated with higher risk opioid use. This is, to our knowledge, the first study to assess analgesia expectancies for BZD use. BZD analgesic expectancies warrant further study as a treatment target in comorbid pain and BZD use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Emma C. Lape
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
| | - Jessica M. Powers
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, 625 North Michigan Avenue, 21st Floor, Chicago, IL 60611, United States
| | - Lisa R. LaRowe
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
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2
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Rigg KK, Weiner MA, Kusiak ES. Patterns of polydrug use among Black Americans who misuse opioids. J Behav Health Serv Res 2024:10.1007/s11414-024-09878-3. [PMID: 38468073 DOI: 10.1007/s11414-024-09878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.
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Affiliation(s)
- Khary K Rigg
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.
| | - Michael A Weiner
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - Ethan S Kusiak
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
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3
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Kozak Z, Urquhart GJ, Rouhani S, Allen ST, Park JN, Sherman SG. Factors associated with daily use of benzodiazepines/tranquilizers and opioids among people who use drugs. Am J Addict 2024; 33:83-91. [PMID: 37717256 DOI: 10.1111/ajad.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Co-use of benzodiazepines and opioids significantly increases fatal overdose risk, yet few studies have examined co-use of these drugs when obtained both with and without a prescription. We examined associations of daily co-use of prescribed benzodiazepines/tranquilizers (BZD/TRQ) and prescribed and nonprescribed opioids among people who use street opioids (PWUO). METHODS PWUO (N = 417) were recruited from Baltimore City and neighboring Anne Arundel County, Maryland, and surveyed on sociodemographic characteristics, structural vulnerabilities, healthcare access and utilization, substance use, and overdose experiences. Multivariable logistic regression was used to identify factors associated with self-reported co-use. RESULTS Participants were 46 years old on average, and predominantly Black (74%) males (62%). Daily co-use was reported by 22%. In multivariable analyses, odds of co-use were significantly higher among participants who did not have a high school degree/GED (adjusted odds ratio [aOR]: 1.71, 95% confidence interval [CI]: 1.02-2.88), endorsed receiving mental health treatment in the past 6 months (aOR: 2.13, 95% CI: 1.28-3.56), reported daily use of powdered cocaine (aOR: 3.57, 95% CI: 1.98-6.45), and synthetic cannabinoids (aOR: 3.11, 95% CI: 1.40-6.93). Odds of co-use were significantly lower among Black participants compared to white participants (aOR: 0.39, 95% CI: 0.19-0.82). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Clinicians working with PWUO or who prescribe BZDs or opioids should screen patients who use cocaine or synthetic cannabinoids, have low level of educational attainment, or recently accessed mental health services, as these patients may be at higher risk for daily co-use of BZD/TRQ and opioids, and therefore lethal overdose.
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Affiliation(s)
- Zofia Kozak
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Glenna J Urquhart
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju N Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Warren Alpert Medical School, Brown University, Providence, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rintoul K, Song E, McLellan-Carich R, Schjelderup ENR, Barr AM. A scoping review of psychiatric conditions associated with chronic pain in the homeless and marginally housed population. FRONTIERS IN PAIN RESEARCH 2023; 4:1020038. [PMID: 37187857 PMCID: PMC10175796 DOI: 10.3389/fpain.2023.1020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
The present review sought to examine and summarise the unique experience of concurrent pain and psychiatric conditions, that is often neglected, within the population of homeless individuals. Furthermore, the review examined factors that work to aggravate pain and those that have been shown to improve pain management. Electronic databases (MEDLINE, EMBASE, psycINFO, and Web of Science) and the grey literature (Google Scholar) were searched. Two reviewers independently screened and assessed all literature. The PHO MetaQAT was used to appraise quality of all studies included. Fifty-seven studies were included in this scoping review, with most of the research being based in the United States of America. Several interacting factors were found to exacerbate reported pain, as well as severely affect other crucial aspects of life that correlate directly with health, within the homeless population. Notable factors included drug use as a coping mechanism for pain, as well as opioid use preceding pain; financial issues; transportation problems; stigma; and various psychiatric disorders, such as post-traumatic stress disorder, depression, and anxiety. Important pain management strategies included cannabis use, Accelerated Resolution Therapy for treating trauma, and acupuncture. The homeless population experiences multiple barriers which work to further impact their experience with pain and psychiatric conditions. Psychiatric conditions impact pain experience and can work to intensify already adverse health circumstances of homeless individuals.
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Affiliation(s)
- Kathryn Rintoul
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Esther Song
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - Rachel McLellan-Carich
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Elizabeth N. R. Schjelderup
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
- Correspondence: Alasdair M. Barr
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Badin D, Ortiz-Babilonia CD, Gupta A, Leland CR, Musharbash F, Parrish JM, Aiyer AA. Prescription Patterns, Associated Factors, and Outcomes of Opioids for Operative Foot and Ankle Fractures: A Systematic Review. Clin Orthop Relat Res 2022; 480:2187-2201. [PMID: 35901447 PMCID: PMC10476710 DOI: 10.1097/corr.0000000000002307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain management after foot and ankle surgery must surmount unique challenges that are not present in orthopaedic surgery performed on other parts of the body. However, disparate and inconsistent evidence makes it difficult to draw meaningful conclusions from individual studies. QUESTIONS/PURPOSES In this systematic review, we asked: what are (1) the patterns of opioid use or prescription (quantity, duration, incidence of persistent use), (2) factors associated with increased or decreased risk of persistent opioid use, and (3) the clinical outcomes (principally pain relief and adverse events) associated with opioid use in patients undergoing foot or ankle fracture surgery? METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our review. We searched PubMed, Embase, Scopus, Cochrane, and Web of Science on October 15, 2021. We included studies published from 2010 to 2021 that assessed patterns of opioid use, factors associated with increased or decreased opioid use, and other outcomes associated with opioid use after foot or ankle fracture surgery (principally pain relief and adverse events). We excluded studies on pediatric populations and studies focused on acute postoperative pain where short-term opioid use (< 1 week) was a secondary outcome only. A total of 1713 articles were assessed and 18 were included. The quality of the 16 included retrospective observational studies and two randomized trials was evaluated using the Methodological Index for Non-Randomized Studies criteria and the Jadad scale, respectively; study quality was determined to be low to moderate for observational studies and good for randomized trials. Mean patient age ranged from 42 to 53 years. Fractures studied included unimalleolar, bimalleolar, trimalleolar, and pilon fractures. RESULTS Proportions of postoperative persistent opioid use (defined as use beyond 3 or 6 months postoperatively) ranged from 2.6% (546 of 20,992) to 18.5% (32 of 173) and reached 39% (28 of 72) when including patients with prior opioid use. Among the numerous associations reported by observational studies, two or more preoperative opioid prescriptions had the strongest overall association with increased opioid use, but this was assessed by only one study (OR 11.92 [95% confidence interval (CI) 9.16 to 13.30]; p < 0.001). Meanwhile, spinal and regional anesthesia (-13.5 to -41.1 oral morphine equivalents (OME) difference; all p < 0.01) and postoperative ketorolac use (40 OME difference; p = 0.037) were associated with decreased opioid consumption in two observational studies and a randomized trial, respectively. Three observational studies found that opioid use preoperatively was associated with a higher proportion of emergency department visits and readmission (OR 1.41 to 17.4; all p < 0.001), and opioid use at 2 weeks postoperatively was associated with slightly higher pain scores compared with nonopioid regimens (β = 0.042; p < 0.001 and Likert scale 2.5 versus 1.6; p < 0.05) in one study. CONCLUSION Even after noting possible inflation of the harms of opioids in this review, our findings nonetheless highlight the need for opioid prescription guidelines specific for foot and ankle surgery. In this context, surgeons should utilize short (< 1 week) opioid prescriptions, regional anesthesia, and multimodal pain management techniques, especially in patients at increased risk of prolonged opioid use. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Carlos D. Ortiz-Babilonia
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Arjun Gupta
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Farah Musharbash
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - James M. Parrish
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
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6
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Boileau-Falardeau M, Contreras G, Gariépy G, Laprise C. Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence. Health Promot Chronic Dis Prev Can 2022; 42:47-59. [PMID: 35170930 PMCID: PMC8935897 DOI: 10.24095/hpcdp.42.2.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Polysubstance use-the use of substances at the same time or close in time-is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use. METHODS We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar. RESULTS We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria ("high"). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Self-medication for a pre-existing condition was also the intention behind sequential or simultaneous use. CONCLUSION Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis.
