1
|
Shiue KY, Austin AE, Naumann RB, Aiello AE, Marshall SW, Golightly YM. Age, period and cohort-related trends in prescription opioid use in the USA, 1999-2018. J Epidemiol Community Health 2023; 77:714-720. [PMID: 37507219 DOI: 10.1136/jech-2023-220701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND To provide insight into the longitudinal dynamics of opioid use throughout the overdose crisis, this study estimated the separate influences of age, period and cohort on prescription opioid use during 1999-2018 in the USA. METHODS Data from 10 cycles of the cross-sectional National Health and Nutrition Examination Survey were used to conduct an age-period-cohort analysis of the prevalence of prescription opioid use (n=63 500 across 1999-2018). Temporal trends were graphically visualised. The median polish approach was used to estimate age, period and cohort-related effects on prescription opioid use. RESULTS Prescription opioid use broadly increased across the lifespan, with steeper prevalence increases observed from young adulthood to mid-adulthood. Period-related variation was consistent with recognised nationwide declines in opioid prescribing. While there was no evidence of systematic cohort effects, compared with individuals born in 1951-1954, those born during 1963-1966 had greater prescription opioid use (prevalence ratio (PR)=1.23, 95% CI: 1.05 to 1.43), whereas the 1991-1994 and 1999-2002 cohorts had lower prescription opioid use (PR91-94=0.70, 95% CI: 0.50 to 0.98; PR99-02=0.72, 95% CI: 0.63 to 0.81). CONCLUSION In the USA, longitudinal trends in prescription opioid use during 1999-2018 were predominantly driven by age and period influences. The cohort of youngest baby boomers experienced greater prescription opioid use, whereas recent-born cohorts have had lower use. As the overdose crisis continues evolving, such population-level characterisations of age, period and cohort dynamics are instrumental in understanding opioid use and can inform prevention and intervention approaches by identifying population groups more likely to use opioids who, thus, may also experience related outcomes.
Collapse
Affiliation(s)
- Kristin Y Shiue
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rebecca B Naumann
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison E Aiello
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stephen W Marshall
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yvonne M Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
2
|
Servais J, Ramage-Morin PL, Gal J, Hales CM. Prescription medication use among Canadian children and youth, 2012 to 2017. HEALTH REPORTS 2021; 32:3-16. [PMID: 33728887 PMCID: PMC8647816 DOI: 10.25318/82-003-x202100300001-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Prescription medications are used throughout the life course, including among children and youth. Prescribing practices may be influenced by emerging medical conditions, the availability of new medications, changing clinical practices, and evolving knowledge of the safety and effectiveness of medications. The Canadian Health Measures Survey (CHMS) provides national-level information to help monitor the use of prescribed medications in the population. DATA AND METHODS Based on data from the CHMS (2012 to 2017), this article describes prescription medication use in the past month among those aged 3 to 19 years. Information on up to 45 prescription medications was recorded and classified according to Health Canada's Anatomical Therapeutic Chemical classification. Frequencies and bivariate analyses examined medication use by sociodemographic and health-related factors. The most common medication classes were identified for each age group. RESULTS An estimated 23% of Canadian children and youth (1.5 million) had used at least one prescription medication in the past month and 9% had used two or more prescription medications.Prescription medication use was more common among those who reported lower levels of general and mental health, as well as among those with asthma (51%), a mood disorder (71%), attention deficit disorder (60%) or a learning disability (43%). Medications for the respiratory and nervous systems were among those most commonly prescribed. Of youth aged 14 years or older, 4% had misused prescription medications for non-medicinal purposes, for the experience, for the feeling they cause or to get high. DISCUSSION Prescription medication use among children and youth is common in Canada. It is associated with lower levels of self-reported health and the presence of chronic conditions. The estimates provide a benchmark to help monitor prescription drug use in Canada.
Collapse
Affiliation(s)
- Jennifer Servais
- Centre for Population Health Data, Statistics Canada, Ottawa, Ontario
| | | | - Julia Gal
- Centre for Population Health Data, Statistics Canada, Ottawa, Ontario
| | - Craig M Hales
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| |
Collapse
|
3
|
Ford JA, Schepis TS, McCabe SE. Poly-prescription drug misuse across the life course: Prevalence and correlates across different adult age cohorts in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 88:103017. [PMID: 33227640 PMCID: PMC8005409 DOI: 10.1016/j.drugpo.2020.103017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Most research on prescription drug misuse (PDM) focuses on the misuse of specific classes of psychoactive prescription drugs among adolescents or young adults. The current research addressed important gaps in the literature by assessing poly-prescription drug misuse (poly-PDM), the misuse of more than one class of psychoactive prescription drug, across different adult age cohorts. METHODS We used the 2015-2018 National Survey on Drug Use and Health to examine the prevalence of past-year poly-PDM and specific combinations of PDM. Multinomial logistic regression was used to identify demographic, health-related factors, and substance use behaviors that were significantly associated with poly-PDM. RESULTS The prevalence of poly-PDM decreases with age and is common among individuals who engage in PDM. Slightly more than one in four respondents in age cohorts 18-25 (31.66%, 95% CI = 30.35, 33.00) and 26-34 (29.92%, 95% CI = 25.82, 30.12) who engage in PDM, misused more than one class of prescription drug. Additionally, poly-PDM was identified as a high-risk type of PDM as roughly 60% of adults younger than 65 who endorse poly-PDM reported having a substance use disorder (SUD). While certain characteristics (i.e., race/ethnicity, marital status, depression, suicidal ideation, illegal drug use, and SUD) were consistently associated with poly-PDM across age cohorts, other characteristics (i.e., sexual identity, income, and justice involvement) varied across age cohorts. Finally, a comparison of poly-PDM to single PDM showed, in all age cohorts, that having an SUD was associated with an increased likelihood of poly-PDM, while Black adults were less likely than whites to report poly-PDM. CONCLUSIONS By identifying prevalence and correlates of poly-PDM across adult age cohorts, the current research has significant implications. Understanding stability and heterogeneity in the characteristics associated with poly-PDM should inform interventions, identify at-risk groups, and shape public health approaches to dealing with high-risk substance use behavior.
