1
|
Lund IO, Andersen N, Ask H, Andreas JB. Parental drinking, mental health and educational level, and offspring's subsequent prescription drugs treatment for sleep problems. A longitudinal HUNT survey and registry study. BMC Public Health 2023; 23:1372. [PMID: 37464314 DOI: 10.1186/s12889-023-16301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Parental drinking, mental health and family socioeconomic status are all associated with offspring sleep problems, but there is a paucity of research that considers the effect of risk factors, as they co-occur within and across families. Also, sleep problems are closely linked with mental health problems. Disentangling the effects on one or the other are important. We examined whether parental risk constellations are differently associated with offspring's subsequent prescription drug use for sleep problems during nine years with or without prescription drug use for anxiety and/or depression. METHODS The sample included 8773 adolescent offspring of 6696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway. The exposures were five parental risk constellations, previously identified via Latent Profile Analysis, characterized by drinking frequencies and quantities, mental health, and years of education. The outcomes were dispensed prescription drugs in offspring during 2008-2016 for (a) only sleep problems (b) sleep problems and anxiety/depression or (c) only anxiety/depression. We used multinomial logistic regression to model the odds of the outcomes. RESULTS Compared to the overall low-risk parental constellation, none of the risky constellations were significantly associated with increased risk of being dispensed prescription drugs only for sleep problems. Offspring from two different risk profiles were at increased risk for being dispensed both sleep and anxiety/depression prescription drugs. These were parental profiles marked by (1) low education, symptoms of mental health problems and weekly binge drinking in both parents (OR 1.90, CI = 1.06;3.42); and (2) frequent heavy drinking in both parents and symptoms of mental health problems in fathers (OR 3.32, CI = 1.49;7.39). Offspring from the risk profile with lowest parental education had increased risk of only anxiety/depression prescription drugs (OR 1.25, CI = 1.05;1.49). CONCLUSION Our findings suggest that parental risk constellations are not associated with increased risk of offspring receiving sleep medications without also receiving anxiety/depression medications, as two risk constellations were associated with increased risk of dispensation of both sleep and anxiety/depression prescription drugs. Receiving both may be an indication of severity. The findings underscore the importance of including measures of mental health problems when investigating sleep problems to avoid misattribution of effects.
Collapse
Affiliation(s)
- Ingunn Olea Lund
- Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway.
- Department of Psychology, Faculty of Social Sciences, University of Oslo, PO Box 1094, Blindern, Oslo, 0317, Norway.
| | - Njål Andersen
- Department of International Business, NTNU Ålesund, Postboks, Ålesund, 1517, 6025, Norway
| | - Helga Ask
- Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, PO Box 1094, Blindern, Oslo, 0317, Norway
| | - Jasmina Burdzovic Andreas
- Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, PO Box 1094, Blindern, Oslo, 0317, Norway
| |
Collapse
|
2
|
Giombi K, Thompson J, Wines C, Haughney R, Sullivan HW, Betts KR. A scoping review of empirical research on prescription drug promotion. Res Social Adm Pharm 2023; 19:859-872. [PMID: 36931982 DOI: 10.1016/j.sapharm.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Pharmaceutical spending on prescription drug promotion is considerable, and exposure to advertising can influence demand and behavior. The U.S. Food and Drug Administration (FDA) provides industry guidance to help ensure that communications to consumers and health care providers about prescription drug promotion are truthful, balanced, and accurately communicated. As empirical research has accelerated on this topic in the past decade, an understanding of the current landscape of the science will help inform future research. OBJECTIVES Using systematic methods, this rigorous scoping review of the literature over the past decade (2012-2021) (1) examined the extent to which prescription drug promotion has been empirically investigated with consumers, patients, and health care providers; (2) examined the extent to which content and features of prescription drug promotion have been empirically investigated; and (3) identified themes across the literature to better understand the current landscape of prescription drug promotion. METHODS Databases searched include PubMed, Web of Science, CINAHL, APA PsycInfo, Business Source Corporate, Communication Source, Cochrane Library, and ClinicalTrials.gov for original research published in English from January 1, 2012, through November 10, 2021, using terms related to direct-to-consumer advertising, prescription drugs, and outcomes of interest (e.g., attitudes, perceptions, intentions, behaviors). RESULTS Of 804 screened references, 151 studies addressed the first research question, and 40 studies addressed the second. The most common theme across the body of evidence focused on testing of features and content in prescription drug promotional materials (84), followed by studies examining attitudes, perceptions, and behaviors toward prescription drug promotion more generally (43). Some (27) studies focused on targeted populations, such as patients, the elderly, non-English speaking people or individuals of a non-white race/ethnicity. Twenty-four studies assessed influence of exposure to prescription drug promotion on actual clinical outcomes, while 11 studies examined emerging technologies around prescription drug promotion. Seven studies evaluated the extent to which prescription drug promotion complied with existing guidelines and requirements. CONCLUSIONS Findings from this scoping review suggest there has been an increase in the number of empirical studies conducted on prescription drug promotion over the past decade. Potential areas that warrant further study include examination of emerging technologies, an expanded focus on targeted populations, and construct measurement.
Collapse
Affiliation(s)
| | | | - Candi Wines
- RTI International, Research Triangle Park, NC, USA
| | | | - Helen W Sullivan
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion, Silver Spring, MD, USA
| | - Kevin R Betts
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion, Silver Spring, MD, USA
| |
Collapse
|
3
|
Guindon GE, Fatima T, Garasia S, Khoee K. A systematic umbrella review of the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. BMC Health Serv Res 2022; 22:297. [PMID: 35241088 PMCID: PMC8895849 DOI: 10.1186/s12913-022-07554-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing spending and use of prescription drugs pose an important challenge to governments that seek to expand health insurance coverage to improve population health while controlling public expenditures. Patient cost-sharing such as deductibles and coinsurance is widely used with aim to control healthcare expenditures without adversely affecting health. METHODS We conducted a systematic umbrella review with a quality assessment of included studies to examine the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. We searched five electronic bibliographic databases, hand-searched eight specialty journals and two working paper repositories, and examined references of relevant reviews. At least two reviewers independently screened the articles, extracted the characteristics, methods, and main results, and assessed the quality of each included study. RESULTS We identified 38 reviews. We found consistent evidence that having drug insurance and lower cost-sharing among the insured were associated with increased drug use while the lack or loss of drug insurance and higher drug cost-sharing were associated with decreased drug use. We also found consistent evidence that the poor, the chronically ill, seniors and children were similarly responsive to changes in insurance and cost-sharing. We found that drug insurance and lower drug cost-sharing were associated with lower healthcare services utilization including emergency room visits, hospitalizations, and outpatient visits. We did not find consistent evidence of an association between drug insurance or cost-sharing and health. Lastly, we did not find any evidence that the association between drug insurance or cost-sharing and drug use, health services use or health differed by socioeconomic status, health status, age or sex. CONCLUSIONS Given that the poor or near-poor often report substantially lower drug insurance coverage, universal pharmacare would likely increase drug use among lower-income populations relative to higher-income populations. On net, it is probable that health services use could decrease with universal pharmacare among those who gain drug insurance. Such cross-price effects of extending drug coverage should be included in costing simulations.