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Affiliation(s)
- Michèle Boileau-Falardeau
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Geneviève Gariépy
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Quebec, Canada
| | - Claudie Laprise
- Public Health Agency of Canada, Montréal, Quebec, Canada
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Quebec, Canada
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7
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Guarino H, Mateu-Gelabert P, Quinn K, Sirikantraporn S, Ruggles KV, Syckes C, Goodbody E, Jessell L, Friedman SR. Adverse Childhood Experiences Predict Early Initiation of Opioid Use Behaviors. FRONTIERS IN SOCIOLOGY 2021; 6:620395. [PMID: 34055961 PMCID: PMC8158934 DOI: 10.3389/fsoc.2021.620395] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/07/2021] [Indexed: 05/26/2023]
Abstract
Introduction: Although a substantial body of research documents a relationship between traumatic stress in childhood and the initiation of substance use later in the life course, only limited research has examined potential linkages between adverse childhood experiences (ACEs) and the initiation of non-medical prescription opioid use and other opioid use behaviors. The present study contributes to this growing body of work by investigating the association of childhood trauma with early initiation of a series of opioid use behaviors. Methods: New York City young adults (n = 539) ages 18-29 who reported non-medical use of prescription opioids or heroin use in the past 30 days were recruited using Respondent-Driven Sampling in 2014-16. Ten ACEs were assessed via self-report with the ACE Questionnaire. Associations between number of ACEs and self-reported ages of initiating seven opioid use behaviors (e.g., non-medical prescription opioid use, heroin use, heroin injection) were estimated with multivariable logistic regression. Results: Eighty nine percent of participants reported at least one ACE, and 46% reported four or more ACEs, a well-supported threshold indicating elevated risk for negative health consequences. Every increase of one trauma was associated with a 12-23% increase in odds of early initiation across the seven opioid use behaviors. Findings also document that the mean age at initiation increased with increasing risk severity across the behaviors, contributing to evidence of a trajectory from opioid pill misuse to opioid injection. Discussion: Increasing number of childhood traumas was associated with increased odds of earlier initiation of multiple opioid misuse behaviors. In light of prior research linking earlier initiation of substance use with increased substance use severity, present findings suggest the importance of ACEs as individual-level determinants of increased opioid use severity. Efforts to prevent onset and escalation of opioid use among at-risk youth may benefit from trauma prevention programs and trauma-focused screening and treatment, as well as increased attention to ameliorating upstream socio-structural drivers of childhood trauma.
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Affiliation(s)
- Honoria Guarino
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Kelly Quinn
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | | | - Kelly V. Ruggles
- Division of Translational Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | | | - Elizabeth Goodbody
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Lauren Jessell
- Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Samuel R. Friedman
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, United States
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8
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Johnson ME, Zaidi F. Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children. ADDICTION RESEARCH & THEORY 2021; 29:479-489. [PMID: 35035335 PMCID: PMC8758115 DOI: 10.1080/16066359.2021.1891414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 06/14/2023]
Abstract
AIM Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. METHODS A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. RESULTS Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. CONCLUSION Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.
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Affiliation(s)
- Micah E. Johnson
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | - Farwah Zaidi
- The Study of Teen Opioid Misuse and Prevention Laboratory, Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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Kelley-Quon LI, Kirkpatrick MG, Ricca RL, Baird R, Harbaugh CM, Brady A, Garrett P, Wills H, Argo J, Diefenbach KA, Henry MCW, Sola JE, Mahdi EM, Goldin AB, St Peter SD, Downard CD, Azarow KS, Shields T, Kim E. Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. JAMA Surg 2021; 156:76-90. [PMID: 33175130 PMCID: PMC8995055 DOI: 10.1001/jamasurg.2020.5045] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
IMPORTANCE Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery. EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique. FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery. CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.
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Affiliation(s)
- Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | | | - Robert L Ricca
- Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Robert Baird
- Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ashley Brady
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Paula Garrett
- Department of Pediatric Surgery, University of Michigan, Ann Arbor
| | - Hale Wills
- Division of Pediatric Surgery, Hasbro Children's Hospital, Providence, Rhode Island
- Department of Surgery, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jonathan Argo
- Department of Pediatric Anesthesiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Marion C W Henry
- Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Juan E Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Elaa M Mahdi
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Kenneth S Azarow
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland
| | - Tracy Shields
- Division of Library Services, Naval Medical Center, Portsmouth, Virginia
| | - Eugene Kim
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
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10
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Valente PK, Bazzi AR, Childs E, Salhaney P, Earlywine J, Olson J, Biancarelli DL, Marshall BDL, Biello KB. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102934. [PMID: 32911318 PMCID: PMC7770041 DOI: 10.1016/j.drugpo.2020.102934] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polysubstance use (i.e., using ≥2 psychoactive substances concomitantly) is associated with increased morbidity and mortality and complicates drug treatment needs among people who inject drugs (PWID). We explored patterns, contexts, motivations, and perceived consequences of polysubstance use among PWID in small cities and towns in the U.S. Northeast. METHODS Between October 2018 and March 2019, we conducted semi-structured interviews with 45 PWID living outside of the capital cities of Rhode Island and Massachusetts recruited online and through community-based organizations. Written transcripts were coded inductively and deductively using a team-based approach and analyzed thematically. RESULTS All participants reported recent polysubstance use, with most using five or more classes of substances in the past three months. Polysubstance use often followed long personal drug use histories (i.e., years or decades of occasional drug use). Reasons for polysubstance use included obtaining synergistic psychoactive effects as a result of mixing drugs (i.e., using drugs to potentiate effects of other drugs) and managing undesirable effects of particular drugs (e.g., offsetting the depressant effects of opioids with stimulants or vice-versa). Polysubstance use to self-medicate poorly managed physical and mental health conditions (e.g., chronic pain, anxiety, and depression) was also reported. Inadequately managed cravings and withdrawal symptoms prompted concomitant use of heroin and medications for opioid use disorder, including among individuals reporting cocaine or crack as their primary "issue" drugs. Polysubstance use was perceived to increase overdose risks and to be a barrier to accessing healthcare and drug treatment services. CONCLUSION Healthcare services and clinicians should acknowledge, assess, and account for polysubstance use among patients and promote harm reduction approaches for individuals who may be using multiple drugs. Comprehensive healthcare that meets the social, physical, mental health, and drug treatment needs of PWID may decrease the perceived need for polysubstance use to self-medicate poorly managed health conditions and symptoms.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Ellen Childs
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Peter Salhaney
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Joel Earlywine
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118, USA
| | - Jennifer Olson
- Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, 8th Floor, Providence, RI 02912, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 2nd Floor, Providence, RI 02912, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
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12
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McClure FL, Niles JK, Kaufman HW, Gudin J. Drug Misuse and Hepatitis C Virus Infection Profiles for Three Generations of Patients Being Monitored for Prescription Drug Adherence. J Addict Med 2020; 13:123-130. [PMID: 30334927 PMCID: PMC6430589 DOI: 10.1097/adm.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objectives: Two epidemics in the United States are related: opioid drug injection and hepatitis C virus (HCV) infection. This study quantifies the relationship between illicit/prescription drug misuse and HCV infection in 3 population generations: baby boomers (born 1945–1965, inclusive), pre-baby boomers, and post-baby boomers. Methods: This retrospective study included prescription drug consistency (March–December 2015) and HCV (2011–2015) patient test results performed at a large national clinical reference laboratory. HCV positivity, drug use consistency/inconsistency with prescribed drug information, type of inconsistent use, and inconsistent use of individual drug classes were assessed. Results: This study evaluated 39,231 prescription drug monitoring and HCV sets of test results from 18,410 patients. Of these patients, 25.1% tested positive for HCV and 57.3% demonstrated drug test results that were inconsistent with the prescribed medication(s). The types of drug test inconsistency differed substantially between HCV-positive and -negative patients, particularly testing positive for both non-prescribed drugs and prescribed drugs. Specimens from HCV-positive baby boomer and post-baby boomers demonstrated non-prescribed use of opioids and many other drug classes more often than from HCV-negative patients. Conclusions: The rates of inconsistent drug test results and types of drugs misused suggest that HCV-positive patients are more likely than HCV-negative patients to display high-risk behavior, even beyond opioid use. This difference is most pronounced in the post-baby boomer generation. Healthcare professionals should consider these patterns and how they differ by generation when monitoring for both prescription and illicit drugs, the results of which can impact treatment decisions including prescribing analgesics.
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Liu S, Vivolo-Kantor A. A latent class analysis of drug and substance use patterns among patients treated in emergency departments for suspected drug overdose. Addict Behav 2020; 101:106142. [PMID: 31639639 DOI: 10.1016/j.addbeh.2019.106142] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Polysubstance use and misuse can increase risks for nonfatal and fatal drug overdose. To categorize drugs used in combination in nonfatal overdoses, we analyzed data from emergency department (ED) overdose-related visits in 18 states funded by CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program. METHODS From 2017 to 2018, 120,706 ED visits included at least one hospital discharge code indicating acute drug poisoning for opioids, stimulants, hallucinogens, cannabis, anti-depressants, sedatives, alcohol, benzodiazepines, or other psychotropic drugs. Latent class analyses were conducted to determine the groupings of drug combinations in overdose visits. RESULTS Latent class analyses indicated a model of 5 classes - mostly heroin overdose (42.5% of visits); mostly non-heroin opioid overdose/use (27.3%); opioid, polysubstance (11.0%); female, younger (<25 years), other non-opioid drugs (10.5%); female, older (>55 years), benzodiazepine (8.0%). Findings indicated that heroin continues to be a large burden to EDs, yet EDs are also seeing overdose survivors with polydrug toxicity. CONCLUSIONS Medication-assisted treatment could be initiated in the emergency department following overdose for patients with opioid use disorder, and post-overdose protocols, such as naloxone provision and linkage to treatment and harm reduction services, have the potential to prevent future overdose for those at risk.
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Affiliation(s)
- Stephen Liu
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA.