Collapse
Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL United States.
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX United States
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
4
|
Fink DS, Stohl M, Sarvet AL, Cerda M, Keyes KM, Hasin D. Medical marijuana laws and driving under the influence of marijuana and alcohol. Addiction 2020; 115:1944-1953. [PMID: 32141142 PMCID: PMC7483706 DOI: 10.1111/add.15031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022]
Abstract
AIMS Medical marijuana law (MML) enactment in the United States has been associated with increased cannabis use but lower traffic fatality rates. We assessed the possible association of MML and individual-level driving under the influence of cannabis (DUIC) and also under the influence of alcohol (DUIA). DESIGN AND SETTING Three cross-sectional U.S. adult surveys: The National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the NESARC-III (2012-2013). PARTICIPANTS The total n was 118 497: 41 764, 41 184, and 35 549 from NLAES, NESARC, and NESARC-III, respectively. MEASUREMENTS Across the three surveys, similar questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule assessed DUIC and DUIA. Ever-MML states enacted MML between 1991-1992 and 2012-2013 (overall period). Early-MML states enacted MML between 1991-1992 and 2001-2002 (early period). Late-MML states enacted MML between 2001-2002 and 2012-2013 (late period). MML effects on change in DUIC and DUIA prevalence were estimated using a difference-in-differences specification to compare changes in MML and other states. FINDINGS From 1991-1992 to 2012-2013, DUIC prevalence nearly doubled (from 1.02% to 1.92%), increasing more in states that enacted MML than other states (difference-in-differences [DiD] = 0.59%; 95% CI = 0.06%-1.12%). Most change in DUIC prevalence occurred between 2001-2002 and 2012-2013. DUIC prevalence increased more in states that enacted MML 2001-2002 to 2012-2013 than in never-MML states (DiD = 0.77%; 95% CI = -0.05%-1.59%), and in two early-MML states, California (DiD = 0.82; 95% CI = 0.06-1.59) and Colorado (DiD = 1.32; 95% CI = 0.11-2.53). In contrast, DUIA prevalence appeared unrelated to MML enactment. CONCLUSIONS Medical marijuana law enactment in US states appears to have been associated with increased prevalence of driving under the influence of cannabis, but not alcohol.
Collapse
Affiliation(s)
- David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Aaron L. Sarvet
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard, Boston, MA, USA
| | - Magdalena Cerda
- Department of Population Health, New York University, New York, NY, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
5
|
Schepis TS, Klare DL, Ford JA, McCabe SE. Prescription Drug Misuse: Taking a Lifespan Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820909352. [PMID: 32214819 PMCID: PMC7065295 DOI: 10.1177/1178221820909352] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.
Collapse
Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Dalton L Klare
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of MI, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Park JY, Wu LT. Sources of Misused Prescription Opioids and Their Association with Prescription Opioid Use Disorder in the United States: Sex and Age Differences. Subst Use Misuse 2020; 55:928-936. [PMID: 31975639 PMCID: PMC7166157 DOI: 10.1080/10826084.2020.1713818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Prescription opioid (PO) misuse and prescription opioid use disorder (POUD) are a national crisis in the USA. To inform strategies for reducing the PO epidemic, research is needed on the sources of misused POs and their association with POUD. Methods: Past-year PO misusers aged ≥12 (N = 6033) from the 2015 to 2016 National Surveys on Drug Use and Health were analyzed. The most recent source of misused POs was assessed. Logistic regression analyses were used to determine the association between the sources of misused POs and past-year POUD. All analyses were stratified by age groups for each sex. Results: Overall, the most common sources of misused POs were obtaining from friends/relatives for free (40.27%) and physicians (36.59%). Males had a higher prevalence of buying POs from friends/relatives or drug dealers/strangers than females. Significant age differences also emerged. Buying POs from drug dealers/strangers (vs. obtaining POs free from friends/relatives) was strong predictor of past-year POUD in both sexes. In the sex- and age-stratified analyses, significant associations of past-year POUD with (1) buying from drug dealers/strangers emerged among males aged 18+ and females aged 26+; (2) buying from friends/relatives emerged among males aged 12+ and females aged 18-25; (3) obtaining from physicians emerged among males aged 18+ and females aged 26+. Conclusions: Our findings indicate different risk profiles for POUD across sex and age groups with different diversion sources. Prevention and treatment programs for POUD should be tailored to consider sex and developmental age differences in sources of opioids.