Collapse
Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Tooba Fatima
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kimia Khoee
- Centre for Health Economics and Policy Analysis, McMaster University, Room 229, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| |
Collapse
|
4
|
Sullivan HW, O'Donoghue AC, Lynch M, Johnson M, Davis C, Amoozegar JB, Rupert DJ. Visual images of prescription drug benefits in direct-to-consumer television advertisements. Patient Educ Couns 2021; 104:2240-2249. [PMID: 33618970 PMCID: PMC8362835 DOI: 10.1016/j.pec.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Images demonstrating a prescription drug's efficacy are often included in direct-to-consumer television advertisements. The current research assessed whether exaggerated efficacy images can mislead individuals, and whether providing accurate quantitative information can reduce these misperceptions. METHODS We conducted two experimental studies with internet panelists 60 years and older testing drug efficacy images in television ads for wet age-related macular degeneration (N = 901) and plaque psoriasis (N = 902). In each study, participants viewed one of six ads that varied in the efficacy images included (no image, accurate image, exaggerated image) and the presentation of quantitative information (absent, present). Measures included recall, perceptions, and numeracy. RESULTS In both studies, participants who saw exaggerated images were more likely than those who saw no image or accurate images to overestimate efficacy. Presenting quantitative information increased participants' gist and verbatim recall of drug efficacy, and in some cases, led participants to have more accurate perceptions of the drug's efficacy even in the presence of exaggerated images. Higher numeracy was associated with better gist and verbatim recall. CONCLUSIONS These results support visual persuasion theory. Moreover, they show that exaggerating benefits visually can mislead viewers. PRACTICE IMPLICATIONS Stakeholders should ensure that images in direct-to-consumer promotion are accurate and non-misleading.
Collapse
Affiliation(s)
- Helen W Sullivan
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - Amie C O'Donoghue
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Molly Lynch
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Mihaela Johnson
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Christine Davis
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Jacqueline B Amoozegar
- Center for Health Informatics Research, RTI International, Research Triangle Park, NC, USA
| | - Douglas J Rupert
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| |
Collapse
|
5
|
Mirahmadizadeh A, Banihashemi SA, Hashemi M, Amiri S, Basir S, Heiran A, Keshavarzian O. Estimating the prevalence and incidence of treated type 2 diabetes using prescription data as a proxy: A stepwise approach on Iranian data. Heliyon 2021; 7:e07260. [PMID: 34179534 PMCID: PMC8213903 DOI: 10.1016/j.heliyon.2021.e07260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/16/2020] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
AIMS Type 2 diabetes is a serious health challenge, and large-scale studies on its prevalence in Iran are lacking. In pharmacoepidemiology, case-finding can be done by reviewing the prescription databases for specific drug(s) prescribed for a disease. We aimed to determine the prevalence and incidence of type 2 diabetes in Fars province, Iran, using prescription data and a stepwise approach to ascertain the results. METHODS A dataset of 3,113 insured individuals aged ≥35 years were selected. Their Prescription Data Centre records were reviewed for all drugs frequently used in controlling type 2 diabetes available in the Iranian pharmacopeia. Then we used a stepwise method for case-finding. In step one, each individual with a positive drug history for type 2 diabetes was labeled as an individual with diabetes. The next two steps were implemented for ascertainment of step one estimations. RESULTS Prevalence of type 2 diabetes based on prescription, internist opinion, and phone call verification in 2015 and 2016 was 9.3% and 10.3%, 8.5% and 9.8%, and 7.2% and 8.7%, respectively. An incidence of 1.9% was determined for 2016. CONCLUSIONS We obtained a realistic estimation of prevalence and incidence of treated type 2 diabetes, using prescription data which are large-scale, low cost, and real-time.
Collapse
Affiliation(s)
- Alireza Mirahmadizadeh
- Noncommunicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Sanaz Amiri
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Suzan Basir
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Heiran
- Noncommunicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Keshavarzian
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
6
|
Boudier-Revéret M, Chang MC. Serotonin syndrome in a patient with chronic pain taking analgesic drugs mistaken for psychogenic nonepileptic seizure. Yeungnam Univ J Med 2021; 38:371-373. [PMID: 33813810 PMCID: PMC8688781 DOI: 10.12701/yujm.2021.00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/02/2021] [Indexed: 12/02/2022] Open
Abstract
Serotonin syndrome (SS) is a potentially life-threatening condition that is caused by the administration of drugs that increase serotonergic activity in the central nervous system. We report a case of serotonin syndrome in a patient with chronic pain who was taking analgesic drugs. A 36-year-old female with chronic pain in the lower back and right buttock area had been taking tramadol hydrochloride 187.5 mg, acetaminophen 325 mg, pregabalin 150 mg, duloxetine 60 mg, and triazolam 0.25 mg daily for several months. After amitriptyline 10 mg was added to achieve better pain control, the patient developed SS, which was mistaken for psychogenic nonepileptic seizure. However, her symptoms completely disappeared after discontinuation of the drugs that were thought to trigger SS and subsequent hydration with normal saline. Various drugs that can increase serotonergic activity are being widely prescribed for patients with chronic pain. Clinicians should be aware of the potential for the occurrence of SS when prescribing pain medications to patients with chronic pain.
Collapse
Affiliation(s)
- Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
7
|
Kidd JD, Goetz TG, Shea EA, Bockting WO. Prevalence and minority-stress correlates of past 12-month prescription drug misuse in a national sample of transgender and gender nonbinary adults: Results from the U.S. Transgender Survey. Drug Alcohol Depend 2021; 219:108474. [PMID: 33360852 DOI: 10.1016/j.drugalcdep.2020.108474] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prescription drug (PD) misuse, particularly opioid misuse, is a major US public health concern. While transgender and gender nonbinary (TGNB) individuals experience numerous health disparities, including substance use disparities, little research has focused on PD misuse in this population. METHODS Data for this secondary analysis come from the US Transgender Survey (N = 26,689). First, we examined bivariate differences in past 12-month PD misuse among binary transgender women, binary transgender men, nonbinary individuals assigned-female-at-birth (AFAB), and nonbinary individuals assigned-male-at-birth (AMAB). We then used multivariable logistic regression (separately based on sex-assigned-at-birth) to examine the relationship between gender-identity related discrimination and PD misuse. RESULTS PD misuse was significantly more common among binary transgender men (17.3 %), nonbinary AFAB individuals (18.7 %), and nonbinary AMAB individuals (18.0 %); compared to binary transgender women (13.5 %). In multivariable analyses, nonbinary identity was associated with higher odds of PD misuse among TGNB AFAB individuals (OR = 1.121; 95 %CI 1.021-1.232) and AMAB individuals (OR = 1.315; 95 % CI 1.133-1.527). Controlling for overall health status and psychological distress, public accommodations discrimination was associated with PD misuse among TGNB AMAB individuals (OR = 1.578, 95 %CI 1.354-1.839). Among both groups, healthcare discrimination was associated with PD misuse (AFAB OR = 1.388, 95 %CI 1.255-1.534; AMAB OR = 1.227, 95 %CI 1.073-1.404). CONCLUSION In this national sample of TGNB individuals, nonbinary individuals were at greater risk for PD misuse than binary individuals, possibly due to less societal affirmation. Similar to other TGNB health disparities, discrimination based on gender identity/expression was associated with PD misuse. This highlights the importance of interventions to reduce discrimination against TGNB individuals.