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
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Shrestha R, Altice FL, DiDomizio E, Sibilio B, Ranjit YS, Copenhaver MM. Feasibility and Acceptability of an mHealth-Based Approach as an HIV Prevention Strategy Among People Who Use Drugs on Pre-Exposure Prophylaxis. Patient Prefer Adherence 2020; 14:107-118. [PMID: 32021122 PMCID: PMC6971384 DOI: 10.2147/ppa.s236794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There has been increasing interest in the use of mHealth technology in health care. To our knowledge, however, there is a lack of empirical evidence on the utilization of text messaging services (short message service; SMS) for HIV prevention among opioid-dependent people who use drugs (PWUD). As part of our formative work, we conducted an in-depth feasibility and acceptability study on the use of SMS reminders for HIV prevention in this risk group. METHODS Forty HIV-negative, opioid-dependent PWUD who are currently taking pre-exposure prophylaxis (PrEP) were enrolled in the study. Participants received daily PrEP text reminders and weekly HIV risk reduction-related messages, which were developed using a user-centered approach. Participants were assessed at baseline and immediately post-intervention. Following the post-intervention assessment, participants completed an in-depth qualitative interview. RESULTS Feasibility of text messaging service was high, as assessed by participants' willingness to receive text messages (100%), retention (95%), and successful delivery of text messages (97%). Results further showed that participants were satisfied and perceived the use of daily PrEP reminder text messages as valuable and acceptable [mean: 75.0 (range 0-100)]. Whereas, acceptability for the weekly text messages on HIV risk reduction was 60.3 (±15.6), with 58.3% recommending them for future use. Thematic data exploration revealed important information for understanding and refining SMS content as well as logistical preferences. CONCLUSION Our findings provide preliminary evidence of the feasibility and acceptability of a text messaging-based approach as a potential tool for primary HIV prevention to improve PrEP adherence and HIV risk reduction among this underserved population. HIV risk reduction text messages need further modifications to become more appealing, with participant feedback taken into consideration.
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Affiliation(s)
- Roman Shrestha
- Aasaman Nepal, HIV Prevention Group, Lalitpur, Nepal
- Correspondence: Roman Shrestha Asaman Nepal, HIV Prevention Group, Ring Road, Lalitpur44700, NepalTel +977-9849783132 Email
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth DiDomizio
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brian Sibilio
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Yerina S Ranjit
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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15
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Vosburg SK, Robbins RS, Antshel KM, Faraone SV, Green JL. Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit. Front Psychiatry 2020; 11:631792. [PMID: 33597899 PMCID: PMC7883730 DOI: 10.3389/fpsyt.2020.631792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults. Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews. Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways. Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.
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Affiliation(s)
| | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Stephen V Faraone
- Department of Psychiatry, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Jody L Green
- Inflexxion, An IBH Company, Costa Mesa, CA, United States
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Mintz CM, Hartz SM, Borodovsky JT, Bierut LJ, Grucza RA. Changes in associations of prescription opioid use disorder and illegal behaviors among adults in the United States from 2002 to 20. Addiction 2019; 114:2150-2159. [PMID: 31033084 PMCID: PMC6819203 DOI: 10.1111/add.14638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/11/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In the United States, the availability of prescription opioids has decreased in recent years. Whether there have been corresponding changes in the likelihood of people with prescription opioid use disorder (POUD) to engage in illegal behaviors related to drug use remains unknown. We examined changes in prevalence of illegal behaviors between people with and without POUD over time, and how transactions for obtaining opioids have changed among people with POUD over time. DESIGN Temporal trend analysis of repeated cross-sectional data. SETTING United States household dwelling population from all 50 states and District of Columbia. PARTICIPANTS Adult subsamples from the 2002-14 National Survey of Drug Use and Health (n = 5393 people with POUD; n = 486 768 people without POUD). MEASUREMENTS Outcome variables were selected illegal behaviors and sources of opioids used non-medically. POUD was defined using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Time was treated as a continuous variable. The variable of interest for each illegal behavior analysis was the interaction between POUD diagnosis and time. Covariates included age, sex and race/ethnicity. FINDINGS During the 13-year period examined, the adjusted interaction odds ratio (AIOR) describing the change in association between POUD and selling illicit drugs increased by a factor of 2.41 [95% confidence interval (CI) = 1.56-3.71, P < 0.001]. Similar trends were noted for stealing (AIOR = 2.12, 95% CI = 1.31-3.44, P = 0.002) and for life-time history of arrest (AIOR = 1.53, 95% CI = 1.06-2.19, P = 0.021). People with POUD became less likely to receive opioids for free from friends and family [adjusted odds ratio (AOR) = 0.42, 95% CI = 0.25-0.71, P = 0.001] and more likely to buy them from friends and family (AOR = 3.29, 95% CI = 1.76-6.13, P < 0.001) from 2005 to 2014. CONCLUSIONS In the United States, against a backdrop of a decreasing prescription opioid supply, rates of some crimes potentially related to drug use increased among people with prescription opioid use disorder compared with those without prescription opioid use disorder from 2002 to 2014.
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Affiliation(s)
- Carrie M Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Sarah M Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Jacob T Borodovsky
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Richard A Grucza
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA
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Kelley-Quon LI, Cho J, Strong DR, Miech RA, Barrington-Trimis JL, Kechter A, Leventhal AM. Association of Nonmedical Prescription Opioid Use With Subsequent Heroin Use Initiation in Adolescents. JAMA Pediatr 2019; 173:e191750. [PMID: 31282942 PMCID: PMC6618794 DOI: 10.1001/jamapediatrics.2019.1750] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/17/2019] [Indexed: 12/23/2022]
Abstract
IMPORTANCE There is concern that nonmedical prescription opioid use is associated with an increased risk of later heroin use initiation in adolescents, but to our knowledge, longitudinal data addressing this topic are lacking. OBJECTIVE To determine whether nonmedical prescription opioid use is associated with subsequent initiation of heroin use in adolescents. DESIGN, SETTING, AND PARTICIPANTS This prospective longitudinal cohort study conducted in 10 high schools in Los Angeles, California, administered 8 semiannual surveys from 9th through 12th grade that assessed nonmedical prescription opioid use, heroin use, and other factors from October 2013 to July 2017. Students were baseline never users of heroin recruited through convenience sampling. Cox regression models tested nonmedical prescription opioid use statuses at survey waves 1 through 7 as a time-varying and time-lagged regressor and subsequent heroin use initiation across waves 2 to 8 as the outcome. EXPOSURES Self-reported nonmedical prescription opioid use (past 30-day [current] use vs past 6-month [prior] use without past 30-day use vs no past 6-month use) at each wave from 1 to 7. MAIN OUTCOMES AND MEASURES Self-reported heroin use initiation (yes/no) during waves 2 to 8. RESULTS Of 3298 participants, 1775 (53.9%) were adolescent girls, 1563 (48.3%) were Hispanic, 548 (17.0%) were Asian, 155 (4.8%) were African American, 529 (16.4%) were non-Hispanic white, and 220 (6.8%) were multiracial. Among baseline never users of heroin in ninth grade with valid data (3298 [97% of cohort enrollees]; mean [SD] age, 14.6 [0.4] years), the number of individuals with outcome data available at each follow-up ranged from 2987 (90.6%) to 3200 (97.0%). The mean per-wave prevalence of prior and current nonmedical prescription opioid use from waves 1 to 7 was 1.9% and 2.7%, respectively. Seventy students (2.1%) initiated heroin use during waves 2 to 8. Prior vs no (hazard ratio, 3.59; 95% CI, 2.14-6.01; P < .001) and current vs no (hazard ratio, 4.37; 95% CI, 2.80-6.81; P < .001) nonmedical prescription opioid use were positively associated with subsequent heroin use initiation. For no, prior, and current nonmedical prescription opioid use statuses at waves 1 to 7, the estimated cumulative probabilities of subsequent heroin use initiation by wave 8 (42-month follow-up) were 1.7%, 10.7%, and 13.1%, respectively. In covariate-adjusted models, associations were attenuated but remained statistically significant and current nonmedical prescription opioid use risk estimates were stronger than corresponding associations of nonopioid substance use with subsequent heroin use initiation. CONCLUSIONS AND RELEVANCE Nonmedical prescription opioid use was prospectively associated with subsequent heroin use initiation during 4 years of adolescence among Los Angeles youth. Further research is needed to understand whether this association is causal.
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Affiliation(s)
- Lorraine I. Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Preventive Medicine, University of Southern California, Los Angeles
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - David R. Strong
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla
| | - Richard A. Miech
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Afton Kechter
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles
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Bouvier BA, Kinnard EN, Yedinak JL, Li Y, Elston B, Green TC, Hadland SE, Marshall BDL. Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically. J Psychoactive Drugs 2019; 51:441-452. [PMID: 31411548 DOI: 10.1080/02791072.2019.1654151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.
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Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Department of Emergency Medicine, Boston Medical Center Injury Prevention Center and Boston University School of Medicine, Boston, MA, USA.,Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.,Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Gaps in HCV Knowledge and Risk Behaviors among Young Suburban People Who Inject Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111958. [PMID: 31159479 PMCID: PMC6604001 DOI: 10.3390/ijerph16111958] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 01/28/2023]
Abstract
Background: Hepatitis C virus (HCV) among young suburban people who inject drugs (PWID) is a growing epidemic in the United States, yet little is known about the factors contributing to increased exposure. The goal of this study was to explore and assess HCV knowledge and attitudes about treatment and identify risk behaviors among a cohort of young suburban PWID. Methods: We conducted interviews with New Jersey (NJ) service providers and staff from the state’s five syringe service programs to inform a semistructured survey addressing HCV knowledge, treatment, and risk factors among young suburban PWID. We then used this survey to conduct qualitative interviews with 14 young suburban PWID (median age 26 years) in NJ between April and May 2015. Data were analyzed using a modified grounded theory approach and coded to identify thematic relationships among respondents. Results: Most participants had substantial gaps in several aspects of HCV knowledge. These included: HCV transmission, HCV symptoms, and the availability of new direct-acting antiviral therapy. Participants also downplayed the risk of past and current risk behaviors, such as sharing drug paraphernalia and reusing needles, which also reflected incomplete knowledge regarding these practices. Conclusion: Young suburban PWID are not receiving or retaining accurate and current HCV information. Innovative outreach and prevention messages specifically tailored to young suburban PWID may help to disseminate HCV prevention and treatment information to this population.
