1
|
Cesur R, Sabia JJ, Bradford WD. The effect of combat deployments on veteran opioid abuse. Health Econ 2024; 33:1284-1318. [PMID: 38424463 DOI: 10.1002/hec.4812] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
Grim national statistics about the U.S. opioid crisis are increasingly well known to the American public. Far less well known is that U.S. servicemembers are at ground zero of the epidemic, with veterans facing an overdose death rate of up to twice that of civilians. Exploiting a quasi-experiment in overseas deployment assignment, this study estimates the causal impact of combat exposure among the deployed in the Global War on Terrorism on opioid abuse. We find that exposure to war theater substantially increased the risk of prescription painkiller abuse and illicit heroin use among active duty servicemen. The magnitudes of our estimates imply lower-bound combat exposure-induced healthcare costs of $1.04 billion per year for prescription painkiller abuse and $470 million per year for heroin use.
Collapse
Affiliation(s)
- Resul Cesur
- Finance Department, University of Connecticut, NBER & IZA, Storrs, Connecticut, USA
| | - Joseph J Sabia
- Center for Health Economics & Policy Studies, San Diego State University and IZA, San Diego, California, USA
| | - W David Bradford
- Department of Public Administration & Policy, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
2
|
Wuyts SCM, Torensma B, Schellekens AFA, Kramers CK. Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm. J Clin Med 2023; 12:4296. [PMID: 37445331 DOI: 10.3390/jcm12134296] [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: 06/01/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
The persisting use of opioids following bariatric surgery has emerged as a prevalent complication, heightening the probability of opioid-related harm (ORM), such as opioid-related fatalities and prescription opioid use disorder (OUD). A comprehensive review of PubMed literature from 1990 to 2023 was conducted to pinpoint physiological influences on postoperative ORM. As a result, we found that patients undertaking bariatric operations often exhibit an inherently higher risk for substance use disorders, likely attributable to genetic predisposition and related neurobiological changes that engender obesity and addiction-like tendencies. Furthermore, chronic pain is a common post-bariatric surgery complaint, and the surgical type impacts opioid needs, with increased long-term opioid use after surgeries. Additionally, the subjective nature of pain perception in patients with obesity can distort pain reporting and the corresponding opioid prescription both before and after surgery. Furthermore, the postoperative alterations to the gastrointestinal structure can affect the microbiome and opioid absorption rates, resulting in fluctuating systemic exposure to orally ingested opioids. The prospect of ORM development post-bariatric surgery appears amplified due to a preexisting susceptibility to addictive habits, surgically induced pain, modified gut-brain interaction and pain management and the changed pharmacokinetics post-surgery. Further research is warranted to clarify these potential risk variables for ORM, specifically OUD, in the bariatric population.
Collapse
Affiliation(s)
- Stephanie C M Wuyts
- Pharmacy Department, Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium
- Research Group Clinical Pharmacology and Clinical Pharmacy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Bart Torensma
- Department of Anesthesiology, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Cornelis Kees Kramers
- Department of Internal Medicine and Pharmacology-Toxicology, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands
| |
Collapse
|
3
|
Teker C, Aslan R, İpekçi C, Tokdemir M, Akgür SA. Pregabalin Qualitative Detection in Turkish Forensic Cases Between 2017 to 2018. J Psychoactive Drugs 2023:1-7. [PMID: 37343948 DOI: 10.1080/02791072.2023.2226138] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.
Collapse
Affiliation(s)
- Ceyda Teker
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Rukiye Aslan
- Toxicology and Pharmaceutical Science, Ege University Institute on Drug Abuse, Izmir, Turkey
| | - Cahit İpekçi
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Mehmet Tokdemir
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
- Department of Forensic Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| | - Serap Annette Akgür
- Toxicology and Pharmaceutical Science, Ege University Institute on Drug Abuse, Izmir, Turkey
| |
Collapse
|
4
|
Schepis TS, Wastila L, McCabe SE. Family history of substance use disorder and likelihood of prescription drug misuse in adults 50 and older. Aging Ment Health 2023; 27:1020-1027. [PMID: 35686721 PMCID: PMC9734280 DOI: 10.1080/13607863.2022.2084711] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Individuals who are family history positive (FHP) for substance use problems have increased risk for substance use, substance use disorders (SUDs), and psychopathology. Links between FHP status and prescription drug misuse (PDM) have not been well investigated; this study examined PDM in adults 50 and older by FHP status. METHODS Data were from the US NESARC-III (n = 14,667). Participants reported their opioid PDM, tranquilizer/sedative PDM, SUD, psychopathology, and family history status (i.e. first- and second-degree relatives with alcohol/substance use problems). Prevalence rates were estimated by FHP status, and logistic regressions compared FHP and family history negative (FHN) groups. RESULTS FHP status was associated with significantly higher rates of PDM (e.g. past-year opioid PDM, FHP: 3.8%, FHN: 1.5%) and SUD from PDM (e.g. past-year SUD, FHP: 1.2%, FHN: 0.2%); also, prevalence varied by family history density, with the highest rates in those with three or more relatives with substance use problems (e.g. past-year opioid PDM: 5.5%). Overall, 32.2% of FHP individuals with past-year PDM had past-year co-occurring SUD and psychopathology diagnoses, versus 11.0% of FHN individuals. CONCLUSION FHP status could inform treatment decisions in adults 50 and older with conditions for which prescription opioids or tranquilizer/sedatives are indicated.
Collapse
Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Linda Wastila
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland, Baltimore, Maryland, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Sahebi-Fakhrabad A, Sadeghi AH, Kemahlioglu-Ziya E, Handfield R, Tohidi H, Vasheghani-Farahani I. The Impact of Opioid Prescribing Limits on Drug Usage in South Carolina: A Novel Geospatial and Time Series Data Analysis. Healthcare (Basel) 2023; 11:healthcare11081132. [PMID: 37107966 PMCID: PMC10137799 DOI: 10.3390/healthcare11081132] [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: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study investigates the impact of South Carolina's prescription limit law (S.C. Code Ann. 44-53-360), which aims to reduce opioid overdose deaths, on opioid prescription rates. The study utilizes South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) data and proposes a distance classification system to group records based on proximity and evaluates prescription volumes in each distance class. Prescription volumes were found to be highest in classes with pharmacies located further away from the patient. An Interrupted Time Series (ITS) model is utilized to assess the policy impact, with benzodiazepine prescriptions as a control group. The ITS models indicate an overall decrease in prescription volume, but with varying impacts across the different distance classes. While the policy effectively reduced opioid prescription volumes overall, an unintended consequence was observed as prescription volume increased in areas where prescribers were located at far distances from patients, highlighting the limitations of state-level policies on doctors. These findings contribute to the understanding of the effects of prescription limit laws on opioid prescription rates and the importance of considering location and distance in policy design and implementation.
Collapse
Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Eda Kemahlioglu-Ziya
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
| | | | | |
Collapse
|
6
|
Soeiro T, Micallef J. Commentary on Perry et al.: New means, new measures-without discarding all the previous ones! Addiction 2022; 117:205-206. [PMID: 34661941 DOI: 10.1111/add.15691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Soeiro
- Inserm, Aix-Marseille Université, Marseille, France.,Hôpitaux Universitaires de Marseille, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| | - Joëlle Micallef
- Inserm, Aix-Marseille Université, Marseille, France.,Hôpitaux Universitaires de Marseille, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| |
Collapse
|
7
|
Dumonceau RG, Soeiro T, Lacroix C, Giocanti A, Frauger É, Mezaache S, Micallef J. Antidepressants abuse in subjects with opioid use disorders: A 10-year study in the French OPPIDUM program. Fundam Clin Pharmacol 2021; 36:436-442. [PMID: 34837277 DOI: 10.1111/fcp.12738] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023]
Abstract
Accumulating evidence shows that some antidepressants are abused for their psychostimulant effects, but the extent of antidepressants abuse is unknown in subjects with opioid use disorders (OUD). The objective of this work is to assess the prevalence of antidepressant abuse and its correlates in subjects with OUD. Subjects ≥18 year-old in an opiate maintenance treatment (OMT) program who reported using an antidepressant were selected from the OPPIDUM program from 2011 to 2020. The outcome was antidepressant abuse. Antidepressant abusers were identified as subjects reporting at least one of the following behaviors: "drug abuse," "concomitant use of alcohol," "illegal obtaining," and "dose higher than recommended in the Summary of Product Characteristics." Among the 83 040 observations of subjects ≥18 year-old in an OMT program included in the OPPIDUM program from 2011 to 2020, 2708 (3.3%) subjects reported using an antidepressant in monotherapy. Among them, there were 385 (14.2%) abusers. The proportion of abusers was the highest for amitriptyline (n = 31, 25.0%). In multivariate analysis, antidepressant abuse was positively associated with amitriptyline (OR 2.07, 95% CI [1.16, 3.73]; p = 0.015), unemployment (OR 1.52, 95% CI [1.16, 2.01]; p = 0.003), the use of intravenous route of administration (OR 1.77, 95% CI [1.12, 2.80]; p = 0.014), and the use of benzodiazepines (OR 1.53, 95% CI [1.21, 1.94]; p < 0.001). Clinicians should be aware of the risk of antidepressant abuse when prescribing in subjects with OUD, accounting for their heterogeneous pharmacological properties that may account for their abuse potential.
