Prescription opiate misuse among rural stimulant users in a multistate community-based study

The fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspective

The current opioid epidemic in the United States has been characterized as having three waves: prescription opioid use, followed by heroin use, and then use of synthetic opioids (e.g., fentanyl), with early waves affecting a population that was younger, less predominantly male, and more likely to be Caucasian and rural than in past opioid epidemics. A variety of recent data suggest that we have entered a fourth wave which can be characterized as a stimulant/opioid epidemic, with mental illness co-morbidities being more evident than in the past. Stimulant use has introduced new complexities in terms of behavioral consequences (e.g., neurological deficits, suicidal ideation, psychosis, hostility, violence), available treatments, and engagement into services. These compound existing issues in addressing the opioid epidemic in rural areas, including the low density of populations and the scarcity of behavioral health resources (e.g., fewer credentialed behavioral health professionals, particularly those able to prescribe Buprenorphine). Considerations for addressing this new wave are discussed, along with the drawbacks of a wave perspective and persistent concerns in confronting drug abuse such as stigma.

Effect of bile duct ligation-induced liver dysfunction on methamphetamine pharmacokinetics in male and female rats

BACKGROUND

Several disease states commonly associated with methamphetamine (METH) use produce liver dysfunction, and in the bile duct ligation (BDL) model of hepatic dysfunction, rats with liver injury are more sensitive to METH effects. Additionally, both female rats and humans are known to be more sensitive to METH than males. In consideration of known sex-dependent differences in METH pharmacokinetics, this study sought to determine the potential interaction between sex and liver dysfunction variables on METH pharmacokinetics.

METHODS

Sham or BDL surgery was performed on male and female rats on day 0. Serum biomarker and pharmacokinetics studies with 3 mg/kg subcutaneous (SC) METH were performed on day 7. METH-induced weight loss was measured on day 8. Liver histology evaluation and brain METH concentration measurements were performed on day 9.

RESULTS

While BDL surgery produced significantly elevated alanine aminotransferase and bile duct proliferation in male compared to female rats, there were no significant interactions between sex and liver function in the pharmacokinetic parameters. Both liver dysfunction and female sex, however, were associated with significantly slower METH serum clearance and significantly higher brain METH concentrations (p < .05).

CONCLUSIONS

BDL-induced hepatic dysfunction produces substantial reductions in METH clearance and increased brain METH concentrations in both male and female rats, despite less liver injury in females. This preclinical model may be useful to identify and correct potential liver dysfunction comorbidity-related problems with future pharmacotherapy for stimulant use disorder with METH prior to expensive clinical trials.

Effect of Bile Duct Ligation-induced Liver Dysfunction on Methamphetamine Pharmacokinetics and Locomotor Activity in Rats

PURPOSE

Methamphetamine (METH) abuse is associated with hepatic dysfunction related comorbidities such as HIV, hepatitis C, and polysubstance abuse with acetaminophen-containing opioid formulations. We aimed to develop a bile duct ligation (BDL)-induced hepatic dysfunction model for studying both METH and experimental treatments for METH abuse in this comorbidity.

METHODS

Sham or BDL surgery was performed in male Wistar rats on day 0. Liver function was measured throughout the study. On days 7 and 19, serum pharmacokinetics studies were performed with 1 mg/kg subcutaneous (sc) METH. On day 21, this dose was repeated to determine 2 h post-METH brain concentrations. METH-induced open field behaviors were measured every other day (days 12 - 16) with ascending sc doses (0.3 - 3 mg/kg).

RESULTS

BDL transiently increased alanine aminotransferase levels and altered liver structure, which resulted in significantly greater METH serum and brain exposure. In the BDL compared to sham group, there was a longer duration of METH-induced locomotor activity (after 1 and 3 mg/kg) and stereotypy (after 3 mg/kg).

CONCLUSIONS

In rats, liver dysfunction reduced METH clearance, increased brain METH concentrations, and enhanced METH effects on locomotor activity in a dose dependent manner. In addition, this model could be further developed to simulate the associated hepatic dysfunction of key METH abuse comorbidities for preclinical testing of novel pharmacotherapies for effectiveness and/or toxicity in vulnerable populations.