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Roth AM, Kral AH, Mitchell A, Mukherjee R, Davidson P, Lankenau SE. Overdose Prevention Site Acceptability among Residents and Businesses Surrounding a Proposed Site in Philadelphia, USA. J Urban Health 2019; 96:341-352. [PMID: 31168733 PMCID: PMC6565835 DOI: 10.1007/s11524-019-00364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Overdose prevention sites (OPS) are places where people use previously obtained drugs under the supervision of a health professional. They have been proposed in six United States (US) cities, including Philadelphia, to help reduce opioid-related overdose deaths and public injection. Philadelphia has the highest overdose rate among large cities in the US, which has led a local community-based organization to plan the implementation of OPS. Kensington, a neighborhood with the highest drug mortality overdose rates in the city, is a likely site for the proposed OPS. Given the dearth of research systematically assessing public opinion towards OPS prior to implementation, we enrolled 360 residents and 79 business owners/staff in the Kensington neighborhood in a cross-sectional acceptability study. Face-to-face surveys assessed participant characteristics, experiences with drug-related social problems, and OPS acceptability. Using descriptive statistics, we estimated factors associated with favorability towards opening an OPS in the Kensington neighborhood. Ninety percent of residents were in favor of an OPS opening in Kensington. Support was significantly higher among unstably housed individuals and persons who currently use opioids. In the business sample, 63% of owners/staff were in favor of opening an OPS in Kensington. A greater proportion of Asian/Pacific Islanders, Hispanic/Latinx respondents, and non-Hispanic/Latinx Black respondents were in favor of an OPS opening in Kensington compared with white respondents (p < 0.04). While details about implementation are still being considered, results indicate general acceptability among Kensington residents and businesses for an OPS, especially if it can deliver benefits that curb drug-related social problems. Should an OPS be implemented in Philadelphia, it would be important to monitor changes in drug-related social problems and acceptability post implementation.
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Affiliation(s)
- Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, CA, USA
| | - Allison Mitchell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Rohit Mukherjee
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Peter Davidson
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
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Rich KM, Bia J, Altice FL, Feinberg J. Integrated Models of Care for Individuals with Opioid Use Disorder: How Do We Prevent HIV and HCV? Curr HIV/AIDS Rep 2019; 15:266-275. [PMID: 29774442 PMCID: PMC6003996 DOI: 10.1007/s11904-018-0396-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose of Review To describe models of integrated and co-located care for opioid use disorder (OUD), hepatitis C (HCV), and HIV. Recent Findings The design and scale-up of multidisciplinary care models that engage, retain, and treat individuals with HIV, HCV, and OUD are critical to preventing continued spread of HIV and HCV. We identified 17 models within primary care (N = 3), HIV specialty care (N = 5), opioid treatment programs (N = 6), transitional clinics (N = 2), and community-based harm reduction programs (N = 1), as well as two emerging models. Summary Key components of such models are the provision of (1) medication-assisted treatment for OUD, (2) HIV and HCV treatment, (3) HIV pre-exposure prophylaxis, and (4) behavioral health services. Research is needed to understand differences in effectiveness between co-located and fully integrated care, combat the deleterious racial and ethnic legacies of the “War on Drugs,” and inform the delivery of psychiatric care. Increased access to harm reduction services is crucial. Electronic supplementary material The online version of this article (10.1007/s11904-018-0396-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine M Rich
- Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Joshua Bia
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Frederick L Altice
- Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Centre of Excellence on Research in AIDS (CERIA), University of Malaya, Kuala Lumpur, Malaysia
| | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry and Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
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Quinn K, Frueh BC, Scheidell J, Schatz D, Scanlon F, Khan MR. Internalizing and externalizing factors on the pathway from adverse experiences in childhood to non-medical prescription opioid use in adulthood. Drug Alcohol Depend 2019; 197:212-219. [PMID: 30849646 PMCID: PMC6507420 DOI: 10.1016/j.drugalcdep.2018.12.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Research demonstrates strong associations between adverse childhood experiences (ACEs) and non-medical prescription opioid use (NMPO), but pathways are not understood, hindering prevention and treatment responses. METHODS We assessed hypothesized mediators of the association between ACEs and NMPO in a nationally-representative U.S. SAMPLE National Longitudinal Study of Adolescent to Adult Health data (N = 12,288) yielded an ordinal exposure comprising nine ACEs (neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, experienced violence) and a binary lifetime NMPO outcome. Nine potential mediators measured in adolescence and/or adulthood included depression, anxiety, suicidality, delinquency, impulsivity, and risk-taking. We estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for sex-stratified associations of: ACEs and mediators; mediators and NMPO; and ACEs and NMPO adjusting for mediators individually and simultaneously. RESULTS All associations of ACEs and mediators were statistically significant and similar by sex. All mediators had statistically significant associations with NMPO (except one depression measurement for each sex). Delinquency was strongly associated with ACEs and NMPO and was the strongest individual mediator. Every ACE increase was associated with increased NMPO odds of 32% for males and 27% for females. Adjusting for all mediators, odds of NMPO were attenuated partially for males [AOR = 1.18 (95% CI:1.07, 1.31)] and somewhat more for females [AOR = 1.11 (95% CI:1.00, 1.25)]. CONCLUSIONS Internalizing and externalizing factors partially explained the pathway from ACEs to NMPO. Substance abuse may be more difficult to treat with co-occurring psychopathologies and maladaptive behaviors, highlighting the need to address trauma early in life.
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Affiliation(s)
- Kelly Quinn
- NYU Langone Health, Department of Population Health, 227 E. 30th St, New York, NY 10016, United States.
| | - Bartley C. Frueh
- Professor, Psychology, University of Flawaii, 200 W.Kāwili St, Hilo, HI 96720
| | - Joy Scheidell
- NYU Langone Health, Department of Population Health, 227 E. 30th St, New York, NY 10016, United States.
| | - Daniel Schatz
- NYU Langone Health, Department of Population Health, 227 E. 30th St, New York, NY 10016, United States.
| | - Faith Scanlon
- Texas Tech University, Department of Psychological Sciences, 1800 18th Street, Lubbock, TX 79409, United States.
| | - Maria R. Khan
- Associate Professor, NYU Langone Health, Department of Population Health, 227 E. 30 St, New York, NY 10016
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Mravčík V, Janíková B, Drbohlavová B, Popov P, Pirona A. The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic. Harm Reduct J 2018; 15:60. [PMID: 30514306 PMCID: PMC6280526 DOI: 10.1186/s12954-018-0268-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbara Janíková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Barbora Drbohlavová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czech Republic
| | - Petr Popov
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alessandro Pirona
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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George N, Harrell SM, Rhodes KD, Duarte-Rojo A. Recreational Drug and Psychosocial Profile in Chronic Hepatitis C Patients Seeking Antiviral Therapy. Ann Hepatol 2018; 17:76-84. [PMID: 29311404 DOI: 10.5604/01.3001.0010.7537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Practitioners treating hepatitis C (HCV) provide healthcare to a special population with high rates of substance abuse and psychiatric disorders. We investigated the psychosocial profile in HCV patients and tested what variables affect commencement of antiviral therapy. MATERIAL AND METHODS Recreational drug use (RDU), marijuana (THC), alcohol use, and psychiatric history were initially investigated with a questionnaire prior to history and physical. Following an educational intervention, we reinterrogated patients for RDU and THC use, and revision of initial statement was documented. Variables affecting commencement of antiviral therapy were analysed with logistic regression. RESULTS Out of 153 patients, 140 (92%) answered the questionnaire. Intervention increased total yield by 6%, however, 39% (11/28) of those initially denying use revised their statement. Drug screening identified 9 more patients with RDU/THC use. Half of patients consuming alcohol were heavy drinkers, and psychiatric disease was identified in 54%. Only 73 (48%) of 139 patients eligible for antivirals received treatment. Multivariable analysis revealed that younger patients (OR = 1.04, 95% CI 1.01-1.08), and those testing positive on drug screen (OR = 0.41, 95% CI 0.19-0.92) were less likely to be treated. Denial by insurance and loss to follow-up were the most common reasons for not starting antiviral treatment. CONCLUSION Substance abuse is highly prevalent among HCV patients, and it is difficult to tell prior from current users. Integral care of HCV patients should include a diligent screen for substance abuse and rehabilitation referral, aiming to increase the pool of patients eligible for antiviral therapy. This can only be achieved through a multidisciplinary approach.
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Affiliation(s)
- Nayana George
- Department of Internal Medicine. University of Arkansas for Medical Sciences; Little Rock, Arkansas, USA
| | - Sherrie M Harrell
- Division of Gastroenterology and Hepatology. University of Arkansas for Medical Sciences; Little Rock, Arkansas, USA
| | - Kimberly D Rhodes
- Division of Gastroenterology and Hepatology. University of Arkansas for Medical Sciences; Little Rock, Arkansas, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology. University of Arkansas for Medical Sciences; Little Rock, Arkansas, USA
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Wang T, Ma J, Wang R, Liu Z, Shi J, Lu L, Bao Y. Poly-Drug Use of Prescription Medicine among People with Opioid Use Disorder in China: A Systematic Review and Meta-Analysis. Subst Use Misuse 2018; 53:1117-1127. [PMID: 29281497 DOI: 10.1080/10826084.2017.1400066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) causes substantial public health and social problems worldwide. Poly-drug use is common in people with OUD and increases morbidity and mortality. Investigation of the patterns and characteristics of poly-drug use of prescription medicine among opioid users is needed to develop appropriate prevention and intervention strategies. OBJECTIVES To estimate the prevalence of poly-drug use of prescription medicine among people with OUD in China using meta-analysis. METHODS We searched relevant epidemiological studies published before February 2017 in English and Chinese databases. The quality of included studies was assessed using the Agency for Healthcare Research and Quality scale. The pooled prevalences of prescription medicine use among people with OUD were estimated. RESULTS We included 80 eligible studies in the meta-analysis. The main prescription medicines were benzodiazepines (BZDs) and prescription opioid analgesics. The pooled prevalence of unclassified BZDs and prescription opioids was 40.6% and 23.2%, respectively. Diazepam was the most frequently co-used BZD (32.6%), followed by triazolam (32.1%), and estazolam (9.2%). Tramadol was the most commonly used prescription opioid (27.3%), followed by methadone (16.8%), buprenorphine (12.6%), pethidine (8.9%), morphine (6.5%), dihydroetorphine (3.9%), and codeine-containing cough syrup (3.7%). BZDs were mainly used for self-medication (56.1%), whereas prescription opioids were primarily coused for nonmedical purposes (69.4%). CONCLUSIONS The results demonstrate that prescription medicine use is widespread among opioid users in China. There needs to be more consideration of poly-drug use, and early interventions and management strategies are needed to prevent poly-drug use among opioid users in China.