Collapse
Affiliation(s)
- Ji-Yeun Park
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| |
Collapse
|
7
|
Canizares M, Power JD, Rampersaud YR, Badley EM. Patterns of opioid use (codeine, morphine or meperidine) in the Canadian population over time: analysis of the Longitudinal National Population Health Survey 1994-2011. BMJ Open 2019; 9:e029613. [PMID: 31345978 PMCID: PMC6661673 DOI: 10.1136/bmjopen-2019-029613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE This study aimed to investigate cohort effects in selected opioids use and determine whether cohort differences were associated with changes in risk factors for use over time. DESIGN This study presents secondary analyses of a longitudinal survey panel of the general population that collected data biannually. SETTING Data from the Canadian Longitudinal National Population Health Survey 1994-2011. POPULATION This study included 12 542 participants from the following birth cohorts: post-World War I (born 1915-1924), pre-World War II (born 1925-1934), World War II (born 1935-1944), Older Baby Boom (born 1945-1954), Younger Baby Boom (born 1955-1964), Older Generation X (born 1965-1974) and Younger Generation X (born 1975-1984). MAIN OUTCOME Responses to a single question asking about the use of codeine, morphine or meperidine in the past month (yes/no) were examined. RESULTS Over and above age and period effects, there were significant cohort differences in selected opioids use: each succeeding recent cohort had greater use than their predecessors (eg, Gen Xers had greater use than younger baby boomers). Selected opioids use increased significantly from 1994 to 2002, plateauing between 2002 and 2006 and then declining until 2011. After accounting for cohort and period effects, there was a decline in use of these opioids with increasing age. Although pain was significantly associated with greater selected opioids use (OR=3.63, 95% CI 3.39 to 3.94), pain did not explain cohort differences. Cohort and period effects were no longer significant after adjusting for the number of chronic conditions. Cohort differences in selected opioids use mirrored cohort differences in multimorbidity. Use of these opioids was significantly associated with taking antidepressants or tranquillisers (OR=2.52, 95% CI 2.27 to 2.81 and OR=1.60, 95% CI 1.46 to 1.75, respectively). CONCLUSIONS The findings underscore the need to consider multimorbidity including possible psychological disorders and associated medications when prescribing opioids (codeine, morphine, meperidine), particularly for recent birth cohorts. Continued efforts to monitor prescription patterns and develop specific opioid use guidelines for multimorbidity appear warranted.
Collapse
Affiliation(s)
- Mayilee Canizares
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J Denise Power
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K. An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 2018; 13:41. [PMID: 30482215 PMCID: PMC6260714 DOI: 10.1186/s13011-018-0180-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nonmedical prescription opioid use (NMPOU) is a serious public health problem in North America. At a population-level, previous research has identified differences in the prevalence and correlates of NMPOU among younger versus older age groups; however, less is known about age-related differences in NMPOU among people who use illegal drugs. METHODS Data were collected between 2013 and 2015 from two linked prospective cohort studies in Vancouver, Canada: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Factors independently associated with NMPOU among younger (ARYS) and older (VIDUS) participants were examined separately using bivariate and multivariate generalized estimating equations. RESULTS A total of 1162 participants were included. Among 405 eligible younger participants (Median age = 25; Inter-Quartile Range [IQR]: 22-28), 40% (n = 160) reported engaging in NMPOU at baseline; among 757 older participants (Median age = 48, IQR: 40-55), 35% (n = 262) reported engaging in NMPOU at baseline. In separate multivariate analyses of younger and older participants, NMPOU was positively and independently associated with heroin use (younger: Adjusted Odds Ratio [AOR] = 3.12, 95% Confidence Interval [CI]: 2.08-4.68; older: AOR = 2.79, 95% CI: 2.08-3.74), drug dealing (younger: AOR = 2.22, 95% CI: 1.58-3.13; older: AOR = 1.87, 95% CI: 1.40-2.49), and difficulty accessing services (younger: AOR = 1.47, 95% CI: 1.04-2.09; older: AOR = 1.74, 95% CI: 1.32-2.29). Among the youth cohort only, NMPOU was associated with younger age (AOR = 1.12, 95% CI: 1.05-1.19), crack use (AOR = 1.56, 95% CI: 1.06-2.30), and binge drug use (AOR = 1.41, 95% CI: 1.00-1.97); older participants who engaged in NMPOU were more likely to report crystal methamphetamine use (AOR = 1.97, 95% CI: 1.46-2.66), non-fatal overdose (AOR = 1.76, 95% CI: 1.20-2.60) and sex work (AOR = 1.49, 95% CI: 1.00-2.22). DISCUSSION The prevalence of NMPOU is similar among younger and older people who use drugs, and independently associated with markers of vulnerability among both age groups. Adults who engage in NMPOU are at risk for non-fatal overdose, which highlights the need for youth and adult-specific strategies to address NMPOU that include better access to health and social services, as well as a range of addiction treatment options for opioid use. Findings also underscore the importance of improving pain treatment strategies tailored for PWUD.