Collapse
|
8
|
Egan KL, Gregory E, Foster SE, Cox MJ. Modifiable Risk Factors Associated With Disposal of Unused Prescription Drugs by Parents of Adolescents. J Prim Prev 2020; 41:529-545. [PMID: 33106915 PMCID: PMC7688568 DOI: 10.1007/s10935-020-00614-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 01/20/2023]
Abstract
The safe disposal of unused medications is one primary prevention strategy to reduce nonmedical prescription drug use among adolescents. We sought to identify modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents residing in ten south central Kentucky counties with disposal programs. In the fall of 2017, 4148 parents of adolescents participated in an anonymous, paper-based survey. We conducted generalized logit mixed models adjusted for within-school clustering to assess the relationship between disposal behaviors and modifiable risk factors while controlling for respondents' sociodemographic characteristics. The analytic sample consisted of parents in households in which someone had been prescribed an opioid medication within the past 12 months (N = 627). Our findings indicated that almost 42% of parents reported disposing of unused prescription medication within the past 12 months, and the majority disposed of medications at home rather than using a disposal program. Parents who perceived that any, compared to none, of their child's close friends engaged in nonmedical prescription opioid use had higher odds of reporting use of a disposal program. Parents who were aware of disposal programs, compared to those who were not aware, had greater odds of using them, rather than not disposing at all or disposing unused prescription medications at home. Compared to parents who perceived prescription drugs to be hard for adolescents to obtain for nonmedical use, parents who believed that prescription drugs were easily accessible to adolescents for nonmedical use had lower odds of using disposal programs than disposing of medications at home. Collectively, our findings suggest that enhancing awareness of disposal programs, while addressing parents' perceptions of their children's peers' use of nonmedical prescription opioids, should be considered to facilitate the disposal of unused medications and optimize current public health prevention efforts related to adolescent nonmedical use of these drugs.
Collapse
Affiliation(s)
- Kathleen L Egan
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3105 Carol G. Belk Building, Greenville, NC, 27858, USA.
| | - Eric Gregory
- Community Survey Solutions, LLC, Bowling Green, KY, USA
| | - Samantha E Foster
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3105 Carol G. Belk Building, Greenville, NC, 27858, USA
| | - Melissa J Cox
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3105 Carol G. Belk Building, Greenville, NC, 27858, USA
| |
Collapse
|
9
|
Egan KL, Wolfson M, Lukacena KM, Zelaya CM, McLeary MS, Helme DW. Developing a health communication campaign for disposal of unused opioid medications. Addict Behav Rep 2020; 12:100291. [PMID: 33364300 PMCID: PMC7752658 DOI: 10.1016/j.abrep.2020.100291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Communities throughout the United States have implemented medicine disposal programs to prevent diversion of unused opioid analgesics from homes but a general lack of awareness may contribute to low rates of utilization. The objective of this study was to develop and test community-based campaign messages promoting appropriate disposal of unused opioids at disposal programs. METHODS In Fall 2019, 491 residents (79% female, 97% White, mean age: 40 years) of five rural, Appalachian counties (3 in Kentucky and 2 in North Carolina) completed a web-based, experimental survey. Participants were randomly exposed to two of four messages and rated each message separately. A pretest-posttest design was utilized to assess change in beliefs about retaining unused prescription opioids in the home following exposure to message sets. RESULTS All messages favorably influenced participants' perceptions related to concerns and risks of retaining unused prescription opioids and importance of - and self-efficacy in disposing of unused opioid medications. After controlling for social and demographic characteristics and baseline beliefs in generalized linear mixed models, Message 1 outperformed other messages in increasing participants' concern about retaining unused prescription opioids in the home and Message 3 was most effective in increasing self-efficacy to dispose of unused prescription opioids. CONCLUSIONS Messages including young children and pictorially demonstrate how to dispose of medications may have the greatest impact on behavioral actions related to medication disposal. The findings from this study can be used to inform community-based campaigns to facilitate disposal of unused prescription opioids.
Collapse
Affiliation(s)
- Kathleen L. Egan
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, Riverside, CA, United States
| | - Kaylee M. Lukacena
- Department of Communication, University of Kentucky, Lexington, KY, United States
| | - Carina M. Zelaya
- Department of Communication, University of Kentucky, Lexington, KY, United States
| | - Monique S. McLeary
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Donald W. Helme
- Department of Communication, University of Kentucky, Lexington, KY, United States
| |
Collapse
|
10
|
Imtiaz S, Shield KD, Fischer B, Elton-Marshall T, Sornpaisarn B, Probst C, Rehm J. Recent changes in trends of opioid overdose deaths in North America. Subst Abuse Treat Prev Policy 2020; 15:66. [PMID: 32867799 DOI: 10.1186/s13011-020-00308-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
Background As several regulatory and environmental changes have occurred in North America, trends in overdose deaths were examined in the United States (US), Ontario and British Columbia (BC), including changes in consumption levels of prescription opioids (PO) and overdose deaths, changes in correlations between consumption levels of PO and overdose deaths and modeled differences between observed and predicted overdose deaths if no changes had occurred. Methods Consumption levels of PO included defined daily doses for statistical purposes per million inhabitants per day for the US and Canada (2001–2015). Overdose deaths included opioid overdose deaths for the US (2001–2017) and Ontario (2003–2017) and illicit drug overdose deaths for BC (2001–2017). The analytic techniques included structural break point analyses, Pearson product-moment correlations and multivariate Gaussian state space modeling. Results Consumption levels of PO changed in the US in 2010 and in Canada in 2012. Overdose deaths changed in the US in 2014 and in Ontario and BC in 2015. Prior to the observed changes in consumption levels of PO, there were positive correlations between consumption levels of PO and overdose deaths in the US (r = 0.99, p < 0.001) and Ontario (r = 0.92, p = 0.003). After the observed changes in consumption levels of PO, there was a negative correlation between consumption levels of PO and overdose deaths in the US (r = − 0.99, p = 0.002). Observed overdose deaths exceeded predicted overdose deaths by 5.7 (95% Confidence Interval [CI]: 4.8–6.6), 3.5 (95% CI: 3.2–3.8) and 21.8 (95% CI: 18.6–24.9) deaths per 100,000 people in the US, Ontario and BC, respectively in 2017. These excess deaths corresponded to 37.7% (95% CI: 31.9–43.6), 39.2% (95% CI: 36.3–42.1) and 72.2% (95% CI: 61.8–82.6) of observed overdose deaths in the US, Ontario and BC, respectively in 2017. Conclusions The opioid crisis has evolved in North America, as a sizeable proportion of overdose deaths are now attributable to the several regulatory and environmental changes. These findings necessitate substance use policies to be conceptualized more broadly as well as the continued expansion of harm reduction services and types of pharmacotherapy interventions.