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Affiliation(s)
- Tongyu Wang
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China.,d Beijing Center for Diseases Prevention and Control , Beijing , China
| | - Jun Ma
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China
| | - Rujia Wang
- a National Institute on Drug Dependence , Peking University , Beijing , China.,b School of Public Health , Peking University , Beijing , China
| | - Zhimin Liu
- a National Institute on Drug Dependence , Peking University , Beijing , China
| | - Jie Shi
- a National Institute on Drug Dependence , Peking University , Beijing , China
| | - Lin Lu
- a National Institute on Drug Dependence , Peking University , Beijing , China.,c Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital , Peking University , Beijing , China
| | - Yanping Bao
- a National Institute on Drug Dependence , Peking University , Beijing , China.,e National Drug and Alcohol Research Centre , University of New South Wales Australia , Sydney , NSW , Australia
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28
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Motta-Ochoa R, Bertrand K, Arruda N, Jutras-Aswad D, Roy É. "I love having benzos after my coke shot": The use of psychotropic medication among cocaine users in downtown Montreal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:15-23. [PMID: 28826127 DOI: 10.1016/j.drugpo.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/21/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal. METHOD Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner. RESULTS Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) "downers" from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of "trip" (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine). CONCLUSION PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients' substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.
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Affiliation(s)
- Rossio Motta-Ochoa
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada.
| | - Karine Bertrand
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Nelson Arruda
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada; Department of Psychiatry, Université de Montréal, Université de Montréal, Pavillon Roger-Gaudry, Faculté de médecine, Département de psychiatrie, C.P. 6128, succursale Centre-ville Montréal, Québec, H3C 3J7, Canada
| | - Élise Roy
- Addiction Unit, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-LeMoyne, Office 200, Longueuil, Quebec, J4K 0A8, Canada; Institut national de santé publique du Québec, 190, boulevard Crémazie Est Montréal, Québec, H2P 1E2, Canada
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Pouget ER, Bennett AS, Elliott L, Wolfson-Stofko B, Almeñana R, Britton PC, Rosenblum A. Development of an opioid-related Overdose Risk Behavior Scale (ORBS). Subst Abus 2017; 38:239-244. [PMID: 28113004 PMCID: PMC5522769 DOI: 10.1080/08897077.2017.1282914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug overdose has emerged as the leading cause of injury-related death in the United States, driven by prescription opioid (PO) misuse, polysubstance use, and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations, there is a need for a more comprehensive assessment of related risk behaviors. Drawing on existing research, formative interviews, and discussions with community and scientific advisors an opioid-related Overdose Risk Behavior Scale (ORBS) was developed. METHODS Military veterans reporting any use of heroin or POs in the past month were enrolled using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. Internal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectivelyInternal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectively. RESULTS Data for 220 veterans were analyzed. The 5 subscales-(A) Adherence to Opioid Dosage and Therapeutic Purposes; (B) Alternative Methods of Opioid Administration; (C) Solitary Opioid Use; (D) Use of Nonprescribed Overdose-associated Drugs; and (E) Concurrent Use of POs, Other Psychoactive Drugs and Alcohol-generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. CONCLUSIONS These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research and could help improve the precision of overdose education and prevention efforts.
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Affiliation(s)
- Enrique R. Pouget
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Alex S. Bennett
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Luther Elliott
- National Development and Research Institutes, Inc., New York, New York, USA
| | | | - Ramona Almeñana
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Peter C. Britton
- Canandaigua VA Medical Center, Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Andrew Rosenblum
- National Development and Research Institutes, Inc., New York, New York, USA
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Puzhko S, Roy É, Jutras-Aswad D, Artenie AA, Fortier E, Zang G, Bruneau J. High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 47:61-68. [PMID: 28666636 DOI: 10.1016/j.drugpo.2017.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/26/2017] [Accepted: 05/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prescription opioid (PO) injection and poly-drug use have been associated with hepatitis C virus (HCV) infection among people who inject drugs (PWID). Poly-drug use is often a barrier to key HCV preventive programmes including opioid agonist treatment. The contribution of specific drug combinations to high HCV incidence in poly-drug users has not been assessed previously. Addressing this knowledge gap could enhance HCV treatment and prevention efforts. We examined the association between specific drugs and number of drugs used in addition to injected POs, and HCV seroconversion. METHODS PWID participating in a cohort study in Montréal (HEPCO), HCV-seronegative at baseline and followed between 2004 and 2013, were included. Data were collected by interview-administered questionnaires. Blood samples were tested for HCV new infections at each 3-6 month follow-up visit. Time-varying Cox regression models were utilized. RESULTS Of 356 participants (81.5% males; mean age: 34.7 years), 123 (34.6%) reported injected POs in the past month at baseline. In univariate analyses, recent use of the following drugs was associated with HCV seroconversion: injected POs, injected cocaine, injected heroin, non-injected tranquilisers, and smoked crack/cocaine. The relative excess risk of HCV seroconversion due to interaction (RER1HR) was the highest for co-use of injected POs with the following substances: injected cocaine (RER1HR=3.44), smoked crack/cocaine (RER1HR=1.27), and non-injected tranquilisers (RER1HR=0.8). In addition, a significant linear trend (p<0.001) towards higher risk was observed with increasing the number of these three drugs used in combination with injected POs. CONCLUSION Specific drugs and number of drugs used in addition to injected POs play a modulating role in the risk of HCV primary infection. Poly-drug use among people who inject POs has to be addressed in order to improve harm reduction programmes and reduce HCV transmission in this high-risk population.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Suite 300, Montréal, QC H3S 1Z1, Canada; Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1111 rue St-Charles Ouest, Suite 500, Longueuil, QC J4 K 5G4, Canada; Institut National de Santé Publique, 190 Crémazie Blvd. E, Montréal, QC H2P 1E2, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Andreea Adelina Artenie
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Emmanuel Fortier
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC H2X0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada.
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County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States. J Acquir Immune Defic Syndr 2017; 73:323-331. [PMID: 27763996 DOI: 10.1097/qai.0000000000001098] [Citation(s) in RCA: 305] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, unsterile injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify US communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of HCV infections among PWID. DESIGN We conducted a multistep analysis to identify indicator variables highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. METHODS We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012-2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county's vulnerability. RESULTS A parsimonious set of 6 indicators were associated with acute HCV infection rates (proxy for IDU): drug-overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. CONCLUSIONS Our analysis highlights US counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission.
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High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:17-27. [PMID: 28577506 DOI: 10.1016/j.drugpo.2017.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/08/2017] [Accepted: 05/03/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Benzodiazepines are a widely prescribed psychoactive drug; in the U.S., both medical and nonmedical use of benzodiazepines has increased markedly in the past 15 years. Long-term use can lead to tolerance and dependence, and abrupt withdrawal can cause seizures or other life-threatening symptoms. Benzodiazepines are often used nonmedically in conjunction with other drugs, and with opioids in particular-a combination that can increase the risk for fatal and non-fatal overdose. This mixed-methods study examines nonmedical use of benzodiazepines among young adults in New York City and its relationship with opioid use. METHODS For qualitative analysis, 46 90-minute semi-structured interviews were conducted with young adult opioid users (ages 18-32). Interviews were transcribed and coded for key themes. For quantitative analysis, 464 young adult opioid users (ages 18-29) were recruited using Respondent-Driven Sampling and completed structured interviews. Benzodiazepine use was assessed via a self-report questionnaire that included measures related to nonmedical benzodiazepine and opioid use. RESULTS Participants reported using benzodiazepines nonmedically for a wide variety of reasons, including: to increase the high of other drugs; to lessen withdrawal symptoms; and to come down from other drugs. Benzodiazepines were described as readily available and cheap. There was a high prevalence (93%) of nonmedical benzodiazepine use among nonmedical opioid users, with 57% reporting regular nonmedical use. In bivariate analyses, drug-related risk behaviours such as polysubstance use, drug binging, heroin injection and overdose were strongly associated with regular nonmedical benzodiazepine use. In multivariate analysis, growing up in a middle-income household (earning between $51,000 and $100,000 annually), lifetime overdose experience, having ever used cocaine regularly, having ever been prescribed benzodiazepines, recent drug binging, and encouraging fellow drug users to use benzodiazepines to cope with opioid withdrawal were consistently strong predictors of regular nonmedical benzodiazepine use. CONCLUSION Nonmedical benzodiazepine use may be common among nonmedical opioid users due to its drug-related multi-functionality. Harm reduction messages should account for the multiple functions benzodiazepines serve in a drug-using context, and encourage drug users to tailor their endorsement of benzodiazepines to peers to include safer alternatives.