Collapse
Affiliation(s)
- Tessa Cheng
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC V6B 5K3 Canada
| |
Collapse
|
9
|
Hua K, Wang T, Li C, Li S, Ma X, Li C, Li M, Fu S, Yin Y, Wu Y, Liu M, Yu K, Fang J, Wang P, Jiang G. Abnormal degree centrality in chronic users of codeine-containing cough syrups: A resting-state functional magnetic resonance imaging study. NEUROIMAGE-CLINICAL 2018; 19:775-781. [PMID: 29988765 PMCID: PMC6031869 DOI: 10.1016/j.nicl.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 11/29/2022]
Abstract
Codeine-containing cough syrups (CCS) have become one of the most popular drugs of abuse in young population worldwide. However, the neurobiological mechanisms underlying CCS-dependence are yet ill-defined. Therefore, understanding the brain abnormalities in chronic users of CCS is crucial for developing effective interventions. The present study depicted the intrinsic dysconnectivity pattern of whole-brain functional networks at the voxel level in chronic users of CCS. In addition, the degree centrality (DC) changes were correlated to the Barratt Impulsiveness Scale (BIS-11) total score, dose, duration of CCS use, and the age at first use of cough syrups. The current study included 38 chronic CCS users and 34 matched control subjects. All patients were evaluated using the BIS-11. Next, resting-state functional magnetic resonance imaging (rs-fMRI) datasets were acquired from these CCS users and controls. Whole-brain connectivity was analyzed using a graph theory approach: degree centrality (DC). CCS-dependent individuals exhibited low DC values in the left inferior parietal lobule and the left middle temporal gyrus, while high DC values were noted in the right pallidum and the right hippocampus (P < 0.01, AlphaSim corrected). Also, significant correlations were established between average DC value in the left inferior parietal lobule and attentional impulsivity scores and the age at first CCS use. The rs-fMRI study suggested that the abnormal intrinsic dysconnectivity pattern of whole-brain functional networks may provide an insight into the neural substrates of abnormalities in the cognitive control circuit, the reward circuit, and the learning and memory circuit in CCS-dependent individuals. The abuse of CCS has gained a severe foothold among young individuals worldwide. DC is one of the more reliable and compelling measures among several nodal network metrics. The present study depicted intrinsic dysconnectivity pattern of whole-brain functional networks in CCS-dependent individuals. CCS-dependent individuals showed altered DC in the right pallidum, right hippocampus, left IPL and left middle temporal gyrus. Significant correlations were established between average DC value in the left IPL and attentional impulsivity scores and the age at first CCS use.
Collapse
Affiliation(s)
- Kelei Hua
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Cheng Li
- Department of Renal Transplantation, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Shumei Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Xiaofen Ma
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Chao Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Meng Li
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Shishun Fu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Yi Yin
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Yunfan Wu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Mengchen Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Kanghui Yu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Jin Fang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China
| | - Peijun Wang
- Department of Medical Imaging, Chinese People's Armed Police Forces, Hubei Provincial Corps Hospital, People's Republic of China
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, People's Republic of China.
| |
Collapse
|
10
|
Sacco P, Cagle JG, Moreland ML, Camlin EA. Screening and Assessment of Substance Use in Hospice Care: Examining Content from a National Sample of Psychosocial Assessments. J Palliat Med 2017; 20:850-856. [DOI: 10.1089/jpm.2016.0538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Paul Sacco
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
| | - John G. Cagle
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
| | - Melissa L. Moreland
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
| | | |
Collapse
|
11
|
Hasin DS, Sarvet AL, Cerdá M, Keyes KM, Stohl M, Galea S, Wall MM. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013. JAMA Psychiatry 2017; 74:579-588. [PMID: 28445557 PMCID: PMC5539836 DOI: 10.1001/jamapsychiatry.2017.0724] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/01/2017] [Indexed: 12/24/2022]
Abstract
Importance Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time. Objective To present national data on state MML and degree of change in the prevalence of cannabis use and disorders. Design, Participants, and Setting Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period"). Main Outcomes and Measures Past-year illicit cannabis use and DSM-IV cannabis use disorder. Results Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04). Conclusions and Relevance Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.
Collapse
Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aaron L Sarvet
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento
| | - Katherine M Keyes
- Department of Psychiatry, Columbia University Medical Center, New York, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Malka Stohl
- New York State Psychiatric Institute, New York
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York6Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
12
|
Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS, Grant BF. Nonmedical Prescription Opioid Use and DSM-5 Nonmedical Prescription Opioid Use Disorder in the United States. J Clin Psychiatry 2016; 77:772-80. [PMID: 27337416 PMCID: PMC5555044 DOI: 10.4088/jcp.15m10386] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/04/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The authors present 12-month and lifetime prevalence, correlates, psychiatric comorbidity, and treatment of nonmedical prescription opioid use (NMPOU) and DSM-5 NMPOU disorder (NMPOUD). METHODS Data were derived from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (N = 36,309). RESULTS Prevalences of 12-month and lifetime NMPOU were 4.1% and 11.3%, exceeding rates in the 2001-2002 NESARC (1.8%, 4.7%). Twelve-month and lifetime rates of DSM-5 NMPOUD were 0.9% and 2.1%. NESARC-III DSM-IV NMPOUD rates (0.8%, 2.9%) were greater than those observed in the 2001-2002 NESARC (0.4% and 1.4%). Rates of NMPOU were greater among men, but no sex differential was observed for NMPOUD. Prevalences of NMPOU and NMPOUD were generally greater among 18- to 64-year-old individuals, whites, and Native Americans, and individuals with lower socioeconomic status. Associations were observed between 12-month and lifetime NMPOU and NMPOUD and other drug use disorders, posttraumatic stress disorder, and borderline, schizotypal, and antisocial personality disorders; persistent depression and major depressive disorder (for NMPOU); and bipolar I disorder (for NMPOUD). Only 5.5% and 17.7% of individuals with 12-month NMPOU and NMPOUD were ever treated. CONCLUSIONS NMPOU and NMPOUD have considerably increased over the past decade, are associated with a broad array of risk factors and comorbidities, and largely go untreated in the United States. More information on the determinants, characteristics, and outcomes of NMPOU and NMPOUD is needed to support evidence-based interventions and prevention.