Collapse
|
11
|
Shupp R, Loveridge S, Skidmore M, Green B, Albrecht D. Recognition and stigma of prescription drug abuse disorder: personal and community determinants. BMC Public Health 2020; 20:977. [PMID: 32571263 PMCID: PMC7310116 DOI: 10.1186/s12889-020-09063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prescription drug abuse (PDA) disorders continue to contribute to the current American opioid crisis. Within this context, our study seeks to improve understanding about stigma associated with, and symptom recognition of, prescription drug abuse. AIMS Model the stigma and symptom recognition of PDA in the general population. METHODS A randomized, nation-wide, online, vignette-focused survey of the general public (N = 631) was implemented with an oversample for rural counties. Logit estimation was used for analysis, with regional and county-level sociodemographic variables as controls. RESULTS Individual respondents that self-identify as having or having had "a prescription drug abuse issue" were less likely to correctly identify the condition and were 4 times more likely to exhibit stigma. Male respondents were approximately half as likely to correctly identify PDA as female respondents while older respondents (55+) were more likely to correctly identify PDA, relative to those aged 35-54. Being both male and younger was associated with slightly more stigma, in that they were less likely to disagree with the stigma statement. CONCLUSIONS In light of the continued risks that individuals with PDA behaviors face in potentially transitioning to illicit opioid use, the findings of this survey suggested a continued need for public education and outreach. Of particular note is the perspective of those who have self-identified with the condition, as this population faces the largest risks of adverse health outcomes from illicit drug use within the survey respondents.
Collapse
Affiliation(s)
- Robert Shupp
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Scott Loveridge
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Mark Skidmore
- Department of Agricultural, Food and Resource Economics & Economics, Michigan State University, East Lansing, MI 48824 USA
| | - Brandn Green
- JG Research & Evaluation, 2103 Bridger Drive, Suite 1, Bozeman, MT 59715 USA
| | - Don Albrecht
- Western Rural Development Center, Utah State University, 4880 Old Main Hill, Logan, UT 84322 USA
| |
Collapse
|
12
|
Egan KL, Gregory E, Osborne VL, Cottler LB. Power of the Peer and Parent: Gender Differences, Norms, and Nonmedical Prescription Opioid Use Among Adolescents in South Central Kentucky. Prev Sci 2020; 20:665-673. [PMID: 30637670 DOI: 10.1007/s11121-019-0982-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6th through 12th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, the adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU, whereas male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.
Collapse
Affiliation(s)
- Kathleen L Egan
- Department of Heath Education and Promotion, East Carolina University, 3105 Carol G. Belk Building, Greenville, NC, 27858, USA.
| | - Eric Gregory
- Community Survey Solutions, LLC, Bowling Green, KY, USA
| | - Vicki L Osborne
- Drug Safety Research Unit, Southampton, UK.,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
13
|
Aikin KJ, Betts KR, Boudewyns V, Johnson M, Davis CN. Consumer responses to framing statements preceding the major risk statement in prescription drug DTC TV ads. Res Social Adm Pharm 2019; 16:1237-1247. [PMID: 31838056 DOI: 10.1016/j.sapharm.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Research on the major risk statement in direct-to-consumer (DTC) prescription drug television ads has shown that risk severity and actionability can affect consumers' risk comprehension and perceptions. A framing statement presented just before the major risk statement may serve as a cue that directs attention to the risk statement that follows, or it may guide consumers' interpretation of the severity of the risks that follow. OBJECTIVE Examine how the use of different framing statements (severe, life-threatening; serious; or basic) that precede the major risk statement in DTC television ads affect consumers' risk perceptions, risk recognition, benefit perceptions, interest in the drug, and other relevant outcomes. METHODS An online experiment was conducted using a 1 × 3 between-subjects design to compare three different framing statements, which was replicated across three different DTC television ads that focused on different medical conditions (arthritis, lung cancer, and type 2 diabetes). A sample of US adults (N = 1961) was randomly assigned to view one of nine television ads and asked to respond to a questionnaire. RESULTS The type of framing statement had significant effects on perceived risk severity, perceived utility of risk and benefit information, fear of risks, and perceived likelihood of explicit and implicit benefits. CONCLUSIONS Consumers pay attention to and use cues to process and interpret the risk information presented to them in DTC television ads. Using lead-in language that describes risk severity, particularly for products with severe, life-threatening risks, may better allow consumers to make evaluative judgments on risk severity in DTC ads than stating the drug can cause serious reactions or simply that reactions are possible. More work is needed to examine the factors that affect people's understanding of the nature of risk severity, particularly with regard to risk recognition.
Collapse
Affiliation(s)
- Kathryn J Aikin
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA.
| | - Kevin R Betts
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA.
| | - Vanessa Boudewyns
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Mihaela Johnson
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Christine N Davis
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| |
Collapse
|
14
|
Lin HC, Wang Z, Simoni-Wastila L, Boyd C, Buu A. Interstate data sharing of prescription drug monitoring programs and associated opioid prescriptions among patients with non-cancer chronic pain. Prev Med 2019; 118:59-65. [PMID: 30316875 DOI: 10.1016/j.ypmed.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/18/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
All fifty states have implemented prescription drug monitoring programs (PDMPs) to reduce misuse and diversion of controlled drugs. Interstate PDMP data sharing has been called for by clinical practitioners, but evidence to support the effectiveness of PDMP data sharing is lacking. This study examined whether PDMP interstate data sharing with bordering states was associated with prescriptions of opioids. This was a cross-sectional study that included patients with non-cancer chronic pain from the 2014 National Ambulatory Medical Care Survey (weighted N = 66,198,751; unweighted N = 2846). Multinomial logistic regression was performed to examine the association between PDMP interstate data sharing status and patients' being prescribed opioids for pain treatment, controlling for covariates guided by the Eisenberg's model of physician decision-making. Findings indicated that patients residing in states with interstate PDMP data sharing with all or partial bordering states were not less likely to be prescribed opioids compared to those living in states without interstate data sharing. Other factors such as patient age, health insurance type, new patient status, and physician adoption of electronic medical records were associated with the likelihood of patients' being prescribed opioids. This study concluded that current practice of interstate PDMP data sharing with bordering states was not associated with patients' being prescribed opioids for non-cancer chronic pain treatment. Future studies and policy efforts that unravel technological, legal, and political barriers to reciprocal and equal interstate data sharing with bordering states should be warranted to inform PDMP redesign and in turn, augment overall PDMP effectiveness in reducing misuse of prescription opioids.
Collapse
Affiliation(s)
- Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, SPH 116, Bloomington, IN 47405, USA.
| | - Zhi Wang
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, SPH 116, Bloomington, IN 47405, USA.