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Quinn K, Boone L, Scheidell JD, Mateu-Gelabert P, McGorray SP, Beharie N, Cottler LB, Khan MR. The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use. Drug Alcohol Depend 2016; 169:190-198. [PMID: 27816251 PMCID: PMC5728665 DOI: 10.1016/j.drugalcdep.2016.09.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND We examined associations between childhood trauma and adulthood prescription pain reliever misuse (PPRM) and injection drug use (IDU) in a nationally-representative U.S. sample to further understanding of factors associated with these epidemics. METHODS National Longitudinal Study of Adolescent to Adult Health data (N=12,288) yielded nine childhood traumas: neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, and experienced violence. We estimated adjusted odds ratios (AOR) and 95% confidence intervals for the association of each trauma and cumulative trauma and drug initiation in emerging and later adulthood. RESULTS Outcome prevalences were 20% (PPRM) and 1% (IDU) in emerging adulthood and 10% PPRM in adulthood. We observed dose-response relationships that varied across outcomes. Cumulative trauma (referent=none) was associated with 34-79% greater odds of PPRM (emerging adulthood) across one to five+ trauma categories. The gradient was most consistent and associations strongest for adulthood PPRM: one trauma AOR=1.46(1.12, 1.91); two AOR=1.71(1.23, 2.36); three AOR=2.16(1.43, 2.36); four AOR=2.70(1.42, 5.62); five+ AOR=3.09(1.52, 6.30). Dose-response was less consistent for IDU, but 4 and 5+ traumas were associated with approximately seven and five times the odds of IDU. Neglect, emotional abuse, and parental incarceration and binge drinking were associated with 25-55% increased odds of PPRM. Sexual abuse and witnessed violence were associated with nearly 3 and 5 times the odds of IDU. CONCLUSIONS Associations between childhood trauma and PPRM/IDU highlight the need for trauma-informed interventions for drug users and early trauma screening and treatment for prevention of drug misuse over the life course.
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Affiliation(s)
- Kelly Quinn
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, United States.
| | - Lauren Boone
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Joy D Scheidell
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, United States
| | - Pedro Mateu-Gelabert
- National Development and Research Institutes, Inc., 71 West 23rd Street, New York, NY 10010, United States
| | - Susan P McGorray
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, United States
| | - Nisha Beharie
- National Development and Research Institutes, Inc., 71 West 23rd Street, New York, NY 10010, United States
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, United States
| | - Maria R Khan
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016, United States
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Lake S, Milloy MJ, Dong H, Hayashi K, Wood E, Kerr T, DeBeck K. Initiation into prescription opioid injection and associated trends in heroin use among people who use illicit drugs. Drug Alcohol Depend 2016; 169:73-79. [PMID: 27780105 PMCID: PMC5140695 DOI: 10.1016/j.drugalcdep.2016.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Prescription opioid (PO) injection among people who use illicit drugs (PWUD) is an ongoing concern, yet little is known about drug use trajectories associated with initiating PO injection, including potential associations with heroin use. This study aimed to identify predictors of PO injection initiation among PWUD, and examine trends in heroin use before and after initiating PO injection. METHODS Data were merged from three cohorts of PWUD recruited between September 2005 and November 2015. Predictors of PO injection initiation were identified using extended Cox regression models. Trends in heroin use pre- and post-initiation were examined with McNemar's test and compared to matched controls with linear growth curve models. RESULTS Among 1580 participants, 247 initiated PO injection yielding an incidence density of 3.9 (95% Confidence Interval [CI]: 3.4-4.4) per 100 person-years. In a multivariable analysis, independent predictors of PO injection initiation included heroin injection (Adjusted Hazard Ratio [AHR]=4.39, 95% CI: 3.24-5.95) and non-injection PO use (AHR=1.99, 95% CI: 1.25-3.17). In a sub-analysis, compared to matched controls, PO injection corresponded with elevated heroin use post-initiation (p≤0.05). DISCUSSION In this study, heroin use and non-injection PO use strongly predicted PO injection initiation. Those who initiated PO injecting had elevated heroin use patterns post-initiation compared to controls. These findings suggest that transitioning to PO injection does not appear to be a substitute for heroin use among PWUD. These findings highlight the importance of addressing PO injection in harm reduction and treatment settings.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, Suite 3271-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Yedinak JL, Kinnard EN, Hadland SE, Green TC, Clark MA, Marshall BDL. Social context and perspectives of non-medical prescription opioid use among young adults in Rhode Island: A qualitative study. Am J Addict 2016; 25:659-665. [PMID: 28051839 DOI: 10.1111/ajad.12466] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This pilot study examined the context of nonmedical prescription opioid (NMPO) use and related risk behaviors among young adults in Rhode Island, a New England region with markedly high prevalence of NMPO use and overdose mortality. METHODS We conducted semi-structured interviews (n = 13) with young adults (18-29 year-olds) who reported current or recent NMPO use. We also conducted focus groups (two groups, n = 14 total) with professional service providers recruited from service organizations. Data were audio-recorded, transcribed, and key themes were analyzed. RESULTS Participants discussed high levels of access to prescription opioids for nonmedical use via prescriptions originally provided to family and friends. The contexts described by participants included social environments such as parties, in which mixing opiates with benzodiazepines, alcohol or other types of drugs, and incidents of unintentional overdose were reported. Participants attributed risk for overdose to individual-level factors (eg, users who "couldn't handle it"), rather than contextual factors, and described negative reactions to being labeled as an "addict" or "addicted." Professional service providers had first-hand experience with young adults in treatment settings, yet limited exposure to young adults who were treatment-naïve. CONCLUSIONS Young adult NMPO users described social settings where polysubstance use and pill use were common, and highlighted an aversion to being labeled as having a substance use disorder. SCIENTIFIC SIGNIFICANCE To reduce harms of NMPO use among young adults, interventions should address the social context in which drug use and risk behaviors occur. (Am J Addict 2016;25:659-665).
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Affiliation(s)
- Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth N Kinnard
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Department of Emergency Medicine, The Warren Alpert School of Brown University, Providence, Rhode Island.,Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa A Clark
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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Marshall BDL, Green TC, Yedinak JL, Hadland SE. Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:25-31. [PMID: 26919826 DOI: 10.1016/j.drugpo.2016.01.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
Abstract
Extra-medical prescription opioid (EMPO) use - intentional use without a prescription or outside of prescribed parameters - is a public health crisis in the United States and around the world. Epidemiological evidence suggests that the prevalence of EMPO use and adverse sequelae, including opioid overdose and hepatitis C infection, are elevated among people aged 18-25. Despite these preventable health risks, many harm reduction interventions are underutilized by, or inaccessible to, EMPO-using youth. In this commentary, we describe key harm reduction strategies for young people who use prescription opioids. We examine individual, social, and policy-level barriers to the implementation of evidence-based approaches that address EMPO use and related harms among young people. We highlight the need for expanded services and new interventions to engage this diverse and heterogeneous at-risk population. A combination of medical, social, and structural harm reduction interventions are recommended. Furthermore, research to inform strategies that mitigate particularly high-risk practices (e.g., polysubstance use) is warranted. Finally, we discuss how the meaningful involvement of youth in the implementation of harm reduction strategies is a critical component of the public health response to the prescription opioid epidemic.
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Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA.
| | - Traci C Green
- Boston University School of Medicine, Department of Emergency Medicine, 771 Albany Street, Room 1208, Boston, MA 02118, USA; The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Health Policy & Management, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Lake S, Hayashi K, Buxton J, Milloy MJ, Dong H, Wood E, Montaner J, Kerr T. The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs. Drug Alcohol Depend 2015; 156:297-303. [PMID: 26454837 PMCID: PMC4633348 DOI: 10.1016/j.drugalcdep.2015.09.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Prescription opioid (PO) use by people who inject drugs (PWID) is a growing public health concern. Non-fatal overdose remains a leading source of morbidity among PWID, however, little is known about the relationship between PO injection and non-fatal overdose in this population. In this study we sought to examine the impact of PO injection on non-fatal overdose among PWID from Vancouver, Canada. METHODS Data were derived from two open prospective cohorts of PWID for the period of December, 2005 to May, 2014. Multivariable generalized estimating equations were used to examine the odds of overdose among those who injected: POs; heroin; and POs and heroin. RESULTS In total, 1660 PWID (33.7% women) participated in this study. In multivariable analyses, in comparison to those who were injecting non-opioid drugs, exclusive PO injection was not significantly associated with non-fatal overdose (adjusted odds ratio [AOR]: 1.17, 95% confidence interval [CI]: 0.74-1.86). The odds of non-fatal overdose were elevated for heroin injection (AOR: 1.72, 95% CI: 1.31-2.27), but were greatest for those who injected both heroin and POs (AOR: 2.46, 95% CI: 1.83-3.30). DISCUSSION Compared to injecting non-opioids, injecting POs exclusively did not increase risk of non-fatal overdose; however, injecting both POs and heroin doubled the risk. This may reflect consistencies in drug potency and composition when POs are used, as well as unique characteristics of exclusive PO injectors. Our findings call for the continued scale-up of evidence-based overdose prevention interventions for people who inject opioids, including POs.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Beletsky L, Cochrane J, Sawyer AL, Serio-Chapman C, Smelyanskaya M, Han J, Robinowitz N, Sherman SG. Police Encounters Among Needle Exchange Clients in Baltimore: Drug Law Enforcement as a Structural Determinant of Health. Am J Public Health 2015; 105:1872-9. [PMID: 26180948 DOI: 10.2105/ajph.2015.302681] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We piloted a monitoring mechanism to document police encounters around programs targeting people who inject drugs (PWID), and assessed their demographic predictors at 2 Baltimore, Maryland, needle exchange program (NEP) sites. METHODS In a brief survey, 308 clients quantified, characterized, and sited recent police encounters. Multivariate linear regression determined encounter predictors, and we used geocoordinate maps to illustrate clusters. RESULTS Within the past 6 months, clients reported a median of 3 stops near NEP sites (interquartile range [IQR] = 0-7.5) and a median of 1 arrest in any location (IQR = 0-2). Three respondents reported police referral to the NEP. Being younger (P = .009), being male (P = .033), and making frequent NEP visits (P = .02) were associated with reported police stops. Among clients reporting arrest or citation for syringe possession, Whites were significantly less likely than non-Whites to report being en route to or from an NEP (P < .001). Reported encounters were clustered around NEPs. CONCLUSIONS Systematic surveillance of structural determinants of health for PWID proved feasible when integrated into service activities. Improved monitoring is critical to informing interventions to align policing with public health, especially among groups subject to disproportionate levels of drug law enforcement.