Collapse
Affiliation(s)
- Robinson Gravier Dumonceau
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France
| | - Thomas Soeiro
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France.,Aix-Marseille Université, Inserm, UMR 1106, Marseille, France
| | - Clémence Lacroix
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France.,Aix-Marseille Université, Inserm, UMR 1106, Marseille, France
| | - Adeline Giocanti
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France
| | - Élisabeth Frauger
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France
| | - Salim Mezaache
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France
| | - Joëlle Micallef
- Assistance publique - Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'Évaluation et d'information sur la pharmacodépendance - Addictovigilance PACA Corse, Marseille, France.,Aix-Marseille Université, Inserm, UMR 1106, Marseille, France
| |
Collapse
|
8
|
Wilson DL. Preventing Prescription Drug Abuse: A Pharmacy Technician Tool Kit. J Pharm Technol 2021; 36:218-219. [PMID: 34752545 DOI: 10.1177/8755122520939639] [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] [Indexed: 11/16/2022] Open
Abstract
The misuse of prescription medications in the United States is a worsening public health problem. Pharmacy technicians are often the first pharmacy staff member to receive newly dropped off prescriptions and to interact with patients in the pharmacy. Having a tool kit of the knowledge and skills needed to distinguish prescriptions that may result in misuse from the legitimate ones and to respond appropriately and professionally to each is essential to pharmacy technicians performing their role and function in the dispensing process.
Collapse
|
9
|
Geise R, Powers MF. Roles of Pharmacy Technicians in Preventing Prescription Drug Abuse. J Pharm Technol 2021; 36:211-217. [PMID: 34752547 DOI: 10.1177/8755122520939640] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: To provide and identify potential roles and strategies for pharmacy technicians to identify and prevent drug abuse within the pharmacy. Data Sources: Related materials were searched via PubMed and Google Scholar from 2000 to present using search terms: "pharmacy," "technicians," "prescription," "drug," and "abuse." Articles describing statistics, warning signs, and prevention strategies for pharmacies were identified through databases and organizations' sites. Portions of the Ohio Administrative Code on OARRS (Ohio Automated Rx Reporting System), and Pennsylvania prescription drug monitoring program information were also identified. Study Selection and Data Extraction: Relevant sections of the Ohio Administrative Code and OARRS were identified through the Ohio Board of Pharmacy website. Information regarding the Pennsylvania Prescription Drug Monitoring was identified via Pennsylvania's Department of Health website. Sections of the Combat Methamphetamine Act of 2005 were identified through the Drug Enforcement Administration Diversion website. Resources on drug abuse and prevention statistics were obtained from Drug Abuse.gov and American Society of Health System Pharmacists. Information regarding warning signs were identified from the National Association of Boards of Pharmacy. Data Synthesis: The data provided for identification of potential roles for technicians within efforts to prevent prescription drug abuse, including evaluation of warning signs, involvement in the use of prescription monitoring programs, and in efforts to prevent methamphetamine abuse and diversion. Conclusions: After identifying potential roles for pharmacy technician involvement in the prevention of prescription drug abuse, it is evident that there is a need for further education and training on the subject specific to pharmacy technicians.
Collapse
|
10
|
Chappuy M, Nourredine M, Clerc B, Fahmi M, Misslin P, Berthier M, Laloi L, Rolland B. Gabapentinoid use in French most precarious populations: Insight from Lyon Permanent Access to Healthcare (PASS) units, 2016-1Q2021. Fundam Clin Pharmacol 2021; 36:448-452. [PMID: 34498306 DOI: 10.1111/fcp.12726] [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: 06/07/2021] [Revised: 08/11/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gabapentinoids (i.e., gabapentin and pregabalin) are medications approved for epilepsy, chronic pain, or generalized anxiety disorder. Recently, there have been regular reports of misuse of pregabalin, and to a lesser extent, gabapentin, in particular among opioid and polydrug users. OBJECTIVES To longitudinally explore the amounts of gabapentinoids dispensed in Lyon's Permanent Access to Healthcare (PASS) units, which offer permanent and free healthcare to precarious populations with no healthcare insurance coverage. METHODS We collected the amounts of pregabalin and gabapentin dispensed in the three PASS units of Lyon and calculated the average doses dispensed monthly between 2016 and the first quarter of 2021 (1Q2021), with and without adjustment for the number of dispensing visits. RESULTS The total doses of gabapentinoid dispensed every month in Lyon's PASS units displayed a 1233% increase for pregabalin, and a 1185% increase for gabapentin, between 2016 and 1Q2021. When adjusted for the number of visits, this increase reached a factor of 8.5 for pregabalin and 8.3 for gabapentin, respectively. However, while the increase in pregabalin dispensing was constant throughout the study period, gabapentin total dispensed doses were more fluctuating over time, and the rise of dispensations was thus less straightforward. CONCLUSION Our study reveals a local but substantial increase in gabapentinoid use in populations with no social insurance. These findings should be confirmed more widely and plead for the systematic collection of anonymous patient data in free healthcare centers in France.
Collapse
Affiliation(s)
- Mathieu Chappuy
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France.,Service Universitaire d'Addictologie de Lyon (SUAL), GH Centre, Hospices Civils de Lyon, Lyon, France.,CSAPA, GH Nord, Hospices Civils de Lyon, Lyon, France
| | - Mikail Nourredine
- Service hospitalo-universitaire de pharmacotoxicologie de Lyon, Hospices Civils de Lyon, Lyon, France.,Service de recherche et épidémiologie clinique, Hospices Civils de Lyon, Lyon, France.,Laboratoire d'évaluation et modélisation des effets thérapeutiques, UMR CNRS 5558, Lyon, France
| | | | - Morgan Fahmi
- Service Permanence d'Accès aux Soins de Santé, CH Le Vinatier, Bron, France
| | - Pauline Misslin
- Service Pharmaceutique, CH Saint Joseph - Saint Luc, Lyon, France
| | - Maude Berthier
- Service Permanence d'Accès aux Soins de Santé, GH Centre, Hospices Civils de Lyon, Lyon, France
| | - Louise Laloi
- Service Pharmaceutique, GH Centre, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France.,Service Universitaire d'Addictologie de Lyon (SUAL), GH Centre, Hospices Civils de Lyon, Lyon, France.,Service hospitalo-universitaire de pharmacotoxicologie de Lyon, Hospices Civils de Lyon, Lyon, France.,INSERM U1028, CNRS UMR 5292, CRNL, Université de Lyon, UCBL1, Bron, France
| |
Collapse
|
11
|
Soeiro T, Lacroix C, Pradel V, Lapeyre-Mestre M, Micallef J. Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network. Front Psychiatry 2021; 12:640120. [PMID: 34079478 PMCID: PMC8165176 DOI: 10.3389/fpsyt.2021.640120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).
Collapse
Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Clémence Lacroix
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université Paul Sabatier, Inserm, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| |
Collapse
|
12
|
Tambon M, Ponté C, Jouanjus E, Fouilhé N, Micallef J, Lapeyre-Mestre M. Gabapentinoid Abuse in France: Evidence on Health Consequences and New Points of Vigilance. Front Psychiatry 2021; 12:639780. [PMID: 33613345 PMCID: PMC7886797 DOI: 10.3389/fpsyt.2021.639780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Gabapentinoid drugs (gabapentin and pregabalin) are widely used worldwide for epileptic and pain disorders. First signals of gabapentinoid abuse occurred in the last decade. This study aims to describe clinical characteristics of gabapentinoid use related disorders and health consequences in France. Materials and Methods: We designed a multisource investigation reviewing data reported to the French Addictovigilance Network (FAN) with pregabalin and gabapentin from 2010 to 2019. Information was obtained through the analysis of Spontaneous Reports (SRs) notified by health professionals and the pharmacoepidemiological surveys OSIAP (suspicious prescriptions forms indicators of potential abuse), OPPIDUM (observation of illicit drugs and misuse of psychotropic medications), DRAMES (death related to prescription drugs and other substances), and DTA (toxic deaths due to analgesics). Results: Over 2010-2019 period, were collected: (i) 265 SRs (258 pregabalin; 7 gabapentin); (ii) 816 forged prescription forms (805 pregabalin, 10 gabapentin, 1 involving both drugs); (iii) 145 cases of gabapentinoid use in people who use drugs (121 pregabalin; 24 gabapentin) and (iv) 31 cases of gabapentinoid-related deaths (25 pregabalin; 6 gabapentin). Risk factors of gabapentinoid abuse were opioid use disorders or psychiatric history, but cases of primary abuse in subjects without any substance abuse history were observed. Adverse outcomes concern almost exclusively pregabalin, with coma, dyspnea, convulsion, and conduction disorders. Treatment demands increased from 10.6% in 2018 to 23.1% in 2019, with pregabalin cited as the first substance leading to addictological care in the 2019 OPPIDUM survey. Gabapentinoid-related deaths increased over time. Pregabalin has become the first drug mentioned in forged prescriptions in 2019 (23.8% of OSIAP), while it ranked at the 15th position in 2017 (2.6%). Discussion: This study shows the importance of addictovigilance monitoring for gabapentinoids. Addictovigilance data helped to make visible the gabapentinoid-abuse related health harms (hospitalization for serious neurologic, psychiatric or cardiac effects, requests for addictological support and deaths) and to confirm the intrinsic abuse potential of pregabalin. These data highlight new points of vigilance considering observed primary abuse. At this point in France, the risk of abuse and related complications is very apparent with pregabalin. Still, it is identical to that observed elsewhere with gabapentin.