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, 20 North Pine Street, Baltimore, MD 21201, USA.
| | - Carol Boyd
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
| | - Anne Buu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
| |
Collapse
|
15
|
McCabe SE, Veliz PT, Boyd CJ, Schepis TS, McCabe VV, Schulenberg JE. A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife. Drug Alcohol Depend 2019; 194:377-385. [PMID: 30481692 PMCID: PMC6355143 DOI: 10.1016/j.drugalcdep.2018.10.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This longitudinal study assesses characteristics associated with adolescents' nonmedical use of prescription opioids (NMUPO) including: frequency, co-ingestion, motives, specific opioid type; sequence of initiation of medical use of prescription opioids and NMUPO in relationship to subsequent substance use disorder (SUD) symptoms. METHODS Twenty-one independent national cohorts of U.S. high school seniors (n = 8,373) were surveyed and followed 17 years from adolescence to age 35. RESULTS The majority of adolescents who engaged in NMUPO reported occasional/frequent NMUPO, non-pain relief motives for NMUPO, simultaneous co-ingestion involving NMUPO and other drugs, opioid analgesics with high misuse potential, and multiple types of opioid analgesics. Adolescents who reported NMUPO for pain relief, NMUPO involving opioid analgesics with high misuse potential, or multiple prescription opioids had significantly greater odds of SUD symptoms at age 35, relative to those who had no history of NMUPO during adolescence. In addition, medical use of prescription opioids after initiating NMUPO (or NMUPO only) during adolescence was associated with significantly greater odds of subsequent SUD symptoms at age 35 relative to those who reported the medical use of prescription opioids only or had no medical use or NMUPO during adolescence. CONCLUSIONS This is the first U.S. national prospective study to examine the relationships between adolescents' NMUPO characteristics and later SUD symptoms in early midlife. Several characteristics (frequency, co-ingestion, motives, opioid type, and medical/NMUPO initiation history) were identified that could be used to screen and detect high-risk youth for indicated interventions to reduce prescription opioid misuse and SUDs.
Collapse
Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Philip T. Veliz
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA
| | - Carol J. Boyd
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48109, USA,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, TX 78666, USA
| | - Vita V. McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI 48109, USA,St. Joseph Mercy Ann Arbor, St. Joseph Mercy Health System, Ypsilanti, MI 48197, USA
| | - John E. Schulenberg
- Developmental Psychology, Department of Psychology, University of Michigan, Ann Arbor, MI 48106, USA,Institute for Social Research, University of Michigan, Ann Arbor, MI 48106, USA
| |
Collapse
|
16
|
Ros-Cucurull E, Palma-Álvarez RF, Daigre C, Jacas C, Perea M, Sorribes-Puertas M, Quesada M, Martínez-Arias R, Ros-Montalbán S, Casas M, Ramos-Quiroga JA, Roncero C, Grau-López L. Sex differences in an old adult sample with substance use disorder: A 6 months follow-up study. Psychiatry Res 2018; 270:1157-1165. [PMID: 30551310 DOI: 10.1016/j.psychres.2018.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/15/2018] [Accepted: 10/15/2018] [Indexed: 01/17/2023]
Abstract
Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.
Collapse
Affiliation(s)
- Elena Ros-Cucurull
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - Raúl Felipe Palma-Álvarez
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Jacas
- Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Perea
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain
| | - Marta Sorribes-Puertas
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain
| | - Marta Quesada
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Miguel Casas
- Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca (IBSAL) Salamanca, Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; Psychiatry Service, CIBERSAM, Vall Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Egan KL, Wolfson M, Dudley WN, Francisco VT, Strack RW, Wyrick DL, Perko MA. Diffusion of medication drop-boxes in North Carolina from 2007 to 2016. Addict Behav 2018; 86:44-50. [PMID: 29631797 DOI: 10.1016/j.addbeh.2018.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A permanent drug donation box ("drop-box") is one strategy implemented in communities across the United States to reduce the availability of excess controlled medications, including prescription opioids, for diversion. The objective of this study was to examine correlates of the diffusion and implementation of drop-boxes in North Carolina. METHODS We assessed the number and location of drop-boxes implemented in North Carolina. Cox proportional hazards models were used to examine covariates associated with drop-box implementation in NC counties (n = 100) between 2007 and 2016. RESULTS There were 311 drop-boxes implemented in 91 (out of 100) counties. Most drop-boxes were in law enforcement agencies (78.8%) and a growing number were in pharmacies (14.5%). Counties with a higher percentage of whites, more educated residents, a substance abuse prevention coalition, higher rates of controlled medications dispensed and prescription opioid overdose, and that were Appalachian were more likely to be early adopters. Rural counties were less likely to have a drop-box. In the multivariate model, only higher rate of controlled medicines dispensed was significant. CONCLUSIONS A growing number of drop-boxes are being implemented in law enforcement offices and pharmacies. Given that communities with higher rates of controlled medication dispensing likely have the highest need for disposal opportunities, it is promising that they are early adopters of drop-boxes. Future research should assess the effectiveness of drop-boxes as they become more widespread in a variety of locations.
Collapse
|
18
|
Abstract
Our objective was to determine whether and how quantitative information about drug benefits and risks is presented to consumers and healthcare professionals on cancer-related prescription drug websites. We analyzed the content of 65 active cancer-related prescription drug websites. We assessed the inclusion and presentation of quantitative information for two audiences (consumers and healthcare professionals) and two types of information (drug benefits and risks). Websites were equally likely to present quantitative information for benefits (96.9 %) and risks (95.4 %). However, the amount of the information differed significantly: Both consumer-directed and healthcare-professional-directed webpages were more likely to have quantitative information for every benefit (consumer 38.5 %; healthcare professional 86.1 %) compared with every risk (consumer 3.1 %; healthcare professional 6.2 %). The numeric and graphic presentations also differed by audience and information type. Consumers have access to quantitative information about oncology drugs and, in particular, about the benefits of these drugs. Research has shown that using quantitative information to communicate treatment benefits and risks can increase patients' and physicians' understanding and can aid in treatment decision-making, although some numeric and graphic formats are more useful than others.
Collapse
Affiliation(s)
- Helen W Sullivan
- U.S. Food and Drug Administration, 10903 New Hampshire Ave, Bldg 51, Silver Spring, MD, 20993-0002, USA.
| | - Kathryn J Aikin
- U.S. Food and Drug Administration, 10903 New Hampshire Ave, Bldg 51, Silver Spring, MD, 20993-0002, USA
| | | |
Collapse
|
19
|
Lin HC, Wang Z, Boyd C, Simoni-Wastila L, Buu A. Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. Addict Behav 2018; 76:348-354. [PMID: 28898808 DOI: 10.1016/j.addbeh.2017.08.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE State-level prescription drug monitoring programs (PDMPs) have been implemented in most states. PDMPs enable registered prescribers to obtain real-time information on patients' prescription history to reduce non-medical use of controlled drugs. This study examined whether PDMP implementation and different levels of PDMP requirements were associated with physicians' patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. METHODS This is a secondary analysis study using cross-sectional national data. Patients with non-cancer chronic pain from the 2012 National Ambulatory Medical Care Survey were included (weighted N=81,018,131; unweighted N=3295). Heckman two-step selection procedure employing two logistic regressions was used to explore the associations between PDMP requirements and physicians' prescribing behaviors, controlling for physician characteristics, patient characteristics, physician-healthcare system interaction, and physician-patient relationship, guided by the Eisenberg's model of physician decision making. RESULTS State PDMP implementation status and requirement levels were not associated with physician opioid prescribing for non-cancer chronic pain treatment (p's ranged 0.30-0.32). Patients with Medicare coverage were more likely to be prescribed opioid analgesics than those with private health insurance (OR=1.55, p<0.01). Hispanic patients were less likely to be prescribed opioid analgesics than non-Hispanic white patients (OR=0.61, p<0.05). CONCLUSIONS Findings indicated that the effectiveness of PDMPs on physicians' opioid prescribing tendency for non-cancer chronic pain treatment could not be supported. Policy makers should be aware of the need for redesigning PDMPs regarding requirements and enforcement for prescribers and related stakeholders. Future studies also are needed to identify characteristics contributing to PDMP effectiveness in reducing non-medical use of prescription opioids.