Collapse
Affiliation(s)
- Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Bradley T. Kerridge
- Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Risë B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| | - Deborah S. Hasin
- Deborah Hasin, Ph.D. Department of Psychiatry, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY 10032
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., Room 3083, Rockville, MD 20852
| |
Collapse
|
13
|
Wu Q, Yu J, Yang C, Chen J, Yang L, Zhang H, Teng S, Li J, Yan D, Cao J, Zhao Y, Wang Z. Nonmedical Use of Cough Syrup Among Secondary Vocational School Students: A National Survey in China. Medicine (Baltimore) 2016; 95:e2969. [PMID: 26962800 PMCID: PMC4998881 DOI: 10.1097/md.0000000000002969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonmedical use of cough syrup (NUCS) among secondary vocational school (SVS) students has been an increasing concern for public health in China, but no data were available. This cross-sectional study aimed to investigate the epidemiological characters of NUCS as well as its risk factors among SVS students in China.From September 2013 to December 2014, a total of 13,614 SVS students were purposively selected through multistage sampling in 6 cities of China. Information on NUCS, demographics, family background, smoking and alcohol consumption, impulsiveness, sensation seeking, and parental monitoring were collected. Logistic regression was used to explore factors related to NUCS.The 12,923 (94.9%) valid responses (16.3 ± 1.0 years old, and 52.6% men) reported 3.47% (95% confidence interval: 3.15-3.79%) lifetime NUCS. Logistic regression indicated that smoking, part-time job experience, high level of impulsiveness, and sensation seeking were risk factors for NUCS, whereas urban living and high parental monitoring were protective ones.NUCS was prevalent among SVS students. Interventions that target on smoking, impulsiveness and sensation seeking control, improvement on parental monitoring may have considerable impact on NUCS among SVS students.
Collapse
Affiliation(s)
- Qingfeng Wu
- From the Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (QW, JY, JC, LY, HZ, ST, DY, JC, YZ, ZW); Department of Preventive Medicine, Gannan Medical University, Ganzhou, China (QW); Department of Public Health Sciences & Office for Scholarship in Learning and Education Research, College of Medicine, Pennsylvania State University, Hershey, PA (CY); and Chongqing Health Information Center, Chongqing, China (JL)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
Collapse
Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
| |
Collapse
|
15
|
Kerridge BT, Saha TD, Chou SP, Zhang H, Jung J, Ruan WJ, Smith SM, Huang B, Hasin DS. Gender and nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. Drug Alcohol Depend 2015; 156:47-56. [PMID: 26374990 PMCID: PMC4633313 DOI: 10.1016/j.drugalcdep.2015.08.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/16/2015] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about sex-specific risk for nonmedical prescription opioid use (NMPOU) and DSM-5 nonmedical prescription opioid use disorder (NMPOUD). The objective of the present study was to present prevalence, correlates, psychiatric comorbidity, treatment and disability of NMPOU and DSM-5 NMPOUD among men and women. METHODS Nationally representative sample of the U.S. RESULTS Prevalences of 12-month and lifetime NMPOU were greater among men (4.4%, 13.0%) than women (3.9%, 9.8%), while corresponding rates of DSM-5 NMPOUD did not differ between men (0.9%, 2.2%) and women (0.9%, 1.9%). Regardless of time frame and sex, NMPOU and NMPOUD generally decreased with age and were lower among Blacks, Asians/Pacific Islanders and Hispanics, and respondents with lower socioeconomic status. Among men with NMPOU, rates were lower among respondents in the Northeast and South and among those previously married (lifetime). Across time frames and gender, NMPOU and NMPOUD were generally associated with other substance use disorders, posttraumatic stress and borderline, schizotypal and antisocial personality disorders, but associated with major depressive disorder, persistent depression and bipolar I disorder only among men. Disability increased with NMPOU frequency and NMPOUD severity. Only 7.6% and 8.2% of men and women with NMPOU ever received treatment, while 26.8% and 31.1% ever received treatment for NMPOUD. CONCLUSIONS NMPOU and NMPOUD are highly disabling, associated with a broad array of sex-specific and shared correlates and comorbidities and largely go untreated in the U.S. Valid assessment tools are needed that include gender as a stratification variable to identify NMPOU and NMPOUD.