Collapse
Affiliation(s)
- Marine Tambon
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Camille Ponté
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
| | - Nathalie Fouilhé
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie-Pharmacosurveillance, CHU Grenoble-Alpes, Grenoble, France
| | - Joelle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France.,CEIP-Addictovigilance PACA Corse, Marseille, France
| | - Maryse Lapeyre-Mestre
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France.,Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
| | | |
Collapse
|
13
|
Witcraft SM, Veronica Smith C, Ann Pollard M, Dixon LJ. Is Greek affiliation a prescription for drug abuse? Examining misuse of prescription stimulants and downers in high school and college. J Am Coll Health 2020; 68:678-682. [PMID: 31210591 DOI: 10.1080/07448481.2019.1623803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Abstract
Objective: Compared to nonaffiliated students, Greek students engage in higher rates of prescription drug abuse (PDA). We examined PDA among Greek students compared to non-Greek students, and whether PDA in high school predicted joining a Greek organization in college.Participants: From November to December 2014, 509 undergraduate students at a large, southeastern institution participated in an online survey.Methods: Stratified random sampling with academic classification as the strata; chi-square analyses were conducted to test study hypotheses.Results: Greek students were no more likely than non-Greek students to ever engage in overall PDA. However, Greek students were significantly more likely to report abuse of stimulants, but not downers, in college and in high school.Conclusions: Future research to examine individual types of prescription drugs abused in high school and their affiliation with PDA among Greek students, compared to non-Greek students, in college is warranted.
Collapse
Affiliation(s)
- Sara M Witcraft
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - C Veronica Smith
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| | - M Ann Pollard
- School of Law, University of Georgia, Athens, Georgia, USA
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, University, Mississippi, USA
| |
Collapse
|
14
|
Ramachandran S, Dertien D, Bentley SI. Prevalence of ADHD symptom malingering, nonmedical use, and drug diversion among college-enrolled adults with a prescription for stimulant medications. J Addict Dis 2020; 38:176-185. [PMID: 32242510 DOI: 10.1080/10550887.2020.1732762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Malingering of ADHD symptoms is a potential means of nonmedical use of prescription stimulants (NMUPS). The Subtle ADHD Malingering Screener (SAMS) provides a potential avenue for identification of symptom malingering. However, no real world evidence of this scale has been published to date. The goal of this study was to examine patterns of use of stimulant prescriptions and to evaluate the ability of the SAMS to identify NMUPS. This study employed a cross-sectional observational design to administer an online, self-administered survey instrument in a convenience sample of college-enrolled young adults with a prescription for stimulant medications at a campus pharmacy. Respondents were asked about their prescription characteristics, nonmedical use and drug diversion behavior, along with ratings on the SAMS. Over 33% of respondents self-reported past-year NMUPS and 18% reported past-year drug diversion. Over 35% of respondents rated NMUPS as being slight or no risk and 55% were classified by the SAMS as likely to be malingering or exaggerating their symptoms. Individuals reporting past-year NMUPS or diversion consistently scored higher on the SAMS. The SAMS showed potential for future application in the pharmacy setting. Further research is needed to evaluate the relationship of SAMS to NMUPS or drug diversion. The results of this study also highlight several growing issues with the diagnosis and treatment of ADHD among young adults enrolled in college. Addressing perception of risk, social norms, and providing healthcare professionals with tools to prevent misdiagnosis is critical to the management of this issue.
Collapse
Affiliation(s)
- Sujith Ramachandran
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Doug Dertien
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Sandra I Bentley
- Department of Pharmacy Practice, School of Pharmacy, University of Mississippi, University, MS, USA
| |
Collapse
|
15
|
Abstract
Objective: The recent rise in ADHD has prompted concerns about adolescents with ADHD diverting and/or misusing stimulants. This is the first study to assess physician perceptions of the pervasiveness of these issues. Method: Questionnaires were mailed to a national sample of pediatric subspecialists. Responses were analyzed (n = 826; 18% response rate) using descriptive statistics and regression analyses. Results: In the past year, 59% of physicians suspected ≥1 patient(s) with ADHD diverted stimulants. Seventy-four percent believed ≥1 patient(s) feigned symptoms to obtain an initial ADHD diagnosis; 66% believed ≥1 patient(s) wanted stimulants to improve academic performance. Child and adolescent psychiatrists were most likely to suspect diversion and feigning symptoms. Thirty-nine percent of physicians believed diversion was at least "common." Conclusion: Although many physicians suspected stimulant diversion and misuse, a substantial number were unaware of these issues, and subspecialist perceptions varied. These findings support the potential pervasiveness of these issues and the need for increased physician awareness.
Collapse
Affiliation(s)
| | - Sarah A Keim
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew Adesman
- Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| |
Collapse
|
16
|
Schepis TS, McCabe SE. Prescription Opioid Misuse in US Older Adults: Associated Comorbidities and Reduced Quality of Life in the National Epidemiologic Survey of Alcohol and Related Conditions-III. J Clin Psychiatry 2019; 80:19m12853. [PMID: 31747489 PMCID: PMC6935372 DOI: 10.4088/jcp.19m12853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/29/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Prescription opioid misuse (POM) prevalence in US older adults (50 years and older) has increased, and preliminary evidence associates POM with poor outcomes. Despite this, little is known about the health-related quality of life, mental and physical health, and substance use profiles of older adults with current and/or past POM. The aim of this study was to evaluate differences in these variables by POM history in US older adults. METHODS Data were from the 2012-2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, using adults 50 years and older (n = 14,667). Respondents were grouped into mutually exclusive categories: no lifetime POM, prior-to-past-year POM, past-year POM, and persistent POM (ie, prior-to-past-year and past-year POM). Groups were compared using design-based linear regression on health-related quality of life and logistic regression on mental health, physical health, and substance use variables, controlling for sociodemographics. RESULTS Older adults with persistent POM had the greatest impairment, including lower mental and physical health-related quality of life and high rates of past-year major depression (17.6%), emergency department use (42.7%), and any substance use disorder (37.4%). Older adults with past-year POM had high rates of physical health diagnoses and health care utilization (eg, 45.6% past-year overnight hospitalization), while those with prior-to-past-year POM had significant current psychopathology (eg, 13.7% with past-year major depression). CONCLUSIONS Older adults with persistent POM likely need multidisciplinary care for their significant physical and mental health and substance use conditions. Given the elevated psychopathology in those with persistent POM, psychiatrists are well placed to identify those with long-term POM.
Collapse
Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
17
|
Cheng S, Siddiqui TG, Gossop M, Kristoffersen ES, Lundqvist C. Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open 2019; 9:e031483. [PMID: 31492795 PMCID: PMC6731874 DOI: 10.1136/bmjopen-2019-031483] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS 246 patients aged 65-90 were included. OUTCOME MEASURES Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs. TRIAL REGISTRATION NUMBER NCT03162081.
Collapse
Affiliation(s)
- Socheat Cheng
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, King's College, London, United Kingdom
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
18
|
Mathis SM, Hagaman A, Hagemeier N, Baker K, Pack RP. Provider-patient communication about prescription drug abuse: A qualitative analysis of the perspective of prescribers. Subst Abus 2019; 41:121-131. [PMID: 31403901 DOI: 10.1080/08897077.2019.1635956] [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] [Indexed: 10/26/2022]
Abstract
Background: Provider-patient communication underpins many initiatives aimed at reducing the public health burden associated with prescription drug abuse in the United States. The purpose of this qualitative analysis was to examine the characteristics of provider-patient communication about prescription drug abuse from the perspective of prescribers. Methods: From 2014 to 2015, 10 semi-structured interviews were conducted with a purposive sample of prescribers from multiple professions and medical fields in Central and South Central Appalachia. The interviews were conducted using a guide informed by Social Cognitive Theory and community theory research, audio-recorded, and transcribed verbatim. Thematic analysis, facilitated by NVivo 10 software, was used to generate themes. Results: Prescribers described 3 primary communication patterns with patients related to prescription drug abuse-informative, counteractive, and supportive. Prescribers also reported multiple factors-personal (e.g., education, experiences, and feelings of tension) and environmental (e.g., relationship with a patient, clinical resources, and policies on controlled prescription drugs)-that affect provider-patient communication and, by association, delivery of patient care related to prescription drug abuse. Conclusions: The findings suggest that provider-patient communication about prescription drug abuse is multidimensional and dynamic, characterized by multiple communication patterns and contributory factors. They have implications for (1) research aimed at advancing theoretical understanding of prescriber prescription drug abuse communication behaviors with patients and (2) interventions aimed at strengthening prescriber prescription drug abuse communication behaviors with patients.