Collapse
|
20
|
Vie TL, Hufthammer KO, Holmen TL, Meland E, Breidablik HJ. Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database. SSM Popul Health 2017; 4:144-152. [PMID: 29349283 PMCID: PMC5769112 DOI: 10.1016/j.ssmph.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/10/2023] Open
Abstract
Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.
Collapse
Affiliation(s)
- Tina Lokke Vie
- Helse Førde HF/Førde Health Trust, postboks 1000, 6807 Førde, Norway
| | | | - Turid Lingaas Holmen
- HUNT Research Centre, Department of Public health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | | |
Collapse
|
21
|
Austin AE, Proescholdbell SK, Creppage KE, Asbun A. Characteristics of self-inflicted drug overdose deaths in North Carolina. Drug Alcohol Depend 2017; 181:44-49. [PMID: 29032024 DOI: 10.1016/j.drugalcdep.2017.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Drug overdose mortality is a major public health concern in the United States, with prescription opioids contributing substantially to recent increases in drug overdose deaths. Compared to unintentional drug overdose deaths, relatively little data describes intentional self-inflicted drug overdose deaths (i.e., suicide by drug overdose). The aim of this study was to examine the characteristics of self-inflicted drug overdose deaths, overall and in comparison to unintentional drug overdose deaths. METHODS We linked vital statistics, prescription drug monitoring program, and toxicology data for self-inflicted and unintentional drug overdose deaths among North Carolina residents in 2012. RESULTS Most self-inflicted (79.2%) and unintentional (75.6%) drug overdose decedents had a prescription for a controlled substance within one year of death. Toxicology results revealed that antidepressants contributed to a significantly higher percent of self-inflicted compared to unintentional drug overdose deaths (45.0% vs. 8.1%). Among deaths in which commonly prescribed opioids (oxycodone, hydrocodone) or benzodiazepines (alprazolam, clonazepam) contributed to death, a significantly higher percent of self-inflicted drug overdose decedents had a prescription for the substance within 30days of death compared to unintentional drug overdose decedents. CONCLUSIONS The results highlight the use of prescription opioids, benzodiazepines, and antidepressants among self-inflicted drug overdose decedents. Importantly, the results indicate that self-inflicted drug overdose decedents were more likely than unintentional drug overdose decedents to have potential contact with the health care system in the weeks preceding death, offering an opportunity for professionals to identify and intervene on risk factors or signs of distress and potential for self-harm.
Collapse
Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - Scott K Proescholdbell
- Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, United States
| | - Kathleen E Creppage
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States
| | - Alex Asbun
- Drug Control Unit, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, North Carolina Department of Health and Human Services, United States
| |
Collapse
|
22
|
Garada M, McLachlan AJ, Schiff GD, Lehnbom EC. What do Australian consumers, pharmacists and prescribers think about documenting indications on prescriptions and dispensed medicines labels?: A qualitative study. BMC Health Serv Res 2017; 17:734. [PMID: 29141618 PMCID: PMC5688705 DOI: 10.1186/s12913-017-2704-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Documenting the indication on prescriptions and dispensed medicines labels is not standard practice in Australia. However, previous studies that have focused on the content and design of dispensed medicines labels, have suggested including the indication as a safety measure. The aim of this study was to investigate the perspectives of Australian consumers, pharmacists and prescribers on documenting the indication on prescriptions and dispensed medicines labels. METHODS Semi-structured interviews were conducted and mock-up of dispensed medicines labels were designed for participants. Consumers (n = 19) and pharmacists (n = 7) were recruited by convenience sample at community pharmacies in Sydney (Australia) and prescribers (n = 8), including two medical students, were recruited through snowballing. RESULTS Thirty-four participants were interviewed. Most participants agreed that documenting the indication would be beneficial especially for patients who are forgetful or take multiple medications. Participants also believed it would improve consumers' medication understanding and adherence. Prescribers and pharmacists believed it could help reduce prescribing and dispensing errors by matching the drug/dosage to the correct indication. Prescribers refrained from documenting the indication to protect patients' privacy; however, most patients did not consider documenting the indication as a breach of privacy. Prescribers raised concerns about the extra time to include indications on prescriptions and best language to document indications, using plain language as opposed to medical terminology. CONCLUSIONS All interviewed stakeholders identified numerous benefits of documenting the indication on prescriptions and dispensed medicines labels. Whether these potential benefits can be realized remains unknown and addressing prescribers' concern regarding the time involved in documenting the indication on prescriptions remains a challenge for vendors of electronic medication management systems.
Collapse
Affiliation(s)
- Mona Garada
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, Australia.,Centre for Education and Research on Ageing, Concord Hospital, Sydney, Australia
| | - Gordon D Schiff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elin C Lehnbom
- Faculty of Pharmacy, University of Sydney, Sydney, Australia. .,Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. .,Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| |
Collapse
|
23
|
Amoozegar JB, Rupert DJ, Sullivan HW, O'Donoghue AC. Consumer confusion between prescription drug precautions and side effects. Patient Educ Couns 2017; 100:1111-1119. [PMID: 28069321 PMCID: PMC7325559 DOI: 10.1016/j.pec.2016.12.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Multiple studies have identified consumers' difficulty correctly interpreting risk information provided about prescription drugs, whether in printed format or online. This study's purpose was to explore whether consumers can distinguish between prescription drug precautions and side effects presented on brand-name drug websites. METHODS Participants (n=873) viewed fictitious drug websites that presented both precautions and side effects for one of four drugs, and they completed a survey assessing recall and comprehension. We coded open-ended recall data to identify whether drug precautions were mentioned and, if so, how they were interpreted. RESULTS Approximately 15% of participants mentioned at least one drug precaution. The majority (59.7%) misinterpreted precautions as potential side effects. Participants who misinterpreted precautions rated the drugs as significantly more likely to cause side effects than participants who accurately interpreted the precautions. Age, education, literacy, and other factors did not appear to predict precaution interpretation. CONCLUSION At least some consumers are likely to interpret precautions on drug websites as potential side effects, which might affect consumer preferences, treatment decisions, and medication safety. PRACTICE IMPLICATIONS Healthcare providers should be aware of this potential confusion, assess patients' understanding of precautions and potential side effects, and address any misunderstandings.
Collapse
Affiliation(s)
- Jacqueline B Amoozegar
- Social and Health Organizational Research and Evaluation Program, RTI International, Research Triangle Park, NC, USA.
| | - Douglas J Rupert
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Helen W Sullivan
- Office of Prescription Drug Promotion, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Amie C O'Donoghue
- Office of Prescription Drug Promotion, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| |
Collapse
|
24
|
Hu T, Decker SL, Chou SY. The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing. Int J Health Econ Manag 2017; 17:10.1007/s10754-017-9211-2. [PMID: 28168448 PMCID: PMC6606398 DOI: 10.1007/s10754-017-9211-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 01/05/2017] [Indexed: 06/01/2023]
Abstract
We test the effect of the introduction of Medicare Part D on physician prescribing behavior by using data on physician visits from the National Ambulatory Medical Care Survey (NAMCS) 2002-2004 and 2006-2009 for patients aged 60-69. We use regression discontinuity designs to estimate the effect of part D around the age of 65 before and after 2006 and then compare the discrete jump in outcomes at age 65 before and after Part D. We find a 32% increase in the number of prescription drugs prescribed or continued per visit and a 46% increase in the number of generic drugs prescribed or continued for the elderly after the introduction of Medicare Part D.