Collapse
Affiliation(s)
- Bradley T. Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, Phone: 831-246-0751
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Deborah S. Hasin
- Department of Psychiatry, College of Physicians and Surgeons, and Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY 10032
| |
Collapse
|
16
|
Schmidt TD, Haddox JD, Nielsen AE, Wakeland W, Fitzgerald J. Key Data Gaps Regarding the Public Health Issues Associated with Opioid Analgesics. J Behav Health Serv Res 2015; 42:540-53. [PMID: 24554390 PMCID: PMC4139477 DOI: 10.1007/s11414-014-9396-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most pharmaceutical opioids are used to treat pain, and they have been demonstrated to be effective medications for many. Their abuse and misuse pose significant public health concerns in the USA. Research has provided much insight into the prevalence, scope, and drivers of opioid abuse, but a holistic understanding is limited by a lack of available data regarding key aspects of this public health problem. Twelve data gaps were revealed during the creation of a systems-level computer model of medical use, diversion, nonmedical use, and the adverse outcomes associated with opioid analgesics in the USA. Data specific to these gaps would enhance the validity and real-world applications of systems-level models of this public health problem and would increase understanding of the complex system in which use and abuse occur. This paper provides an overview of these gaps, argues for the importance of closing them, and provides specific recommendations for future data collection efforts.
Collapse
Affiliation(s)
- Teresa D Schmidt
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | - J David Haddox
- Health Policy, Purdue Pharma L.P., Stamford, CT, USA.
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Alexandra E Nielsen
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | - Wayne Wakeland
- Systems Science Graduate Program, Portland State University, Portland, OR, USA.
| | | |
Collapse
|
17
|
Green TC, Dauria EF, Bratberg J, Davis CS, Walley AY. Orienting patients to greater opioid safety: models of community pharmacy-based naloxone. Harm Reduct J 2015; 12:25. [PMID: 26245865 PMCID: PMC4527253 DOI: 10.1186/s12954-015-0058-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/29/2015] [Indexed: 11/13/2022] Open
Abstract
The leading cause of adult injury death in the USA is drug overdose, the majority of which involves prescription opioid medications. Outside of the USA, deaths by drug overdose are also on the rise, and overdose is a leading cause of death for drug users. Reducing overdose risk while maintaining access to prescription opioids when medically indicated requires careful consideration of how opioids are prescribed and dispensed, how patients use them, how they interact with other medications, and how they are safely stored. Pharmacists, highly trained professionals expert at detecting and managing medication errors and drug-drug interactions, safe dispensing, and patient counseling, are an under-utilized asset in addressing overdose in the US and globally. Pharmacies provide a high-yield setting where patient and caregiver customers can access naloxone—an opioid antagonist that reverses opioid overdose—and overdose prevention counseling. This case study briefly describes and provides two US state-specific examples of innovative policy models of pharmacy-based naloxone, implemented to reduce overdose events and improve opioid safety: Collaborative Pharmacy Practice Agreements and Pharmacy Standing Orders.
Collapse
Affiliation(s)
- Traci C Green
- Department of Emergency Medicine, Rhode Island Hospital, Injury Prevention Center, 55 Claverick St., 2nd Floor, Providence, Rhode Island, 02903, USA. .,Boston Medical Center, Injury Prevention Center, Boston University School of Medicine, 771 Albany St., Boston, Massachusetts, 02118, USA. .,The Warren Alpert Medical School at Brown University, 222 Richmond St, Providence, Rhode Island, 02903, USA. .,, 771 Albany St., Boston, Massachusetts, 02118, USA.
| | - Emily F Dauria
- The Warren Alpert Medical School at Brown University, 222 Richmond St, Providence, Rhode Island, 02903, USA.
| | - Jeffrey Bratberg
- College of Pharmacy, University of Rhode Island, 7 Greenhouse Rd, Kingston, Rhode Island, USA.
| | - Corey S Davis
- Network for Public Health Law, Carrboro, North Carolina, USA.
| | - Alexander Y Walley
- Clinical Addiction Research Education Unit, Boston University School of Medicine/ Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, Massachusetts, 02118, USA.
| |
Collapse
|
18
|
Schmidt T, Zimam A, Nielsen A, Wakeland W. Data Sources Regarding the Nonmedical Use of Pharmaceutical Opioids in the United States. REVIEWS IN HEALTH CARE 2014; 5:33-50. [PMID: 25525498 DOI: 10.7175/rhc.v5i1.883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. This work offers a systematic categorization of data sources regarding the nonmedical use of pharmaceutical opioids in the United States. METHODS A list of keywords regarding the nonmedical use of pharmaceutical opioids was used to conduct systematic searches in PubMed®. Filtration of search results generated 92 peer-reviewed academic articles, published between January 1995 and April 2012, as well as a number of primary data sources. Lists of topics were developed independently by two researchers which were later compared and consolidated. All sources were then categorized according to their relevance to each of these topics and according to their capacity for geographical and longitudinal trend analysis. RESULTS Tables cataloging data sources can be used to identify data relevant to specific topics in diversion, nonmedical use, and adverse outcomes associated with pharmaceutical opioids, and they illustrate global trends in data coverage, identifying several topics that have minimal data. A network diagram illustrates global trends in data coverage, showing variation among sources in the number of topics they cover, as well as variation among topics in the number of sources that cover them. CONCLUSIONS The categorization of data sources is hoped to facilitate ongoing research, analysis, and evaluation of this public health problem by serving as a guide for researchers, policy makers, and others who seek data regarding the nonmedical use of pharmaceutical opioids in the United States.