Collapse
Affiliation(s)
- Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Angela Hagaman
- College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nicholas Hagemeier
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, Tennessee, USA
| |
Collapse
|
19
|
Li J, Xu Q, Shah N, Mackey TK. A Machine Learning Approach for the Detection and Characterization of Illicit Drug Dealers on Instagram: Model Evaluation Study. J Med Internet Res 2019; 21:e13803. [PMID: 31199298 PMCID: PMC6598421 DOI: 10.2196/13803] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/12/2019] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background Social media use is now ubiquitous, but the growth in social media communications has also made it a convenient digital platform for drug dealers selling controlled substances, opioids, and other illicit drugs. Previous studies and news investigations have reported the use of popular social media platforms as conduits for opioid sales. This study uses deep learning to detect illicit drug dealing on the image and video sharing platform Instagram. Objective The aim of this study was to develop and evaluate a machine learning approach to detect Instagram posts related to illegal internet drug dealing. Methods In this paper, we describe an approach to detect drug dealers by using a deep learning model on Instagram. We collected Instagram posts using a Web scraper between July 2018 and October 2018 and then compared our deep learning model against 3 different machine learning models (eg, random forest, decision tree, and support vector machine) to assess the performance and accuracy of the model. For our deep learning model, we used the long short-term memory unit in the recurrent neural network to learn the pattern of the text of drug dealing posts. We also manually annotated all posts collected to evaluate our model performance and to characterize drug selling conversations. Results From the 12,857 posts we collected, we detected 1228 drug dealer posts comprising 267 unique users. We used cross-validation to evaluate the 4 models, with our deep learning model reaching 95% on F1 score and performing better than the other 3 models. We also found that by removing the hashtags in the text, the model had better performance. Detected posts contained hashtags related to several drugs, including the controlled substance Xanax (1078/1228, 87.78%), oxycodone/OxyContin (321/1228, 26.14%), and illicit drugs lysergic acid diethylamide (213/1228, 17.34%) and 3,4-methylenedioxy-methamphetamine (94/1228, 7.65%). We also observed the use of communication applications for suspected drug trading through user comments. Conclusions Our approach using a combination of Web scraping and deep learning was able to detect illegal online drug sellers on Instagram, with high accuracy. Despite increased scrutiny by regulators and policymakers, the Instagram platform continues to host posts from drug dealers, in violation of federal law. Further action needs to be taken to ensure the safety of social media communities and help put an end to this illicit digital channel of sourcing.
Collapse
Affiliation(s)
- Jiawei Li
- Department of Healthcare Research and Policy, University of California - San Diego, Extension, La Jolla, CA, United States.,Global Health Policy Institute, La Jolla, CA, United States
| | - Qing Xu
- Department of Healthcare Research and Policy, University of California - San Diego, Extension, La Jolla, CA, United States.,Global Health Policy Institute, La Jolla, CA, United States
| | - Neal Shah
- Global Health Policy Institute, La Jolla, CA, United States
| | - Tim K Mackey
- Department of Healthcare Research and Policy, University of California - San Diego, Extension, La Jolla, CA, United States.,Global Health Policy Institute, La Jolla, CA, United States.,Department of Anesthesiology, University of California - San Diego, School of Medicine, La Jolla, CA, United States.,Division of Infectious Disease and Global Public Health, University of California - San Diego, School of Medicine, La Jolla, CA, United States
| |
Collapse
|
20
|
Evoy KE, Teng C, Encarnacion VG, Frescas B, Hakim J, Saklad S, Frei CR. Comparison of Quetiapine Abuse and Misuse Reports to the FDA Adverse Event Reporting System With Other Second-Generation Antipsychotics. Subst Abuse 2019; 13:1178221819844205. [PMID: 31068753 PMCID: PMC6495438 DOI: 10.1177/1178221819844205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Second-generation antipsychotics (SGAs) are assumed to have little abuse potential. However, reports of quetiapine abuse have emerged as prescribing has increased in recent years. The US Food and Drug Administration's (FDA) Adverse Event Reporting System (FAERS) provides postmarketing information regarding adverse drug events (ADEs). This is the first study to analyze quetiapine abuse-related ADEs reported to FAERS to determine whether a disproportionate rate of such events have been reported when compared with other commonly used SGAs. METHODS A cross-sectional analysis of FAERS data from January 1, 2015, to December 31, 2017, was performed. The total number of all-cause and abuse-related ADEs reported to FAERS regarding quetiapine, olanzapine, aripiprazole, and risperidone were identified, along with demographic and mortality data. The proportional reporting ratio (PRR) was calculated to assess disproportionate reporting of abuse-related adverse drug reactions between quetiapine and each of three alternative SGA medications. RESULTS Abuse-related ADEs represented 11% (3144/27 962) of total ADEs reported for quetiapine, 8% for olanzapine (1548/19 228), 5% (1380/29 699) for aripiprazole, and 3% (1168/45 518) for risperidone. The PRRs (95% confidence interval) for quetiapine versus olanzapine, aripiprazole, and risperidone were 1.40 (1.32-1.48), 2.42 (2.28-2.57), and 4.38 (4.10-4.68), respectively, indicating that abuse-related events were significantly more likely to be reported with quetiapine than each comparator drug. In addition, more deaths were reported among the abuse-related events regarding quetiapine (673) than olanzapine (200), aripiprazole (88), and risperidone (143). CONCLUSION This study corroborates recent evidence indicating that quetiapine might possess a significantly higher abuse potential than other commonly used SGAs. Although prospective studies are needed to better understand the abuse potential of quetiapine, increased vigilance in monitoring for signs of substance abuse might be warranted when prescribing quetiapine.
Collapse
Affiliation(s)
- Kirk E Evoy
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Department of Pharmacy, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Chengwen Teng
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Victor G Encarnacion
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Brian Frescas
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - John Hakim
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Stephen Saklad
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Christopher R Frei
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Department of Pharmacy, University Health System, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| |
Collapse
|
21
|
Griffin KW, Lowe SR, Botvin C, Acevedo BP. Patterns of adolescent tobacco and alcohol use as predictors of illicit and prescription drug abuse in minority young adults. J Prev Interv Community 2019; 47:228-242. [PMID: 31021312 DOI: 10.1080/10852352.2019.1603672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
The present longitudinal study examined the relationship between patterns of cigarette smoking and alcohol use during adolescence and illicit drug abuse (DA) and prescription drug abuse (PDA) in early adulthood. The sample consisted of 984 predominantly minority young adults (57% women) who completed (a) six annual surveys as adolescents attending New York City public schools (grades 7 through 12) and (b) a follow-up telephone interview as young adults (mean age = 23). Findings from a series of latent growth models indicated that growth in cigarette smoking and alcohol use during adolescence each independently predicted DA in adulthood. Baseline levels of alcohol use in 7th grade also predicted DA in adulthood. Growth in alcohol consumption during adolescence predicted PDA in young adulthood. Results indicate that an escalation during adolescence in the use of substances that are legal for adults (cigarettes and alcohol) contributes to greater DA and PDA in young adulthood. One implication of these findings is that interventions that can prevent cigarette smoking and alcohol use during adolescence may also reduce DA and PDA in young adults.
Collapse
Affiliation(s)
- Kenneth W Griffin
- a Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Sarah R Lowe
- b Department of Psychology , Montclair State University , Montclair , NJ , USA
| | - Caroline Botvin
- c Department of Psychology , Fordham University , Bronx , NY , USA
| | - Bianca P Acevedo
- d Neuroscience Research Institute , University of California , Santa Barbara , CA , USA
| |
Collapse
|
22
|
Zhang Y, Johnson P, Jeng PJ, Reid MC, Witkin LR, Schackman BR, Ancker JS, Bao Y. First Opioid Prescription and Subsequent High-Risk Opioid Use: a National Study of Privately Insured and Medicare Advantage Adults. J Gen Intern Med 2018; 33:2156-2162. [PMID: 30206790 PMCID: PMC6258623 DOI: 10.1007/s11606-018-4628-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/05/2018] [Revised: 05/24/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription. DESIGN Retrospective cohort study using data from a large commercial insurance claims database for 2011-2014 to identify individuals with no recent use of opioids and follow them for 18 months after the first opioid prescription. PARTICIPANTS Privately insured patients aged 18-64 and Medicare Advantage patients aged 65 or older who filled a first opioid prescription between 07/01/2011 and 06/30/2013. MAIN OUTCOMES AND MEASURES High-risk opioid use was measured by having (1) opioid prescriptions overlapping for 7 days or more, (2) opioid and benzodiazepine prescriptions overlapping for 7 days or more, (3) three or more prescribers of opioids, and (4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. KEY RESULTS All three features of the first prescription were strongly associated with high-risk use. For example, among privately insured patients, receiving a long- (vs. short-) acting first opioid was associated with a 16.9-percentage-point increase (95% CI, 14.3-19.5), a daily MME of 50 or more (vs. less than 30) was associated with a 12.5-percentage-point increase (95% CI, 12.1-12.9), and a supply exceeding 7 days (vs. 3 or fewer days) was associated with a 4.8-percentage-point increase (95% CI, 4.5-5.2), in the probability of having a daily dosage of 120 MMEs or more in the long term, compared to a sample mean of 4.2%. Results for the Medicare Advantage patients were similar. CONCLUSIONS Long-acting formulation, high daily dosage, and longer duration of the first opioid prescription were each associated with increased high-risk use of opioids in the long term.