Finding the Hidden Risk Profiles of the United States Opioid Epidemic: Using a Person-Centered Approach on a National Dataset of Noninstitutionalized Adults Reporting Opioid Misuse

Opioid misuse can lead to use disorder and other adverse outcomes. Identifying sociodemographic risk profiles and understanding misuse patterns in combination with health indicators can inform prevention science and clinical practice. A latent class analysis of opioid misuse was conducted on noninstitutionalized United States civilians aged 18 and older that reported opioid dependence or abuse in the 2017 National Survey of Drug Use and Health (n = 476; weighted n = 2,018,922). Opioid misuse was based on heroin and/or prescription pain reliever use, and associated determinants of health and mental health indicators. Five misuse profiles were identified: (1) single heroin or prescription misuse with high-income; (2) female prescription pain reliever misuse with psychological distress and suicidality; (3) younger polyopioid misuse with the highest proportion of Hispanics and heroin use; (4) older polyopioid misuse with the highest proportion of non-Hispanic blacks and disability; and (5) older non-Hispanic white male exclusive dual heroin and/or prescription misuse (27%, 20%, 38%, 10%, and 5% of sample, respectively). The identified risk profiles can inform public health practice to develop interventions for acute and immediate response by providing etiological evidence and to inform prevention and intervention efforts along the continuum from opioid initiation to use disorder.

Friends and relatives as sources of prescription opioids for misuse among young adults: The significance of physician source and race/ethnic differences

Background: Given the public health issues associated with prescription opioid misuse, there is surprisingly little research on sources of prescription opioids for misuse. We know that free from friends/relatives is the most common source, that source is associated with patterns of misuse, and that sources vary based on the sociodemographic characteristics. The current research assesses how friends/relatives obtain the prescription opioids they freely share with others. Methods: Data were from the 2009-2014 National Survey on Drug Use and Health and focused on respondents aged 18 to 25 (N = 106,845), as they report the highest prevalence of opioid misuse and are also more likely to obtain prescription opioids free from friends/relatives. Analyses used weighted cross-tabulations and design-based logistic regression to examine the relationships between sources of prescription opioids shared by friends/relatives and sociodemographic characteristics, substance use disorders, and risk behavior. Results: The most common source was from one physician (68.8%), and 18.4% of respondents reported multiple sources of opioids. We also found significant differences in friend/relative sources based on school enrollment, sex, and race/ethnicity of the person obtaining the opioids. Notably, white respondents were more likely to report theft/fake prescription, purchases, and multiple sources. Finally, friend/relative sources were significantly associated with substance use disorders and other risk behaviors. Conclusions: The current research assesses the sharing of prescription opioids between friends/relatives, highlights physicians as a major source, and identifies whites as a vulnerable group. Policy implications associated with the sharing of prescription opioids among friends/relatives are discussed.

A scoping review of opioid misuse in the rural United States

INTRODUCTION

This study is a scoping review of the original research literature onthe misuse of opioids in the rural United States (US) and maps theliterature of interest to address the question: What does theoriginal research evidence reveal about the misuse of opioids inrural US communities?

METHODS

This study used a modified preferred reporting items for systematicreviews and meta-analyses (PRISMA) approach which is organized byfive distinct elements or steps: beginning with a clearly formulatedquestion, using the question to develop clear inclusion criteria toidentify relevant studies, using an approach to appraise the studiesor a subset of the studies, summarizing the evidence using anexplicit methodology, and interpreting the findings of the review.

RESULTS

The initial search yielded 119 peer reviewed articles and aftercoding, 41 papers met the inclusion criteria. Researcher generatedsurveys constituted the most frequent source of data. Most studieshad a significant quantitative dimension to them. All the studieswere observational or cross-sectional by design.

CONCLUSIONS

This analysis found an emerging research literature that hasgenerated evidence supporting the claim that rural US residents andcommunities suffer a disproportionate burden from the misuseof opioidscompared to their urban or metropolitan counterparts.

Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents

PURPOSE

This study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences.

METHODS

We used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past-year POM among 32,036 adolescents aged 12-17.

RESULTS

Among adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past-year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past-year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs.

CONCLUSIONS

Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents' reliance on emergency departments where opioid prescribing is more likely.

Prevalence and experience of chronic pain in suburban drug injectors

AIMS

To explore the relationship between chronic pain and characteristics, behaviors, and psychological status of suburban Connecticut injection drug users.

METHODS

Cross-sectional study with quantitative interview and serological testing for HIV and hepatitis B and C in 456 individuals who injected drugs in the past month. Participants were dichotomized into those reporting current chronic pain of at least six months duration and all others. The interview covered (i) sociodemographics, (ii) injection drug use, (iii) interactions with drug treatment, criminal justice, and harm reduction, (iv) screening for alcohol use, chronic pain, anxiety, and depression, and (v) knowledge regarding HIV, hepatitis B (HBV) and C (HCV), and opioid overdose. Serological testing for HIV, HBV, and HCV was conducted.

RESULTS

One-third (n = 143) reported chronic pain. These individuals differed significantly from those not reporting chronic pain on characteristics that included older age, lower educational achievement, and injection of pharmaceutical opioids. They also reported experiencing more psychological and family problems on the ASI and higher levels of depression and anxiety. Four of five individuals with chronic pain (n = 117) reported non-medical opioid use prior to the onset of chronic pain.