Collapse
Affiliation(s)
- Tianyan Hu
- Corresponding author. 423 Guardian Drive, Room 1404, Blockley Hall, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, PA 19104. Tel.:+1 215 573 3729;
| | - Sandra L. Decker
- National Center for Health Statistics, CDC. 3311 Toledo Rd., Hyattsville, MD 20782, United States.
| | - Shin-Yi Chou
- Department of Economics, Lehigh University, Bethlehem, PA 18015, United States. Tel.:+1610 758 3444; Fax: +1610 758 4677.
| |
Collapse
|
25
|
Egan KL, Gregory E, Sparks M, Wolfson M. From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data. Am J Drug Alcohol Abuse 2016; 43:69-77. [PMID: 27797283 DOI: 10.1080/00952990.2016.1240801] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Organized disposal of controlled medications, such as take-back events and permanent drug donation boxes, is a prevention strategy that has been widely used to reduce the availability of controlled medications for diversion or abuse. However, little is known as to whether this strategy actually reduces the overall availability of these medications for the purposes of diversion or abuse. OBJECTIVES The objective of this study was to compare the number and types of controlled medications that were disposed through organized efforts to the number dispensed in local communities. METHODS The quantity and type of controlled medication collected from three take-back events and permanent drug donation boxes over 4-week-long periods in five counties in south-central Kentucky was measured and compared to the number of controlled medications dispensed, as reported by Kentucky All Schedule Prescription Electronic Reporting system. RESULTS In 2013, 21,121,658 controlled medications units were dispensed in the participating counties. Of those, 46.9% were opioid analgesics, 13.1% tranquilizers, and 37.3% "other." During the assessment periods, a total of 21,503 controlled medication units were collected. Of those, 39.9% were opioid analgesics, 2.7% tranquilizers, and 57.4% "other." Annually, controlled medications disposed were estimated to account for 0.3% of those dispensed. CONCLUSION Controlled medications collected by take-back events and permanent drug donation boxes constituted a miniscule proportion of the numbers dispensed. Our findings suggest that organized drug disposal efforts may have a minimal impact on reducing the availability of unused controlled medications at a community level.
Collapse
Affiliation(s)
- Kathleen L Egan
- a Department of Social Science and Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Center for Research on Substance Use and Addiction , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Education , University of North Carolina at Greensboro , Greensboro , NC , USA
| | - Eric Gregory
- d Save Our Kids Coalition , Bowling Green , KY , USA
| | | | - Mark Wolfson
- a Department of Social Science and Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Center for Research on Substance Use and Addiction , Wake Forest School of Medicine , Winston-Salem , NC , USA
| |
Collapse
|
26
|
Jamison JJ, Wang J, Surbhi S, Adams S, Solomon D, Hohmeier KC, McDonough S, Eoff JC. Impact of Medicare Part D on Racial and Ethnic Minorities. Divers Equal Health Care 2016; 13:326-333. [PMID: 28008353 PMCID: PMC5166707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Prior to the implementation of Medicare Part D in the United States, inequalities were found to exist in the use of medications between minority and white beneficiaries. Despite improvements in medication affordability after Medicare Part D implementation, it is still not clear whether the characteristics of the program have improved drug utilization patterns among minorities to the same degree as whites. This review aims to determine whether there were barriers for Medicare Part D to realize its potential to improve prescription drug utilization patterns among minorities. METHODS Google Scholar, PubMed, Sciencedirect and Scopus were used to conduct a comprehensive search of the literature published since 2003 when the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed, which authorized the establishment of the Part D program. All studies and documents related to the effects of Medicare Part D on minorities were included to present a relatively comprehensive review on the topic. RESULTS Evidence indicated that minorities are not equally benefiting from Medicare Part D prescription drug coverage compared to whites. Examples of characteristics of Medicare Part D that caused significant racial differences in drug utilization include the donut hole, the complexity and number of drug plans, and drug utilization management strategies. CONCLUSION Medicare Part D has increased access to prescription medications for the elderly. However, continued analysis and research of drug utilization patterns among minorities should be conducted to ensure that all enrollees regardless of race are benefiting equally from Medicare Part D. Identification of these barriers can provide insights on how to improve the program to allow minorities to benefit equally from the Medicare Part D program and remove health inequalities.
Collapse
Affiliation(s)
- JoEllen Jarrett Jamison
- The University of Tennessee Health Science Center, College of Pharmacy, Pharmacy Student, 881 Madison Avenue, Memphis, TN 38163
| | - Junling Wang
- Professor, Health Outcomes and Policy Research, Department of Clinical Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163
| | - Satya Surbhi
- Graduate Research Assistant/Ph.D. Student, Health Outcomes and Policy Research, The University of Tennessee Health Science Center College of Graduate Health Sciences, 956 Court Avenue, Room D224, Memphis, TN 38163
| | - Samantha Adams
- The University of Tennessee Health Science Center, College of Pharmacy, Pharmacy Student, 881 Madison Avenue, Room 221, Memphis, TN 38163
| | - David Solomon
- Department of Clinical Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163
| | - Kenneth C. Hohmeier
- Assistant Professor of Clinical Pharmacy, Director of Community Affairs, Department of Clinical Pharmacy, The University of Tennessee College of Pharmacy, 193 Polk Avenue, Room 2D, Nashville, TN 37210
| | - Sharon McDonough
- Coordinator of Assessment and Assistant Professor, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 252, Memphis, TN 38163
| | - James C. Eoff
- The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 242, Memphis, TN 38163
| |
Collapse
|
27
|
Abstract
This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.).
Collapse
Affiliation(s)
- Debra Houry
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
| | - Grant Baldwin
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| |
Collapse
|
28
|
Agbabiaka T, Wider B, Watson LK, Goodman C. Concurrent use of prescription drugs and herbal medicinal products in older adults: a systematic review protocol. Syst Rev 2016; 5:65. [PMID: 27098011 DOI: 10.1186/s13643-016-0244-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a global increase in the use of herbal medicinal products (HMPs). About a quarter of UK adults use HMPs, bought over the counter by self-prescription and often not disclosed to healthcare professionals. Potential herb-drug interaction is a clinical concern, with older people at greater risk because of co-morbidities and slower clearance of pharmacologically active compounds. While there is a good understanding of general herbal medicine use by older people, less is known about the extent and implications of concurrent use with prescription medicines. The aim of this systematic review is to assess the prevalence, patterns, safety issues and other factors associated with concurrent prescription and herbal medicines use among older adults. METHODS/DESIGN Systematic electronic searches of MEDLINE, PsychINFO, Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Web of Science and Cochrane from inception till present for studies reporting the concurrent use of prescription medicines with HMPs in older adults (≥65 years). Lateral searching via related citation (PubMed) and checking reference lists of identified studies will be performed. Two reviewers will independently screen studies, extract data and appraise methodological quality using the Joanna Briggs Institute checklist for prevalence data and the Critical Appraisal Skills Programme (CASP) checklist. Qualitative and quantitative studies from all settings will be included. Non-empirical papers, in vitro experiments and animal studies will be excluded. Primary outcomes are prevalence and patterns of concurrent use, number and types of prescription and HMPs and adverse reactions reported. Secondary outcomes are disclosure of HMP use to healthcare professionals and cost of HMPs. A narrative synthesis of included studies will be performed to summarise the evidence. DISCUSSION This review will synthesise and critically appraise current knowledge on the concurrent use of drugs and HMPs by older adults and thus provide a better understanding of the issue. It will also identify any gaps in knowledge. By establishing safety issues associated with concurrent use, it will also inform strategies that can help practitioners to identify and manage older people at potential risk of herb-drug interactions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009091.