Collapse
Affiliation(s)
- Yongkang Zhang
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Phyllis Johnson
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Philip J Jeng
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.,Division of Pain Medicine, New York-Presbyterian/Lower Manhattan Hospital, New York, NY, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA
| | - Yuhua Bao
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA. .,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
23
|
McCauley JL, Gilbert GH, Cochran DL, Gordan VV, Leite RS, Fillingim RB, Brady KT. Prescription Drug Monitoring Program Use: National Dental PBRN Results. JDR Clin Trans Res 2018; 4:178-186. [PMID: 30931705 DOI: 10.1177/2380084418808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/15/2022] Open
Abstract
INTRODUCTION The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management. OBJECTIVE The objective of this study was to examine dentists' experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP. METHODS We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics. RESULTS Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk. CONCLUSION Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study. KNOWLEDGE TRANSFER STATEMENT Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.
Collapse
Affiliation(s)
- J L McCauley
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - G H Gilbert
- 2 Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - D L Cochran
- 3 Department of Periodontics, UT Health San Antonio, San Antonio, USA
| | - V V Gordan
- 4 Department of Restorative Dental Sciences, University of Florida, Gainesville, FL, USA
| | - R S Leite
- 5 Department of Stomatology, Medical University of South Carolina, Charleston, SC, USA
| | - R B Fillingim
- 6 Department of Restorative Dental Sciences, University of Florida, USA
| | - K T Brady
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,7 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | -
- 8 National Dental PBRN Collaborative Group, which includes practitioner, faculty, and staff investigators who contributed to this activity ( http://nationaldentalpbrn.org/collaborative-group.php )
| |
Collapse
|
24
|
Peckham AM, Ananickal MJ, Sclar DA. Gabapentin use, abuse, and the US opioid epidemic: the case for reclassification as a controlled substance and the need for pharmacovigilance. Risk Manag Healthc Policy 2018; 11:109-116. [PMID: 30154674 PMCID: PMC6103607 DOI: 10.2147/rmhp.s168504] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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] [Indexed: 11/23/2022] Open
Abstract
The abuse potential of gabapentin is well documented; with gabapentin having been noted as an agent highly sought after for use in potentiating opioids. When combined with opioids, the risk of respiratory depression and opioid-related mortality increases significantly. In the US, gabapentin was approved by the Food and Drug Administration as a non-controlled substance. To date, and in spite of empirical evidence suggestive of diversion and abuse with opioids, gabapentin remains a non-controlled substance at the federal level. This has forced individual US states and jurisdictions – often significantly impacted by the opioid epidemic – to forge ahead with legislative initiatives designed to reclassify and/or monitor the use of gabapentin. Since August 1, 2016, 14 of 51 US states and jurisdictions have either implemented legislative mandates requiring pharmacovigilance programs, amended rules and regulations, are in the throes of crafting policy, or are in the midst of gathering additional data for decision making. This fragmented geographic approach yields only a modest benefit in combating the abuse of gabapentin and/or the national opioid epidemic. Herein, we report state-by-state efforts to enhance pharmacovigilance and call for a re-evaluation of the schedule status of gabapentin at the federal level, and design and implementation of a national pharmacovigilance program.
Collapse
Affiliation(s)
- Alyssa M Peckham
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA,
| | - Maria J Ananickal
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA,
| | - David A Sclar
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA,
| |
Collapse
|
25
|
Chang HY, Murimi I, Faul M, Rutkow L, Alexander GC. Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis. Pharmacoepidemiol Drug Saf 2018; 27:422-429. [PMID: 29488663 PMCID: PMC6664298 DOI: 10.1002/pds.4404] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Received: 05/25/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. METHODS We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed. RESULTS Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions. CONCLUSIONS Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients.
Collapse
Affiliation(s)
- Hsien-Yen Chang
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Irene Murimi
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Faul
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA
| | - Lainie Rutkow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| |
Collapse
|
26
|
Averill LA, Averill CL, Staley LA, Ozawa-Kirk JL, Kauwe JS, Henrie-Barrus P. The Opioid Abuse Risk Screener predicts aberrant same-day urine drug tests and 1-year controlled substance database checks: A brief report. Health Psychol Open 2018; 4:2055102917748459. [PMID: 29379630 PMCID: PMC5779942 DOI: 10.1177/2055102917748459] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The Opioid Abuse Risk Screener was developed to support well-informed decision-making in opioid analgesic prescribing by extending the breadth of psychiatric risk factors evaluated relative to other non–clinician-administered measures. We examined the preliminary predictive validity of the Opioid Abuse Risk Screener relative to the widely used Screener and Opioid Assessment for Patients with Pain–Revised in predicting aberrant urine drug tests and controlled substance database checks. The Opioid Abuse Risk Screener is significantly different from the Screener and Opioid Assessment for Patients with Pain–Revised in predicting aberrant same-day urine drug tests (Z = 2.912, p = 0.0036) and controlled substance database checks within 1 year of assessment (Z = 3.731, p = 0.0002). Promising preliminary analyses using machine learning methods are also discussed.
Collapse
|
27
|
Morrison DA, Wise SK, DelGaudio JM, Chowdhury NI, Levy JM. Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review. Laryngoscope 2017; 128:1767-1771. [PMID: 29280484 DOI: 10.1002/lary.27069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes. DATA SOURCES MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes. RESULTS Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease. CONCLUSION Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.
Collapse
Affiliation(s)
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Naweed I Chowdhury
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
28
|
Abstract
Prescription drug misuse (PDM) is the leading cause of accidental death in the U.S. One in five Americans report at least one lifetime incident of PDM. PDM has been studied extensively, yet there is limited inclusion of racial/ethnic minorities due to purportedly lower rates of PDM. However, health disparate groups often face more detrimental consequences of substance abuse including behavioral, social, and medical/mental health (e.g., injury, HIV/AIDS, incarceration, educational attainment, and comorbidity). Failing to characterize risk factors for and consequences of PDM in racial/ethnic minorities may mask the disproportionate negative impact of this epidemic. This systematic review of three research indexes revealed 28 peer-reviewed studies published on PDM in racial/ethnic minority adults. Results indicated a high prevalence of PDM among veterans, bisexual and gay young adults, and substance abusers compared to the general population. Demographic correlates of PDM included younger age, male gender, less educated, unmarried, and those with health/emotional issues. Rates of PDM in demographically vulnerable populations suggest that broadening inclusiveness in PDM research, interventions, and clinical practice is imperative.
Collapse
|
29
|
Abstract
A counterfeit fentanyl crisis is currently underway in the United States. Counterfeit versions of commonly abused prescription drugs laced with fentanyl are being manufactured, distributed, and sold globally, leading to an increase in overdose and death in countries like the United States and Canada. Despite concerns from the U.S. Drug Enforcement Agency regarding covert and overt sale of fentanyls online, no study has examined the role of the Internet and social media on fentanyl illegal marketing and direct-to-consumer access. In response, this study collected and analyzed five months of Twitter data (from June-November 2015) filtered for the keyword "fentanyl" using Amazon Web Services. We then analyzed 28,711 fentanyl-related tweets using text filtering and a machine learning approach called a Biterm Topic Model (BTM) to detect underlying latent patterns or "topics" present in the corpus of tweets. Using this approach we detected a subset of 771 tweets marketing the sale of fentanyls online and then filtered this down to nine unique tweets containing hyperlinks to external websites. Six hyperlinks were associated with online fentanyl classified ads, 2 with illicit online pharmacies, and 1 could not be classified due to traffic redirection. Importantly, the one illicit online pharmacy detected was still accessible and offered the sale of fentanyls and other controlled substances direct-to-consumers with no prescription required at the time of publication of this study. Overall, we detected a relatively small sample of Tweets promoting illegal online sale of fentanyls. However, the detection of even a few online sellers represents a public health danger and a direct violation of law that demands further study.
Collapse
Affiliation(s)
- Tim K. Mackey
- Global Health Policy Institute, San Diego, CA, USA
- Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, 92093, USA
- Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Janani Kalyanam
- Global Health Policy Institute, San Diego, CA, USA
- Department of Electrical and Computer Engineering, University of California, San Diego, San Diego, CA, 92093, USA
| |
Collapse
|
30
|
Ferries EA, Gilson AM, Aparasu RR, Chen H, Johnson ML, Fleming ML. The Prevalence of and Factors Associated With Receiving Concurrent Controlled Substance Prescriptions. Subst Use Misuse 2017; 52:1639-1645. [PMID: 28557587 DOI: 10.1080/10826084.2017.1298617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Controlled substance prescription (CSP) use and abuse in the United States has become a public health epidemic. One common and dangerous indicator of abuse involves obtaining CSPs concurrently. OBJECTIVE The objective of this study was to identify the prevalence and factors associated with individuals receiving potentially inappropriate concurrent CSPs. METHODS This was a retrospective, cohort analysis using data from the 2013-2014 Texas prescription drug monitoring program (PDMP). Descriptive statistics and a multiple logistic regression analysis were conducted to examine the individual-level and prescription utilization factors associated with individuals obtaining concurrent CSPs. RESULTS Among Texas residents, 1,640,015 individuals (6.10% of all Texas residents and 15.99% of all CSP utilizers) were identified with at least one concurrent CSP combination. Concurrent opioid prescriptions were found to be the most prevalent concurrent use combination (n = 1,574,572). Having prescriptions for opioids, being ≥18 years of age, utilizing CSPs for >30 days, utilizing greater than one CSP, having a multiple provider episode, and traveling >25 miles to obtain CSPs were all statistically significant predictors of utilizing concurrent CSPs. CONCLUSION The study findings indicate a high prevalence of individuals utilizing concurrent CSPs. This practice is concerning when considering that many overdose deaths result from the concurrent use of CSPs. Prescribers should utilize PDMPs to ensure that aberrant prescription drug behaviors, such as the use of concurrent opioids and benzodiazepines do not readily occur.