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Affiliation(s)
- Leo Beletsky
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jess Cochrane
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Anne L Sawyer
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Chris Serio-Chapman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Marina Smelyanskaya
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jennifer Han
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Natanya Robinowitz
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Susan G Sherman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
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Aikins R, Hoefinger H, Guarino H, Rosenblum A, Magura S, Joseph H. Conducting Rapid Street Assessment of Drug Users in New York City Using Oral Fluid and Brief Interviews: A Feasibility Study. J Addict Dis 2015; 34:185-97. [PMID: 26098766 DOI: 10.1080/10550887.2015.1059118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study piloted the feasibility of rapidly collecting both self-reports of drug use and saliva specimens for drug toxicology in field settings. The use of oral fluid collection devices to supplement self-reports is unproven in street settings and may pose challenges for field research. Sixty adults who identified as recent illicit drug users were recruited in public settings in New York City and were asked to complete a brief drug screening inventory and provided saliva specimens. Descriptive findings are detailed along with critical best research practices and limitations that provide important directions for researchers looking to employ both toxicology and self-report in rapid field recruitment designs.
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Affiliation(s)
- Ross Aikins
- a National Development and Research Institutes Inc. , New York City , New York , USA
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Kelly BC, Vuolo M, Pawson M, Wells BE, Parsons JT. Chasing the bean: prescription drug smoking among socially active youth. J Adolesc Health 2015; 56:632-8. [PMID: 26003578 PMCID: PMC4442270 DOI: 10.1016/j.jadohealth.2015.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Alternative consumption practices of prescription drug misuse have been less well monitored than general prevalence. We describe prescription drug smoking among socially active youth and highlight correlates of this practice. We also examine its association with drug problems, drug dependence, and mental health. METHODS We surveyed 404 young adults recruited from nightlife venues in New York via time-space sampling. We use linear and logistic regression models to examine the probability of smoking prescription drugs and its association with drug problems, dependence, and mental health. Qualitative findings supplement the survey data. RESULTS Males have higher odds than females (odds ratio [OR] = 3.4), and heterosexuals have higher odds than sexual minority youth (OR = 2.3) of smoking prescription drugs. Those involved in electronic dance music nightlife have higher odds (OR = 2.1) than those who do not participate in that scene, whereas those in college bar scenes have lower odds (OR = .4) of having smoked prescription drugs. Prescription drug smokers report more drug problems (β = .322) and greater symptoms of dependence net (β = .298) of the frequency of misuse and other characteristics. Prescription drug smokers do not report greater mental health problems. Qualitative interview data support these survey findings. CONCLUSIONS Prescription drug smoking is a significant drug trend among socially active youth. It is associated with drug problems and symptoms of dependence net of frequency of misuse. Prevention and intervention efforts for youth who misuse prescription drugs should address the issue of prescription drug smoking, and this may be an area for clinicians to address with their adolescent patients.
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Affiliation(s)
- Brian C. Kelly
- Department of Sociology, Purdue University, West Lafayette, Indiana,Center for HIV Educational Studies & Training, New York, New York
| | - Mike Vuolo
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Mark Pawson
- Center for HIV Educational Studies & Training, New York, New York,The Graduate Center of the City University of New York, New York, New York
| | - Brooke E. Wells
- Center for HIV Educational Studies & Training, New York, New York,The Graduate Center of the City University of New York, New York, New York,Department of Psychology; Hunter College of the City University of New York, New York, New York
| | - Jeffrey T. Parsons
- Center for HIV Educational Studies & Training, New York, New York,The Graduate Center of the City University of New York, New York, New York,Department of Psychology; Hunter College of the City University of New York, New York, New York
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Martins SS, Santaella-Tenorio J, Marshall BD, Maldonado A, Cerdá M. Racial/ethnic differences in trends in heroin use and heroin-related risk behaviors among nonmedical prescription opioid users. Drug Alcohol Depend 2015; 151:278-83. [PMID: 25869542 PMCID: PMC4447574 DOI: 10.1016/j.drugalcdep.2015.03.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study examines changing patterns of past-year heroin use and heroin-related risk behaviors among individuals with nonmedical use of prescription opioids (NMUPO) by racial/ethnic groups in the United States. METHODS We used data from the National Survey on Drug Use and Health (NSDUH) from 2002 to 2005 and 2008 to 2011, resulting in a total sample of N = 448,597. RESULTS Past-year heroin use increased among individuals with NMUPO and increases varied by frequency of past year NMUPO and race/ethnicity. Those with NMUPO in the 2008-2011 period had almost twice the odds of heroin use as those with NMUPO in the 2002-2005 period (OR = 1.89, 95%CI: 1.50, 2.39), with higher increases in non-Hispanic (NH) Whites and Hispanics. In 2008-2011, the risk of past year heroin use, ever injecting heroin, past-year heroin abuse or dependence, and the perception of availability of heroin increased as the frequency of NMUPO increased across respondents of all race/ethnicities. CONCLUSION Individuals with NMUPO, particularly non-Hispanic Whites, are at high risk of heroin use and heroin-related risk behaviors. These results suggest that frequent nonmedical users of prescription opioids, regardless of race/ethnicity, should be the focus of novel public health efforts to prevent and mitigate the harms of heroin use.
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Affiliation(s)
- Silvia S. Martins
- Department of Epidemiology, Columbia University, New York, NY,Address for correspondence: Silvia S. Martins, Department of Epidemiology, Mailman School of Public Health, 722 W. 168 Street, Room 509 New York, NY 10032-3727, USA; (t) +1 212.305.2848 ()
| | | | | | | | - Magdalena Cerdá
- Department of Epidemiology, Columbia University, New York, NY
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Nonmedical prescription drug use among US young adults by educational attainment. Soc Psychiatry Psychiatr Epidemiol 2015; 50:713-24. [PMID: 25427665 PMCID: PMC4405452 DOI: 10.1007/s00127-014-0980-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Little is known about nonmedical use of prescription drugs among non-college-attending young adults in the United States. METHODS Data were drawn from 36,781 young adults (ages 18-22 years) from the 2008-2010 National Survey on Drug Use and Health public use files. The adjusted main effects for current educational attainment, along with its interaction with gender and race/ethnicity, were considered. RESULTS Compared to those attending college, non-college-attending young adults with at least and less than a HS degree had a higher prevalence of past-year nonmedical use of prescription opioids [NMUPO 13.1 and 13.2 %, respectively, vs. 11.3 %, adjusted odds ratios (aORs) 1.21 (1.11-1.33) and 1.25 (1.12-1.40)], yet lower prevalence of prescription stimulant use. Among users, regardless of drug type, non-college-attending youth were more likely to have past-year disorder secondary to use [e.g., NMUPO 17.4 and 19.1 %, respectively, vs. 11.7 %, aORs 1.55 (1.22-1.98) and 1.75 (1.35-2.28)]. Educational attainment interacted with gender and race: (1) among nonmedical users of prescription opioids, females who completed high school but were not enrolled in college had a significantly greater risk of opioid disorder (compared to female college students) than the same comparison for men; and (2) the risk for nonmedical use of prescription opioids was negligible across educational attainment groups for Hispanics, which was significantly different than the increased risk shown for non-Hispanic whites. CONCLUSIONS There is a need for young adult prevention and intervention programs to target nonmedical prescription drug use beyond college campuses.
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Horyniak D, Agius PA, Degenhardt L, Reddel S, Higgs P, Aitken C, Stoové M, Dietze P. Patterns of, and Factors Associated With, Illicit Pharmaceutical Opioid Analgesic Use in a Prospective Cohort of People Who Inject Drugs in Melbourne, Australia. Subst Use Misuse 2015; 50:1650-9. [PMID: 26576630 DOI: 10.3109/10826084.2015.1027928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are a key population engaging in pharmaceutical opioid analgesic (PO) use, yet little is known about patterns of illicit PO use among this group. OBJECTIVES The aims of this research were to measure the prevalence and frequency of lifetime and past-month illicit PO use and injection in a sample of regular PWID, to examine patterns of past-month illicit PO use within individuals over time, and to identify factors independently associated with past-month illicit PO use. METHODS Data were drawn from a prospective cohort study of regular PWID (N = 666) in Melbourne, Australia. Data from five waves of annual data collection (including baseline) were analyzed descriptively and using generalized estimating equations (GEE). RESULTS At baseline, 59% of participants reported lifetime illicit PO use and 20% reported past-month use, predominantly through injecting. Most illicit PO users at baseline transitioned to nonuse of illicit POs across the study period. In multivariable GEE analysis, factors associated with past-month illicit PO use included past-year arrest [adjusted odds ratio (AOR): 1.39], opioids other than heroin as drug of choice (AOR: 5.14), experiencing poorer physical health (AOR: 0.98) and a range of other drug use variables. CONCLUSIONS We found little evidence of ongoing illicit PO use among those followed up, with illicit PO use linked to polydrug use more broadly. Nonetheless, trends in illicit PO use among PWID should continue to be monitored and harm reduction interventions implemented to reduce the associated public health risks.