Collapse
Affiliation(s)
- Teresa Schmidt
- Systems Science Graduate Program Portland State University
| | - Amanuel Zimam
- Systems Science Graduate Program Portland State University
| | | | - Wayne Wakeland
- Systems Science Graduate Program Portland State University
| |
Collapse
|
19
|
The association between nonmedical use of prescription medication status and change in health-related quality of life: results from a Nationally Representative Survey. Drug Alcohol Depend 2014; 142:161-7. [PMID: 24999057 DOI: 10.1016/j.drugalcdep.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/04/2014] [Accepted: 06/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nonmedical use of prescription medication (NUPM) is associated cross-sectionally with a host of medical and psychosocial consequences. Few studies, however, have examined longitudinal outcomes based on NUPM indicators. This study aimed to address this gap by examining change in health-related quality of life as a function of NUPM status. METHODS Data are from waves 1 and 2 of the National Epidemiological Survey on Alcoholism and Related Conditions (NESARC) a household-based, nationally-representative survey of the US population. 34,653 participants who completed both NESARC waves were included in analyses. The primary outcome measure was the 12-item Short Form Health Survey (SF-12), with history of NUPM of opioids, tranquilizer/sedatives and stimulants (examined separately) at wave 1 and any NUPM between waves 1 and 2 used to group participants. Sociodemographic characteristics were used as control variables. RESULTS Across medication classes, results indicated that individuals who initiated NUPM between waves (initiators) had greater declines or smaller increases on many SF-12 scales, when compared to other groups. Individuals with a history of NUPM at wave 1 but no use between waves (quitters) and never users generally had the best outcomes in terms of change in SF-12 scales, with quitters making larger gains (or smaller losses) in mental health-related quality of life. Persistent users were generally intermediate between initiators and quitters or never users. CONCLUSIONS These data reinforce the importance of preventing NUPM initiation and of promoting NUPM cessation, highlighting the need for greater use of NUPM-related public health interventions.
Collapse
|
20
|
Cerdá M, Bordelois P, Keyes KM, Roberts AL, Martins SS, Reisner SL, Austin SB, Corliss HL, Koenen KC. Family ties: maternal-offspring attachment and young adult nonmedical prescription opioid use. Drug Alcohol Depend 2014; 142:231-8. [PMID: 25024105 PMCID: PMC4134317 DOI: 10.1016/j.drugalcdep.2014.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nonmedical prescription drug use is prevalent among young adults, yet little is known about modifiable determinants of use. We examined whether maternal-offspring attachment reported at mean age 21 was associated with nonmedical prescription opioid use at mean age 26, and investigated whether a history of depressive symptoms and substance use played a role in associations between maternal-offspring attachment and nonmedical prescription opioid use. METHODS We used data from the Growing Up Today Study, a longitudinal cohort of United States adolescents followed into young adulthood. Maternal-offspring attachment was reported by young adults and their mothers, and defined as mutual low, mutual medium or high, and dissonant. Analyses were carried out in the full sample using generalized estimating equation models, and in a sibling subsample, using conditional fixed effects models to control for stable aspects of the family environment. RESULTS Analyses with the full sample and the sibling subsample both showed that mutual medium/high maternal-offspring attachment at age 21 was associated with lower odds of nonmedical prescription opioid use at age 26 (RR=0.74; 95% CI=0.57-0.97 in full sample). The association was partly mediated by mean age 23 offspring smoking, heavy episodic drinking, and illicit drug use. CONCLUSIONS Promoting reciprocal attachment in the maternal-offspring dyad should be investigated as a strategy to prevent nonmedical prescription opioid use by young adulthood. Even in young adulthood, programs that target both parents and offspring may have greater impact on offspring substance use than programs that target offspring alone.
Collapse
Affiliation(s)
- M Cerdá
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
| | - P Bordelois
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - K M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - A L Roberts
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston MA 02115, USA
| | - S S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - S L Reisner
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston MA 02115, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - S B Austin
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston MA 02115, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - H L Corliss
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - K C Koenen
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| |
Collapse
|
21
|
Keyes KM, Nicholson R, Kinley J, Raposo S, Stein MB, Goldner EM, Sareen J. Age, period, and cohort effects in psychological distress in the United States and Canada. Am J Epidemiol 2014; 179:1216-27. [PMID: 24692432 DOI: 10.1093/aje/kwu029] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although treatment utilization for depression and anxiety symptoms has increased substantially in the United States and elsewhere, it remains unclear whether the underlying population distribution of psychological distress is changing over time. We estimated age, period, and cohort effects using data from 2 countries over more than 20 years, including National Health Interview Surveys from 1997 to 2010 (n = 447,058) and Canadian Community Health Surveys from 2000 to 2007 (n = 125,306). Psychological distress was measured with the Kessler Psychological Distress Scale. By period, both countries showed the highest levels of psychological distress in 2001 and the lowest levels in 2007. By age, psychological distress was highest in adolescence and during the late 40s and early 50s. By cohort, Canadian Community Health Survey results indicated a decreasing cohort effect among those born in 1922-1925 through 1935-1939 (β = -0.36, 95% confidence interval: -0.45, -0.27) and then a continuously increasing cohort effect during the remainder of the 20th century through 1989-1992 (β = 0.49, 95% confidence interval: 0.38, 0.61). The National Health Interview Survey data captured earlier-born cohorts and indicated an increased cohort effect for the earliest born (for 1912-1914, β = 0.44, 95% confidence interval: 0.26, 0.61). In sum, individuals in the oldest and more recently born birth cohorts have higher mean psychological distress symptoms compared with those born in midcentury, underscoring the importance of a broad, population-level lens for conceptualizing mental health.