Collapse
Affiliation(s)
- Erin A Ferries
- a Pharmaceutical Health Outcomes & Policy , University of Houston , Houston , Texas , USA
| | - Aaron M Gilson
- b Carbone Cancer Center , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
| | - Rajendar R Aparasu
- a Pharmaceutical Health Outcomes & Policy , University of Houston , Houston , Texas , USA
| | - Hua Chen
- a Pharmaceutical Health Outcomes & Policy , University of Houston , Houston , Texas , USA
| | - Michael L Johnson
- a Pharmaceutical Health Outcomes & Policy , University of Houston , Houston , Texas , USA
| | - Marc L Fleming
- a Pharmaceutical Health Outcomes & Policy , University of Houston , Houston , Texas , USA
| |
Collapse
|
31
|
Lin DH, Lucas E, Murimi IB, Jackson K, Baier M, Frattaroli S, Gielen AC, Moyo P, Simoni-Wastila L, Alexander GC. Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP). Addiction 2017; 112:311-319. [PMID: 27658522 DOI: 10.1111/add.13620] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 03/18/2016] [Revised: 06/27/2016] [Accepted: 09/19/2016] [Indexed: 02/05/2023]
Abstract
AIMS Physicians' use of prescription drug monitoring programs (PDMPs) varies by state. Among Maryland physicians, we sought to (1) estimate the PDMP impact on changes in opioid prescribing, (2) approximate the scope of PDMP utility and (3) determine the barriers to PDMP use after its 2013 implementation. DESIGN Cross-sectional postal survey linking responses to state records of PDMP registration and use, randomly sampling physicians within specialty and registration strata. SETTING Maryland, USA. PARTICIPANTS A total of 1000 surveyed primary care, pain and emergency medicine physicians stratified into three subpopulations: PDMP non-registrants, PDMP registrants who were non-users and PDMP users; 405 respondents (44%) of 916 eligible physicians were analysed. MEASUREMENTS Primary outcome measure was PDMP use. Key predictors were clinic characteristics, including type of practice and number of patients prescribed opioids. FINDINGS No response-wave bias was identified. Seventy per cent of physicians believed PDMP access decreased their amount and increased their comfort level in prescribing opioids. Three-fourths (74%) of PDMP users reported the data very useful for informing opioid prescribing, although one-fifth (20%) reported difficulty accessing the data. Commonly reported barriers to PDMP use were lack of knowledge regarding its existence and registration process. In multivariable analysis after adjusting for key clinic characteristics, practicing at a managed care organization was associated with lower PDMP use [incidence rate ratio (IRR) = 0.19, 95% confidence interval (CI) = 0.05-0.73]. Conversely, physicians who prescribed opioids for more than 50 patients accessed the PDMP three times as often as those prescribing opioids for fewer than 10 patients monthly (IRR = 3.00, 95 % CI = 1.07-8.43). CONCLUSIONS In this survey of Maryland, USA physicians, most participants reported that prescription drug monitoring programs (PDMPs) improved their opioid prescribing by decreasing prescription amounts and increasing comfort with prescribing opioids. Common barriers to PDMP use included not knowing about the program, registration difficulties and data access difficulties.
Collapse
Affiliation(s)
- Dora H Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Eleanor Lucas
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Irene B Murimi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine Jackson
- Behavioral Health Administration, Maryland Department of Health and Mental Hygiene, Catonsville, MD, USA
| | - Michael Baier
- Behavioral Health Administration, Maryland Department of Health and Mental Hygiene, Catonsville, MD, USA
| | - Shannon Frattaroli
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea C Gielen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Injury Research and Policy, Johns Hopkins University, Baltimore, MD, USA
| | - Patience Moyo
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.,Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| |
Collapse
|
32
|
Abstract
This study is the first to analyze public response to a drug take-back program, the American Medicine Chest Challenge, in a single state over a period of 3 years (2010-2012). The study utilized a three-wave repeated cross-sectional design and an annual phone survey conducted with a representative sample of adults ( N = 906 in 2010, N = 907 in 2011, and N = 906 in 2012), which assessed exposure to the campaign, drug disposal behaviors, possible mediators of campaign effects (risk appraisal, personal agency, normative influence, and interpersonal talk), and potential confounders. Logistic regression and causal mediation analysis were employed to estimate confounder-adjusted direct and mediated effects of the campaign. Results showed that the campaign reached a sizable portion (50% to 60%) of state adults and that campaign exposure was associated with increased likelihood of having conversations with others about this topic. About 55% of all adults in the state reported taking at least one of the actions recommended by the campaign, and campaign exposure was associated with increased likelihood of disposing of prescription drugs at a drug collection day event (adjusted odds ratio = 4) and of talking to a child about the risks associated with prescription drug abuse (adjusted odds ratio = 2). The causal mediation analysis demonstrated that the campaign influenced audiences by reinforcing their efficacy to safely dispose of prescription drugs, but also potentially by stimulating conversations among community members about this topic. Drug take-back campaigns can be an effective mechanism to decrease the availability of prescription drugs in communities.
Collapse
|
33
|
Maree RD, Marcum ZA, Saghafi E, Weiner DK, Karp JF. A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults. Am J Geriatr Psychiatry 2016; 24:949-963. [PMID: 27567185 PMCID: PMC5069126 DOI: 10.1016/j.jagp.2016.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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: 01/06/2016] [Revised: 04/28/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The authors assessed the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions. METHODS Following PRISMA guidelines, a literature search of PubMed, PsycINFO, and EMBASE for peer-reviewed journal articles in English through April 2014 with updates through November 2015 was conducted for reports on misuse of prescription benzodiazepines and opioids in older adults. Relevant publications were reviewed that included participants age ≥65 years. Reference lists were manually searched for key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article. RESULTS Of 4,932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and nonprescription use of pain relievers, and health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse, and one study described the effects of provider education and an electronic support tool as an intervention. CONCLUSION There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. The need for further research specific to prescription drug misuse among older adults is discussed.
Collapse
Affiliation(s)
- RD Maree
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - ZA Marcum
- School of Pharmacy, University of Washington
| | - E Saghafi
- Department of Information Science, University of Pittsburgh School of Medicine
| | - DK Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Department of Medicine, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
| | - JF Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
| |
Collapse
|
34
|
Abstract
The non-medical use of prescription medications has been identified as a major public health problem among youth, although few longitudinal studies have examined non-medical use of prescription medications in the context of other drug use. Previous cross-sectional studies have shown gender and race differences in non-medical use of prescription medications. It was hypothesized that (1) non-medical use of prescription medications increases with age, and (2) these increases will be stronger in magnitude among female and Caucasian adolescents. Changes in non-medical use of prescription medications across 4 years were examined and compared with changes in other drug use (e.g., alcohol and marijuana). Middle and high school students enrolled in 5 schools in southeastern Michigan completed web-based surveys at 4 annual time points. The cumulative sample size was 5,217. The sample ranged from 12 to 18 years, 61% were Caucasian, 34% were African American, and 50% were female. Using a series of repeated measures latent class analyses, the trajectories of non-medical use of prescription medications were examined, demonstrating a 2-class solution: (1) the no/low non-medical use of prescription medications group had low probabilities of any non-medical use of prescription medications across all grades, and (2) the any non-medical use of prescription medications group showed a roughly linear increase in the probability of non-medical use of prescription medications over time. The probability of any non-medical use of prescription medications increased during the transition from middle school to high school. Results from this longitudinal study yielded several noteworthy findings: Participants who were classified in the any/high non-medical use of prescription medications group showed a discontinuous pattern of non-medical use of prescription medications over time, indicating that non-medical use of prescription medications is a relatively sporadic behavior that does not persist over time. However, among the "any/high non-medical use of prescription medications" group the pattern of change over time varied by race/ethnicity, with Caucasians showing a clear increase in the probability of non-medical use of prescription medications over time compared to non-Caucasians. This study fills gaps in knowledge by examining non-medical use of prescription medications over time and provides important information about the course of non-medical use of prescription medications among adolescents.