Collapse
|
29
|
Jeffers AJ, Benotsch EG, Green BA, Bannerman D, Darby M, Kelley T, Martin AM. Health anxiety and the non-medical use of prescription drugs in young adults: A cross-sectional study. Addict Behav 2015; 50:74-7. [PMID: 26103426 DOI: 10.1016/j.addbeh.2015.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 04/06/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Studies have demonstrated a relation between health anxiety (hypochondriasis) and substance use, but this minimal body of literature has focused on alcohol or illicit drugs. The use of medications without a physician's prescription (i.e., non-medical use of prescription drugs, NMUPD) is increasingly prevalent among young adults. Health anxiety, a tendency to worry excessively about health, is a factor that could contribute to NMUPD, but this has not been examined. The purpose of the current study was to examine the relations among health anxiety, NMUPD, and other psychological variables related to substance use. METHODS In the present study, young adult college students (N = 758), ages 18-25, completed an anonymous online survey assessing demographics, health anxiety, NMUPD, and other psychological characteristics, including depression and general anxiety. RESULTS Participants who reported NMUPD had higher scores in health anxiety, as well as more frequent healthcare appointments, and were more likely to report having a chronic health condition. Given that multiple factors influence a decision to engage in NMUPD, a multivariable logistic regression analysis was performed. Results suggested that hopelessness, sensation-seeking, and health anxiety were risk factors for NMUPD, and that health anxiety predicted NMUPD over and above these other variables. CONCLUSIONS Medical professionals and mental health service providers should be aware of the increased risk of NMUPD for patients with health anxiety. Future research on NMUPD should more closely examine the role of health anxiety.
Collapse
Affiliation(s)
- Amy J Jeffers
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| | - Eric G Benotsch
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States.
| | - Brooke A Green
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| | - Dana Bannerman
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| | - Miriam Darby
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| | - Tara Kelley
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| | - Aaron M Martin
- Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284, United States
| |
Collapse
|
30
|
Fernandes JC, Campana D, Harwell TS, Helgerson SD. High mortality rate of unintentional poisoning due to prescription opioids in adults enrolled in Medicaid compared to those not enrolled in Medicaid in Montana. Drug Alcohol Depend 2015; 153:346-9. [PMID: 26077605 DOI: 10.1016/j.drugalcdep.2015.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/11/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Unintentional death due to prescription drug-related poisoning has been a growing problem nationally. Some sub-populations have been shown to be at higher risk than others. METHODS In 2014, we matched death records to Medicaid eligibility files to determine enrollment status at the time of unintentional death from prescription opioid poisoning from 2003 to 2012 in Montana. Medicaid prescription claims for decedents were used to assess prescribing patterns and time between refills. RESULTS The age-adjusted mortality rate per 100,000 from opioid poisoning for adults aged 18-64 years and enrolled in Medicaid at the time of death was eight times higher than the rate for non-Medicaid Montana adults (38.2 [95% CI (30.7-45.7)] vs. 4.7 [95% CI (4.1-5.3)]). Twenty-eight percent of unintentional poisoning deaths during this time frame were among Medicaid members. Only 33% of the Medicaid decedents had a claim for an opioid prescription during the month before their death. CONCLUSION Our findings suggest that more needs to be done to address prescription opioid use in Montana. Adults enrolled in Medicaid continue to be at high risk for prescription opioid unintentional poisoning deaths. Data on prescribing practices suggest that there are opportunities to intervene and provide education on use of opioid medications for Medicaid members and prescribing providers.
Collapse
Affiliation(s)
- Jessie C Fernandes
- Injury Prevention Program, Montana Department of Public Health and Human Services, Helena, MT, United States
| | - David Campana
- Montana Medicaid Program, Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Todd S Harwell
- Injury Prevention Program, Montana Department of Public Health and Human Services, Helena, MT, United States.
| | - Steven D Helgerson
- Injury Prevention Program, Montana Department of Public Health and Human Services, Helena, MT, United States
| |
Collapse
|
31
|
Li G, Brady JE, Lang BH, Giglio J, Wunsch H, DiMaggio C. Prescription drug monitoring and drug overdose mortality. Inj Epidemiol 2014; 1:9. [PMID: 27747666 PMCID: PMC5005551 DOI: 10.1186/2197-1714-1-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/04/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Abuse of prescription drugs, particularly opioid analgesics, has become a major source of injury mortality and morbidity in the United States. To prevent the diversion and misuse of controlled substances, many states have implemented prescription drug monitoring programs (PDMPs). This study assessed the impact of state PDMPs on drug overdose mortality. METHODS We analyzed demographic and drug overdose mortality data for state-quarters with and without PDMPs in 50 states and the District of Columbia during 1999-2008, and estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of drug overdose mortality associated with the implementation of state PDMPs through multivariable negative bionomial regression modeling. RESULTS During the study period, annual national death rates from drug overdose increased by 96%, from 5.7 deaths per 100,000 population in 1999 to 11.2 in 2008. The impact of PDMPs on drug overdose mortality varied greatly across states, ranging from a 35% decrease in Michigan (aRR = 0.65; 95% CI = 0.54-0.77) to a more than 3-fold increase in Nevada (aRR = 3.37; 95% CI = 2.48-4.59). Overall, implementation of PDMPs was associated with an 11% increase in drug overdose mortality (aRR = 1.11; 95% CI = 1.02-1.21). CONCLUSIONS Implementation of PDMPs did not reduce drug overdose mortality in most states through 2008. Program enhancement that facilitates the access and use of prescription drug monitoring data systems by healthcare practitioners is needed.
Collapse
Affiliation(s)
- Guohua Li
- Department of Anesthesiology, Columbia University, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, 722 West 168th St, 5th Floor, New York, NY 10032 USA
| | - Joanne E Brady
- Department of Anesthesiology, Columbia University, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, 722 West 168th St, 5th Floor, New York, NY 10032 USA
| | - Barbara H Lang
- Department of Anesthesiology, Columbia University, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - James Giglio
- Department of Emergency Medicine, Columbia University, PH1-137 New York, NY USA
| | - Hannah Wunsch
- Department of Anesthesiology, Columbia University, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, 722 West 168th St, 5th Floor, New York, NY 10032 USA
| | - Charles DiMaggio
- Department of Anesthesiology, Columbia University, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Epidemiology, Columbia University, 722 West 168th St, 5th Floor, New York, NY 10032 USA
| |
Collapse
|