CONCLUSIONS

Chronic pain is common among drug injectors in our study population although it was unusual for chronic pain to have preceded non-medical opioid use. Psychological problems in injectors with co-occurring chronic pain are likely pose significant complications to successful treatment for substance abuse, pain, or infectious disease treatment.

Correlates of prescription drug misuse among heterosexually active homeless men

OBJECTIVE

Prescription drug misuse (PDM) is an emerging epidemic in the United States. This study examines the prevalence and correlates of PDM among homeless men. Homeless men experience higher risk for substance misuse and associated health problems and are particularly vulnerable to PDM and its negative health consequences.

METHODS

Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Interviews assessed demographics, substance use, mental health, and social networks. Logistic regression examined correlates of PDM.

RESULTS

Twenty-six percent of the study population reported PDM in the past year. PDM was more likely among homeless men suffering from posttraumatic stress disorder (PTSD) (odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.03-5.61) and among those with more substance-using social network members (OR = 1.07, 95% CI: 1.01-1.14). Decreased PDM was associated with good health (OR = 0.34, 95% CI: 0.16-0.75).

CONCLUSIONS

The prevalence of PDM is higher among the homeless men in this study than in the general population. Correlates of PDM included PTSD and poor health, suggesting that homeless men may use PDM to self-medicate. PDM was also associated with increased substance-using social network alters. Physical and mental health and social context are important aspects to consider in prevention efforts to reduce PDM among homeless men.

Risk factors for incident nonmedical prescription opioid use and abuse and dependence: results from a longitudinal nationally representative sample

BACKGROUND

There has been a significant increase in opioid prescriptions and the prevalence of opioid nonmedical use. Nonmedical use may lead to opioid abuse/dependence, a serious public health concern. The aim of this paper was to determine the mental and physical health predictors of incident nonmedical prescription opioid use (NMPOU) and abuse/dependence, and the impact of comorbidity in a longitudinal, nationally representative sample.

METHODS

Data come from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=34,653; ≥20 years old). Mental disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV edition. Physical conditions were based on self-reports of physician-diagnoses. Multiple logistic regression models examined the associations between mental and physical health predictors at Wave 1 and their association to incident NMPOU and abuse/dependence disorders at Wave 2.

RESULTS

After adjusting for sociodemographics, Axis I and II mental disorders and physical conditions, the presence of mental disorders (i.e., mood, personality disorders and substance use disorders), physical conditions (i.e., increasing number of physical conditions, any physical condition, arteriosclerosis or hypertension, cardiovascular disease and arthritis) and sociodemographic factors (i.e., sex and marital status) at Wave 1 positively predicted incident abuse/dependence at Wave 2. Comorbid disorders increased the risk of NMPOU and abuse/dependence.

CONCLUSION

These results suggest the importance of mental and physical comorbidity as a risk for NMPOU and abuse/dependence, emphasizing the need for careful screening practices when prescribing opioids.

Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009

The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of POD and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between POD and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in POD and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals POD predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years POD by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.

Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009

The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of POD and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between POD and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in POD and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals POD predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years POD by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.

Prevalence and correlates for nonmedical use of prescription opioids among urban and rural residents

BACKGROUND

In the United States, rural areas have reported an increase in overdose deaths secondary to nonmedical use of prescription opioids. Little is known about the differences in nonmedical use of prescription opioids among urban and rural adults.

METHODS

Using the 2008-2009 National Survey on Drug Use and Health, we examined the prevalence of nonmedical use of prescription opioids in urban and rural counties and determined bivariate and multivariate associations, stratified by county. We also compared type of opioids, stratified by county.

RESULTS

Among 75,964 respondents, the prevalence of nonmedical use of prescriptions opioids was similar among residents in urban and rural counties (4.7% vs. 4.3%, p=0.15). Urban and rural residents with severe psychological distress and nonmedical use of other prescription medications were more likely to report nonmedical use of opioids. Urban residents whose first use of illicit drugs was between the age of 18 and 25 and who reported alcohol use were more likely to report nonmedical use. Black and Hispanic urban residents were less likely to use prescription opioids nonmedically compared to white urban residents. Rural residents were more likely than urban residents to use acetaminophen with propoxyphene (61.1% vs. 55.8%, p=0.02), methadone (14.8% vs. 9.1%, p=0.003) and acetaminophen with codeine (3.5% vs. 1.9%, p=0.05).

CONCLUSIONS

Prevalence and risk factors related to nonmedical use of opioids are similar between urban and rural residents; however rural residents report propoxyphene, codeine, and methadone use more than their urban counterparts. Prevention and treatment interventions may need to be tailored for specific communities.

Characteristics of rural crack and powder cocaine use: gender and other correlates

BACKGROUND

Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio.

OBJECTIVES

Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use.

METHODS

Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine.

FINDINGS

Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.