Collapse
Affiliation(s)
- Carol J. Boyd
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
- Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - James A. Cranford
- Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
35
|
Tai BWB, Hata M, Wu S, Frausto S, Law AV. Prediction of pharmacist intention to provide medication disposal education using the theory of planned behaviour. J Eval Clin Pract 2016; 22:653-61. [PMID: 26804456 DOI: 10.1111/jep.12511] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Accepted: 12/14/2015] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Lack of familiarity with proper medication disposal options among patients can lead to personal and environmental safety concerns, besides signalling non-adherence. Given that community pharmacists are in a position to educate patients, this study assessed community pharmacists' knowledge on medication disposal and examined the utility of the theory of planned behaviour (TPB) in predicting their intention to provide medication disposal education to their patients. METHODS A cross-sectional, self-administered survey was distributed to community pharmacists in California. Descriptive statistics were reported for all survey items. Cronbach's alpha and Pearson correlation were used to determine the reliability for the four TPB constructs (attitude, subjective norm, perceived behavioural control and intention). Multiple linear regressions were performed to predict intent using the other three TPB constructs. RESULTS Pharmacists (n = 142) demonstrated a positive intention to provide education (mean = 5.91 ± 1.22; range: 2 to 8), but most (67.9%) provided this information once a month or less. Attitude (β = 0.266, P = 0.001), subjective norm (β = 0.333, P < 0.001) and perceived behavioural control (β = 0.211, P = 0.009) were significant predictors of intention, accounting for 40.8% of the variance in intention to provide disposal education. Scale reliability ranged from 0.596 to 0.619 for the four constructs. Few pharmacists accurately selected all of the appropriate recommendations of disposal for non-controlled and controlled substances (15.9% and 10.1%, respectively). CONCLUSION Pharmacists showed favourable attitude, subjective norm, perceived behaviour control and intention in providing such education. However, their knowledge in this area may be lacking and they are not consistently providing this information to their patients.
Collapse
Affiliation(s)
| | - Micah Hata
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
| | - Stephanie Wu
- Veterans Affairs Long Beach Healthcare System, Long Beach, CA, USA
| | | | - Anandi V Law
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| |
Collapse
|
36
|
Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY. Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016; 10:300-8. [PMID: 27261669 PMCID: PMC5049966 DOI: 10.1097/adm.0000000000000223] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 10/23/2015] [Accepted: 04/07/2016] [Indexed: 01/23/2023]
Abstract
In March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing).
Collapse
Affiliation(s)
- Jamie K Lim
- Clinical Addiction Research and Education Unit (JKL, AYW), Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; College of Pharmacy (JPB), University of Rhode Island, Kingston, RI; Network for Public Health Law (CSD), St. Paul, MN; Departments of Emergency Medicine and Epidemiology (TCG), Warren Alpert Medical School of Brown University, Providence, RI; and Department of Emergency Medicine (TCG), Boston University School of Medicine, Boston, MA
| | | | | | | | | |
Collapse
|
37
|
Shutler L, Nelson LS, Portelli I, Blachford C, Perrone J. Drug Use in the Twittersphere: A Qualitative Contextual Analysis of Tweets About Prescription Drugs. J Addict Dis 2016; 34:303-10. [PMID: 26364675 DOI: 10.1080/10550887.2015.1074505] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tweets about prescription opioid use may reveal insights into the prescription drug epidemic. We qualitatively assessed 2,100 tweets about prescription opioids utilizing a Twitter Archiving Google Spreadsheet® and determined whether the tweet represented: abuse (i.e., use to get high), not abuse (i.e., use as analgesic), or was not characterizable (e.g., "I need a Percocet") and whether the connotation was positive (i.e. promote psychoactive or analgesic use), negative (i.e., adverse event), or not characterizable. Abuse was commonly described and the majority of terms (>66%) represented a positive connotation. Twitter can be a resource to observe trends in perceptions about prescription opioid use.
Collapse
Affiliation(s)
- Lukas Shutler
- a New York Hospital of Queens , Flushing , New York , USA
| | - Lewis S Nelson
- b New York University School of Medicine , New York , New York , USA
| | - Ian Portelli
- b New York University School of Medicine , New York , New York , USA
| | | | - Jeanmarie Perrone
- d Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania , USA
| |
Collapse
|
38
|
Harrell PT, Fu H. Commentary on Betts et al. (2016): Polysubstance use and opioid substitution therapy among people who inject drugs. Addiction 2016; 111:1224-5. [PMID: 27273387 DOI: 10.1111/add.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Paul T Harrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA. .,Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Hongyun Fu
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| |
Collapse
|
39
|
Novak SP, Glasheen C, Roland CL. Prescription pain reliever misuse and levels of pain impairment: 3-year course in a nationally representative outpatient sample of US adults. Subst Abuse Rehabil 2016; 7:87-98. [PMID: 27418863 PMCID: PMC4935147 DOI: 10.2147/sar.s102251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Indexed: 11/23/2022] Open
Abstract
Background The primary aim of this work was to present the prevalence data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative 3-year longitudinal survey (ages 18+ years) that captured information on patterns of self-reported pain interference and prescription pain reliever misuse. A second aim was to assess the degree to which the risk of various types of opioid misuse (onset, desistance, and incidence of dependence) was related to the longitudinal course of self-reported pain interference over the 3-year period. Methods We used a two-wave, nationally representative sample of adults (aged 18+ years) in which the baseline data were collected during 2001–2002 and a single follow-up was obtained ~3 years later (2004–2005 with 34,332 respondents with complete data on study variables for both waves). Results Our findings indicated that ~10% reported high pain interference in the past month at each wave. There was tremendous stability in levels of pain, with ~5% reporting consistent levels of high impairment over the 3-year study, a proxy for chronic pain. Levels of pain were more strongly associated with prescription pain reliever misuse concurrently rather than prospectively, and the association was largely linear, with the likelihood of misuse increasing with levels of pain. Finally, health service factors were also prominent predictors of onset, but not the outcomes, of desistance or transitions to problem use. Conclusion This study is the first to use a nationally representative sample with measures of pain and drug use history collected over an extended period. These results may help provide clinicians with an understanding that the risk of misuse is greatest when pain is active and may help guide the selection of appropriate intervention materials and monitor strategies for those at greatest risk.
Collapse
Affiliation(s)
| | | | - Carl L Roland
- Clinical Sciences and Outcomes Evidence, Pfizer Inc., Durham, NC, USA
| |
Collapse
|
40
|
O'Kane N, Hallvik SE, Marino M, Van Otterloo J, Hildebran C, Leichtling G, Deyo RA. Preparing a prescription drug monitoring program data set for research purposes. Pharmacoepidemiol Drug Saf 2016; 25:993-7. [PMID: 27273809 DOI: 10.1002/pds.4039] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/21/2016] [Accepted: 04/29/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop a complete and consistent prescription drug monitoring program (PDMP) data set for use by drug safety researchers in evaluating patterns of high-risk use and potential abuse of scheduled drugs. METHODS Using publically available data references from the US Food and Drug Administration and the Centers for Disease Control and Prevention, we developed a strategic methodology to assign drug categories based on pharmaceutical class for the majority of prescriptions in the PDMP data set. We augmented data elements required to calculate morphine milligram equivalents and assigned duration of action (short-acting or long acting) properties for a majority of opioids in the data set. RESULTS About 10% of prescriptions in the PDMP data set did not have a vendor-assigned drug category, and 20% of opioid prescriptions were missing data needed to calculate risk metrics. Using inclusive methods, 19 133 167 (>99.9%) of prescriptions in the PDMP data set were assigned a drug category. For the opioid category, augmenting data elements resulted in 10 760 669 (99.8%) having required values to calculate morphine milligram equivalents and evaluate duration of action properties. CONCLUSIONS Drug safety researchers who require a complete and consistent PDMP data set can use the methods described here to ensure that prescriptions of interest are assigned consistent drug categories and complete opioid risk variable values. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | | | | | - Richard A Deyo
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA.,Oregon Institute of Occupational Health Sciences, Portland, OR, USA
| |
Collapse
|
41
|
Katsuki T, Mackey TK, Cuomo R. Establishing a Link Between Prescription Drug Abuse and Illicit Online Pharmacies: Analysis of Twitter Data. J Med Internet Res 2015; 17:e280. [PMID: 26677966 PMCID: PMC4704982 DOI: 10.2196/jmir.5144] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/28/2015] [Accepted: 11/11/2015] [Indexed: 11/13/2022] Open
Abstract
Background Youth and adolescent non-medical use of prescription medications (NUPM) has become a national epidemic. However, little is known about the association between promotion of NUPM behavior and access via the popular social media microblogging site, Twitter, which is currently used by a third of all teens. Objective In order to better assess NUPM behavior online, this study conducts surveillance and analysis of Twitter data to characterize the frequency of NUPM-related tweets and also identifies illegal access to drugs of abuse via online pharmacies. Methods Tweets were collected over a 2-week period from April 1-14, 2015, by applying NUPM keyword filters for both generic/chemical and street names associated with drugs of abuse using the Twitter public streaming application programming interface. Tweets were then analyzed for relevance to NUPM and whether they promoted illegal online access to prescription drugs using a protocol of content coding and supervised machine learning. Results A total of 2,417,662 tweets were collected and analyzed for this study. Tweets filtered for generic drugs names comprised 232,108 tweets, including 22,174 unique associated uniform resource locators (URLs), and 2,185,554 tweets (376,304 unique URLs) filtered for street names. Applying an iterative process of manual content coding and supervised machine learning, 81.72% of the generic and 12.28% of the street NUPM datasets were predicted as having content relevant to NUPM respectively. By examining hyperlinks associated with NUPM relevant content for the generic Twitter dataset, we discovered that 75.72% of the tweets with URLs included a hyperlink to an online marketing affiliate that directly linked to an illicit online pharmacy advertising the sale of Valium without a prescription. Conclusions This study examined the association between Twitter content, NUPM behavior promotion, and online access to drugs using a broad set of prescription drug keywords. Initial results are concerning, as our study found over 45,000 tweets that directly promoted NUPM by providing a URL that actively marketed the illegal online sale of prescription drugs of abuse. Additional research is needed to further establish the link between Twitter content and NUPM, as well as to help inform future technology-based tools, online health promotion activities, and public policy to combat NUPM online.