Collapse
|
22
|
Sartor CE, Kranzler HR, Gelernter J. Rate of progression from first use to dependence on cocaine or opioids: a cross-substance examination of associated demographic, psychiatric, and childhood risk factors. Addict Behav 2014; 39:473-9. [PMID: 24238782 DOI: 10.1016/j.addbeh.2013.10.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/25/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A number of demographic factors, psychiatric disorders, and childhood risk factors have been associated with cocaine dependence (CD) and opioid dependence (OD), but little is known about their relevance to the rate at which dependence develops. Identification of the subpopulations at elevated risk for rapid development of dependence and the risk factors that accelerate the course of dependence is an important public health goal. METHODS Data were derived from cocaine dependent (n=6333) and opioid dependent (n=3513) participants in a multi-site study of substance dependence. Mean age was approximately 40 and 40% of participants were women; 51.9% of cocaine dependent participants and 29.5% of opioid dependent participants self-identified as Black/African-American. The time from first use to dependence was calculated for each substance and a range of demographic, psychiatric, and childhood risk factors were entered into ordinal logistic regression models to predict the (categorical) transition time to CD and OD. RESULTS In both the cocaine and opioid models, conduct disorder and childhood physical abuse predicted rapid development of dependence and alcohol and nicotine dependence diagnoses were associated with slower progression to CD or OD. Blacks/African Americans were at greater risk than European Americans to progress rapidly to OD. CONCLUSIONS Only a subset of factors known to be associated with CD and OD predicted the rate at which dependence developed. Nearly all were common to cocaine and opioids, suggesting that sources of influence on the timing of transitions to dependence are shared across the two substances.
Collapse
|
23
|
Meier EA, Troost JP, Anthony JC. Extramedical use of prescription pain relievers by youth aged 12 to 21 years in the United States: national estimates by age and by year. ACTA ACUST UNITED AC 2013; 166:803-7. [PMID: 22566515 DOI: 10.1001/archpediatrics.2012.209] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To identify when youth are most likely to start using prescription pain relievers to get high or for other unapproved indications outside the boundaries of what a prescribing physician might intend (ie, extramedical use). DESIGN Cross-sectional surveys of adolescent cohorts, 2004 to 2008. SETTING The United States. PARTICIPANTS Large nationally representative samples of youth in the United States who had been assessed for the 2004 through 2008 National Survey on Drug Use and Health, yielding data from 138 729 participants aged 12 to 21 years. MAIN OUTCOME MEASURES Estimated age-specific risk of starting extramedical use of prescription pain relievers, year by year, and confirmation of age at peak risk by tracing the experience of individual cohorts during this period. RESULTS The estimated peak risk of starting extramedical use of prescription pain relievers occurs in midadolescence, well before the college years. The age at peak risk is 16 years, when an estimated 2% to 3% become newly incident users. Smaller risk estimates are observed at age 12 to 14 years and at age 19 to 21 years. CONCLUSIONS For initiatives to prevent youth from using prescription pain relievers to get high or for other unapproved indications, a focus on the last year of high school and the post-secondary school years may be too little too late. Practice-based approaches are needed in addition to public health interventions based on effective alcohol and tobacco prevention programs during the earlier adolescent years.
Collapse
|
24
|
Exploring age of onset as a causal link between major depression and nonmedical use of prescription medications. Drug Alcohol Depend 2012; 120:99-104. [PMID: 21802221 PMCID: PMC3206988 DOI: 10.1016/j.drugalcdep.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/07/2011] [Accepted: 07/03/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nonmedical use of prescription medications (NUPM) has been associated with major depression (MDD), but the specific processes by which they might interact and influence one another are understudied. This investigation attempted to clarify the relationship between MDD and NUPM by examining whether age of MDD onset influenced current and past NUPM and by examining whether age of NUPM onset influenced lifetime or past year MDD. METHODS These goals were met through use of data from the 2005 to 2007 National Survey on Drug Use and Health. Analyses utilized design-based logistic regression, and current age and order of MDD onset and NUPM initiation were examined in interactions with age of MDD or NUPM onset. RESULTS For each year MDD onset was delayed, odds of lifetime, past year, past 30-day NUPM and substance dependence from NUPM were decreased by 2.3%, 2.6%, 1.9% and 2.3%, respectively. Earlier NUPM onset increased odds of past year (3.8%) and lifetime MDD (4.3%) in young adults, and lifetime MDD (2.5%) in 26-34 age group. Current age also interacted with age of MDD onset, with effects on NUPM pronounced in the 65 and older cohort. Order of MDD/NUPM onset generally did not interact with age of MDD onset, but it did interact with age of NUPM onset; the effects of NUPM onset on past year MDD were only significant in those with NUPM first. CONCLUSIONS These results highlight the need for further investigations of the interactions between depression and NUPM, particularly to evaluate potential causal relationships.
Collapse
|