Nonmedical prescription opioid use and mental health and pain comorbidities: a narrative review

OBJECTIVE

In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations.

METHOD

A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.

RESULTS

Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU.

CONCLUSIONS

The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.

Prevalence and correlates of nonmedical use of prescription opioids in patients seen in a residential drug and alcohol treatment program

Population-based data indicate that rates of nonmedical use of prescription opioids (POs) have increased dramatically over the past decade. However, data are lacking on nonmedical use of POs in individuals seeking treatment for substance use disorders. Patients (N = 351) seeking treatment from a residential drug and alcohol treatment program were assessed for nonmedical use of POs prior to treatment entry. Approximately 68% (65% men and 78% women) of patients reported at least some nonmedical PO use in the 30 days prior to treatment. Our results indicate that nonmedical PO use was more common in those with higher levels of depressive symptoms and pain intensity and in those with lower physical functioning. Treatment programs should consider actively screening participants for nonmedical PO use and consider how nonmedical use of pain medications might influence their treatment planning for patients.

Outcomes following Prison and Jail-Based Treatment among Women Residing in Metro and Non-Metro Communities following Release

This study uses data from the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS) to describe treatment outcomes following prison and jail-based treatment among women residing in metro and non-metro areas following release. The study takes an exploratory look at potential differences in sustained abstinence, community treatment utilization, and recidivism by geographic location (metro/non-metro) and treatment program (jail or prison). Baseline data was collected from women as they entered two prison and two jail-based treatment programs, and follow-up data was collected 12 months post-release in the community. Bivariate group differences were noted with a higher percentage of metro women who participated in prison-based treatment relapsing to cocaine use during the follow-up period compared to non-metro women. In multivariate models, females who participated in jail-based treatment and prison-based treatment fared similarly on study outcomes. There was, however a main effect of residence status in that women living in non-metro areas during the follow-up period were less likely to utilize community-based aftercare treatment and less likely to be re-incarcerated during the follow-up period than women living in metro areas. Findings are discussed with regard to future research and practice implications for women offenders transitioning to geographically different communities following release.

Subtypes of nonmedical opioid users: results from the national epidemiologic survey on alcohol and related conditions

AIMS

To identify subtypes of nonmedical opioid users, gender variations in psychiatric disorders, and quality of life in a representative sample of adults.

METHODS

Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Latent class analysis (LCA) and multinomial logistic regression procedures examined subtypes of nonmedical opioid users.

RESULTS

Approximately 5% (n=1815) of adults used nonmedical opioids. LCA identified four subtypes: opioid-marijuana users (33%), opioid-other prescription drug users (9%), opioid-marijuana-hallucinogen users (28%), and opioid-polydrug users (30%). Subtypes were distinguished by race/ethnicity, gender, familial substance abuse, personal history of substance abuse treatment, and patterns of psychiatric disorders. Whites and men had increased odds of being in the opioid-polydrug and opioid-marijuana-hallucinogen subtypes. The opioid-other prescription drug use subtype had disproportionately affected women who were characterized by high rates of mood/anxiety disorders and low quality of life. Across all subtypes, women and men had similarly problematic substance use disorders; however, women had more major depression and disability in the mental health domain.

CONCLUSIONS

The generally high prevalence of psychiatric disorders among nonmedical opioid users, particularly women, underscores the need for comprehensive assessment and coordinated delivery of services to match needs with treatment, as well as continued monitoring of trends in opioid use and related problems.

Opioid detection in maternal and neonatal hair and meconium: characterization of an at-risk population and implications to fetal toxicology

Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.

Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study

The use of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) has increased dramatically in the past two decades. There has also been a marked increase in the abuse of prescribed opioids and in accidental opioid overdose. Misuse of prescribed opioids may link these trends, but has thus far only been studied in small clinical samples. We therefore sought to validate an administrative indicator of opioid misuse among large samples of recipients of COT and determine the demographic, clinical, and pharmacological risks associated with possible and probable opioid misuse. A total of 21,685 enrollees in commercial insurance plans and 10,159 in Arkansas Medicaid who had at least 90 days of continuous opioid use 2000-2005 were studied for one year. Criteria were developed for possible and probable opioid misuse using administrative claims data concerning excess days supplied of short-acting and long-acting opioids, opioid prescribers and opioid pharmacies. We estimated possible misuse at 24% of COT recipients in the commercially insured sample and 20% in the Medicaid sample and probable misuse at 6% in commercially insured and at 3% in Medicaid. Among non-modifiable factors, younger age, back pain, multiple pain complaints and substance abuse disorders identify patients at high risk for misuse. Among modifiable factors, treatment with high daily dose opioids (especially >120 mg MED per day) and short-acting Schedule II opioids appears to increase the risk of misuse. The consistency of the findings across diverse patient populations and the varying levels of misuse suggest that these results will generalize broadly, but await confirmation in other studies.