Collapse
Affiliation(s)
- Takeo Katsuki
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, United States
| | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Approximately 18% of US adolescents engaged in prescription opioid abuse in 2013. However, this estimate may be misleading because it includes both medical misusers and nonmedical users, and there is evidence that these are 2 groups that differ relative to substance abuse and criminal risk. Thus, this study does not combine medical and nonmedical users; rather, it seeks to better understand the characteristics of nonmedical users. METHODS This was a school-based, cross-sectional study that was conducted during 2009-2010 in southeastern Michigan with a sample of 2627 adolescents using a Web-based survey. Three mutually exclusive groups were created based on responses regarding medical and nonmedical use of opioid analgesics. Group 1 had never used an opioid analgesic, Group 2 used an opioid analgesic only as prescribed, and Group 3 nonmedically used an opioid analgesic. In addition, Group 3 was divided into 2 mutually exclusive subgroups (self-treaters and sensation-seekers) based on reasons for nonmedical use. A series of multinomial logistic regressions were conducted to determine if the groups differed on the presence of pain, psychological symptoms (e.g., affective disorder, conduct disorder, attention-deficit/hyperactivity disorder [ADHD]), and drug abuse. RESULTS Sixty-five percent (65.0%) of the sample was white/Caucasian and 29.5% was African American. The average age was 14.8 years (SD = 1.9). Seventy percent (70.4%; n = 1850) reported no lifetime opioid use, 24.5% (n = 644) were medical users, 3.5% (n = 92) were nonmedical users who used for pain relief only, and 1.6% (n = 41) were classified as nonmedical users for reasons other than for pain relief (e.g., to get high). Both medical users and nonmedical users reported more pain and substance abuse symptoms compared with never users. Those nonmedical users who used opioids for sensation-seeking motivations had greater odds of having psychological symptoms. CONCLUSIONS These data support the need to further consider subgroups of nonmedical users of opioid analgesics.
Collapse
Affiliation(s)
- Carol J Boyd
- a School of Nursing , University of Michigan , Ann Arbor , Michigan , USA
| | | | | |
Collapse
|
43
|
Weaver MF. Prescription Sedative Misuse and Abuse. Yale J Biol Med 2015; 88:247-56. [PMID: 26339207 PMCID: PMC4553644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sedatives are widely prescribed for anxiety or insomnia and include benzodiazepines, selective benzodiazepine receptor subtype agonists (z-drugs), and barbiturates. These sedatives are controlled substances due to their potential for misuse and abuse. Misuse is often self-medication (chemical coping) of psychological symptoms in ways unauthorized by the prescriber, usually as dose escalation leading to requests for early refills. Sedatives are abused for euphoric effects, which may have dangerous consequences. Some sedative overdoses can be treated with flumazenil, a reversal agent, along with supportive care. Sedative withdrawal syndrome is treated by tapering the sedative and may require hospitalization. Long-term treatment of sedative addiction requires counseling, often with the help of an addiction-treatment professional.
Collapse
|
44
|
Abstract
Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.
Collapse
Affiliation(s)
- Julie Worley
- Julie Worley, PhD, FNP, PMHNP, Rush University, Chicago, IL, USA
| | - Mary Johnson
- Mary Johnson, PhD, RN, PMHCNS-BC, FAAN, Rush University, Chicago, IL, USA
| | | |
Collapse
|
45
|
Hawk KF, Vaca FE, D’Onofrio G. Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies. Yale J Biol Med 2015; 88:235-45. [PMID: 26339206 PMCID: PMC4553643] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose.
Collapse
Affiliation(s)
- Kathryn F. Hawk
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Federico E. Vaca
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| |
Collapse
|
46
|
Abstract
OBJECTIVE To provide education to community pharmacists regarding the registration and use of the Texas prescription drug monitoring program (PDMP) and to assess the impact of the education on pharmacists' perceptions of the PDMP. METHOD The study design was a descriptive, pre and post, cross-sectional survey conducted among community pharmacists attending a PDMP education program. The program was designed to present the PDMP as a public health tool available to assist pharmacists with dispensing decisions related to controlled prescription drugs. RESULTS Of the 24 pharmacists who completed the survey, 23 were already registered to use the PDMP. However, all 23 felt that the program successfully educated users regarding the PDMP and agreed that other community pharmacists would benefit from the program presented. After the program, 14 participants responded they would very likely use the PDMP in the next 30 days. Recognition of the use of PDMPs as a program for both pharmacists and physicians was increased from 12.5% (pre) to 73.9% (post). CONCLUSION Pharmacists found the educational program beneficial and they were very likely to use the PDMP in the future. Perceptions of the Texas PDMP were changed from pre- to post-education program, with recognition that a PDMP can be a beneficial tool for pharmacy practice.
Collapse
Affiliation(s)
- Marc L Fleming
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Yen Phan
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Erin A Ferries
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| | - Mark D Hatfield
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX, USA
| |
Collapse
|
47
|
Simon K, Worthy SL, Barnes MC, Tarbell B. Abuse-deterrent formulations: transitioning the pharmaceutical market to improve public health and safety. Ther Adv Drug Saf 2015; 6:67-79. [PMID: 25922655 DOI: 10.1177/2042098615569726] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/17/2022] Open
Abstract
This article evaluates abuse-deterrent formulations (ADFs) as a method to reduce prescription drug abuse while ensuring access to vital medications for individuals with legitimate need; assesses the pros and cons of ADFs and the current state of ADF adoption in the market; and develops policy recommendations to transition the market to ADFs. Although abuse-deterrent technology is still in its nascent stages, ADFs have been proven to reduce prescription drug abuse and its consequences, and even an incremental reduction in abuse can have a significant impact on the nation by reducing the costly social, physical, mental, and public health problems resulting from abuse. Federal ADF policy does not reflect the urgency of the prescription drug abuse epidemic and does not go far enough toward changing the status quo. Policies must be implemented to encourage innovation and a market shift toward ADFs by ensuring any generic medication that references a branded ADF demonstrates that it does not have abuse-deterrent properties inferior to the branded ADF product. Policies must also require federal prescription drug benefit plans to cover ADFs to ensure consumers have access to such medications.
Collapse
Affiliation(s)
- Kyle Simon
- Director of Policy and Advocacy. Center for Lawful Access and Abuse Deterrence, 1000 Potomac Street NW, Suite 150-A, Washington, DC 20007, USA
| | - Stacey L Worthy
- DCBA Law & Policy, 1000 Potomac St., NW, Suite 150-A, Washington, DC 20007, USA
| | - Michael C Barnes
- DCBA Law & Policy, 1000 Potomac St., NW, Suite 150-A, Washington, DC 20007, USA
| | - Benjamin Tarbell
- DCBA Law & Policy, 1000 Potomac St., NW, Suite 150-A, Washington, DC 20007, USA
| |
Collapse
|
48
|
Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health 2015; 36:559-74. [PMID: 25581144 DOI: 10.1146/annurev-publhealth-031914-122957] [Citation(s) in RCA: 900] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.
Collapse
Affiliation(s)
- Andrew Kolodny
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02454; , , ,
| | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Pharmaceutical opioid prescribing, opioid use disorders, and related poisonings have increased substantially in the last decade. In particular, pharmaceutical opioid deaths among youth have markedly increased. One area that has received relatively little attention is the role of home safety, given that parents are an important source of opioids for youth. Parents may intentionally share opioids with youth, due to low perceived risks or limited knowledge, and youth may divert opioids from parents' medicine cabinets. Safe medication storage has long been mandated by treatment programs that provide pharmacologically supported treatment of opioid use disorders, but it is not generally encouraged or required for pharmaceutical opioids prescribed for pain. Greater attention is needed on the development, evaluation, and implementation of 3 preventive strategies. These 3 strategies can be delivered in or supported by adult medical practices: (1) fully informing adults prescribed opioids about the risks of opioids to family members and others; (2) providing locked medication safe storage devices; and (3) educating parents on safe disposal options. However, a critical evidence base is still lacking for these opioid safety interventions.
Collapse
Affiliation(s)
- Ingrid A Binswanger
- a Division of General Internal Medicine and Division of Substance Dependence , University of Colorado School of Medicine , Aurora , Colorado , USA
| | | |
Collapse
|
50
|
Abstract
A phenomenological study explored whether older women who are chronic benzodiazepine users identified themselves as dependent, how dependence was perceived, and how meanings and understandings shaped experiences of benzodiazepine use. Self-reported benzodiazepine dependence was associated with being unable to reduce use or a desire to discontinue use and reliance on benzodiazepines to remain comfortable and able to handle daily life. Themes included: (a) benzodiazepine dependence is similar to dependence to diabetes or blood pressure medications; (b) dependence is distinctive from addiction/abuse; (c) addiction/abuse is perceived as worse than dependence; and (d) concerns of addiction/abuse result in low-dose benzodiazepine use.
Collapse
Affiliation(s)
- Sarah L Canham
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | | | | |
Collapse
|