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Affiliation(s)
- Danielle Horyniak
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul A Agius
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia
| | - Louisa Degenhardt
- c National Drug and Alcohol Research Centre , University of New South Wales , Sydney , New South Wales , Australia.,d School of Population and Global Health , University of Melbourne , Melbourne , Victoria , Australia
| | - Siobhan Reddel
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia
| | - Peter Higgs
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia.,e National Drug Research Institute , Curtin University , Melbourne , Victoria , Australia
| | - Campbell Aitken
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Mark Stoové
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul Dietze
- a Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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Mackesy-Amiti ME, Donenberg GR, Ouellet LJ. Prescription opioid misuse and mental health among young injection drug users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:100-6. [PMID: 25105884 PMCID: PMC4262584 DOI: 10.3109/00952990.2014.940424] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prescription opioid (PO) misuse is a significant concern in the United States. OBJECTIVES This study describes the prevalence and timing of PO misuse, diagnoses of opiate abuse and dependence, and their associations with psychiatric disorders in a sample of young people who inject drugs (PWID). METHODS Participants were 570 young (18-25 years) PWID, primarily heroin users, recruited through outreach and respondent-driven sampling. Trained interviewers administered a semi-structured psychiatric interview. Diagnoses of substance use and mental disorders were based on DSM-IV diagnostic criteria. RESULTS Estimated rates of lifetime PO abuse and dependence were 19% and 17%, respectively. Past year PO misuse was significantly associated with anti-social personality disorder (ASPD, OR = 2.15, 95% CI 1.43-3.24), past year substance-induced major depression (SIMD, OR = 1.81, 95% CI 1.16-2.83), and prior post-traumatic stress disorder (PTSD, OR = 2.45, 95% CI 1.31-4.60). Among male PO users, PTSD was a significant predictor of PO abuse (prior, OR = 7.62, 95% CI 2.16-26.88; past year, OR = 21.67 95% CI 2.46-190.75), and dependence (prior, OR = 4.82, 95% CI 1.48-15.67; past year, OR = 9.65, 95% CI 1.75-53.32). CONCLUSION Among young PWID, PTSD is a significant risk factor for PO misuse for both men and women, and men with PTSD are in addition at increased risk for PO abuse and dependence. These findings have implications for harm reduction and substance abuse prevention efforts.
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Affiliation(s)
- Mary E Mackesy-Amiti
- Community Outreach Intervention Projects, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago , Chicago, IL , USA
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Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, Teper A. High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:84-91. [PMID: 25151334 PMCID: PMC4277710 DOI: 10.1016/j.drugpo.2014.07.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/04/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Yet few studies have examined the overdose knowledge and experience of nonmedical PO users. METHODS In depth, semi-structured, audio-recorded interviews were conducted with 46 New York City young adults (ages 18-32) who reported using POs nonmedically within the past 30 days. Verbatim interview transcripts were coded for key themes in an analytic process informed by grounded theory. RESULTS Despite significant experience with overdose (including overdose deaths), either personally or within opioid-using networks, participants were relatively uninformed about overdose awareness, avoidance and response strategies, in particular the use of naloxone. Overdose experiences typically occurred when multiple pharmaceuticals were used (often in combination with alcohol) or after participants had transitioned to heroin injection. Participants tended to see themselves as distinct from traditional heroin users, and were often outside of the networks reached by traditional opioid safety/overdose prevention services. Consequently, they were unlikely to utilize harm reduction services, such as syringe exchange programs (SEPs), that address drug users' health and safety. CONCLUSIONS These findings suggest that many young adult nonmedical PO users are at high risk of both fatal and non-fatal overdose. There is a pressing need to develop innovative outreach strategies and overdose prevention programs to better reach and serve young PO users and their network contacts. Prevention efforts addressing risk for accidental overdose, including opioid safety/overdose reversal education and naloxone distribution, should be tailored for and targeted to this vulnerable group.
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Affiliation(s)
- David Frank
- The Graduate Center, City University of New York, Dept. of Sociology, 365 Fifth Avenue, Room 6112.04, New York, NY 10016, United States; National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States.
| | - Pedro Mateu-Gelabert
- National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Honoria Guarino
- National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Alex Bennett
- National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Travis Wendel
- St. Ann's Corner of Harm Reduction, 886 Westchester Avenue, Bronx, NY 10459, United States
| | - Lauren Jessell
- National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States
| | - Anastasia Teper
- National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States.
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47
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Correlates and Consequences of Opioid Misuse among High-Risk Young Adults. JOURNAL OF ADDICTION 2014; 2014:156954. [PMID: 25506462 PMCID: PMC4259139 DOI: 10.1155/2014/156954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/25/2022]
Abstract
Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses. Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days. Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantly associated with riskier opioid misuse trajectories. Conclusion. Young adults who reported more debilitating experiences as children and adolescents misused opioids longer and engaged in higher risk alternate modes of administering opioids. Data on decisions both to use and to alter a drug's form can be combined to describe patterns of misuse over time and predict important risk behaviors.
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48
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Lankenau SE, Kecojevic A, Silva K. Associations between prescription opioid injection and Hepatitis C virus among young injection drug users. DRUGS-EDUCATION PREVENTION AND POLICY 2014; 22:35-42. [PMID: 25598589 DOI: 10.3109/09687637.2014.970515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. METHODS Young IDUs (n = 162) aged 18-25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009-2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. RESULTS A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p<0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p<0.05), growing up in a lower social class (AIRR: 1.67, p<0.05), age (AIRR: 1.12, p<0.05), age of injection initiation (AIRR: 0.87, p<0.001), and history of being prescribed stimulants (AIRR: 0.64, p<0.05) were independently associated with HCV positivity. CONCLUSIONS Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US.
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Affiliation(s)
- Stephen E Lankenau
- Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Aleksandar Kecojevic
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Karol Silva
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Jordan AE, Jarlais DD, Hagan H. Prescription opioid misuse and its relation to injection drug use and hepatitis C virus infection: protocol for a systematic review and meta-analysis. Syst Rev 2014; 3:95. [PMID: 25178433 PMCID: PMC4158728 DOI: 10.1186/2046-4053-3-95] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/13/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The production, prescription, and consumption of opioid analgesics to treat non-cancer pain have increased dramatically in the USA in the past decade. As a result, misuse of these opioids has increased; overdose and transition to riskier forms of drug use have also emerged. Research points to a trend in transition to drug injection among those misusing prescription opioids, where clusters of acute hepatitis C virus (HCV) infection are now being reported. This systematic review and meta-analysis aims to synthesize the prevalence of prescription opioid misuse in the USA and examine the rate of transition to injection drug use and incident HCV in these new people who inject drugs (PWID). METHODS/DESIGN Eligible studies will include quantitative, empirical data including national survey data. Scientific databases will be searched using a comprehensive search strategy; proceedings of scientific conferences, reference lists, and personal communications will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa Scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis. DISCUSSION A unique typology of drug use is emerging which is characterized by antecedent prescription opioid misuse among PWID. As the epidemic of prescription opioid misuse matures, this will likely serve as a persistent source of new PWID. Persons who report a recent transition to drug injection are characterized by high rates of HCV seroincidence of 40 per 100 person years or higher. Given the potential for the persistence and escalation of the consequences of prescription opioid misuse in the USA, there is a critical need for synthesis of the current state of the epidemic in order to inform future public health interventions and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014008870.
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Affiliation(s)
- Ashly E Jordan
- New York University College of Nursing, 726 Broadway, New York NY 10003, USA.
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50
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Hayes B, Briceno A, Asher A, Yu M, Evans JL, Hahn JA, Page K. Preference, acceptability and implications of the rapid hepatitis C screening test among high-risk young people who inject drugs. BMC Public Health 2014; 14:645. [PMID: 24965699 PMCID: PMC4091768 DOI: 10.1186/1471-2458-14-645] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/12/2014] [Indexed: 01/02/2023] Open
Abstract
Background People who inject drugs (PWID) are at highest risk for hepatitis C virus (HCV) infection, yet many remain unaware of their infection status. New anti-HCV rapid testing has high potential to impact this. Methods Young adult (<30 years) active PWID were offered either the rapid OraQuick® or standard anti-HCV test involving phlebotomy, then asked to complete a short questionnaire about testing perceptions and preferences. Sample characteristics, service utilization, and injection risk exposures are assessed with the HCV testing choice as the outcome, testing preferences, and reasons for preference. Results Of 129 participants: 82.9% (n = 107) chose the rapid test. There were no significant differences between those who chose rapid vs. standard testing. A majority (60.2%) chose the rapid test for quick results; most (60.9%) felt the rapid test was accurate, and less painful (53.3%) than the tests involving venipuncture. Conclusions OraQuick® anti-HCV rapid test was widely accepted among young PWID. Our results substantiate the valuable potential of anti-HCV rapid testing for HCV screening in this high risk population.
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Affiliation(s)
| | | | | | | | | | | | - Kimberly Page
- Department of Epidemiology and Biostatistics and Global Health Science, University of California San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA.
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