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Rigg KK, Strickland S. Patterns of opioid misuse initiation among African-Americans. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2173050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
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Zaami S, Graziano S, Tittarelli R, Beck R, Marinelli E. BDZs, designer BDZs, and Z-drugs: pharmacology and misuse insights. Curr Pharm Des 2021; 28:1221-1229. [PMID: 34533440 DOI: 10.2174/1381612827666210917145636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
Benzodiazepines (BZDs) are a widely prescribed class of sedative-hypnotics compounds for the treatment of a broad range of conditions as anxiety and obsessive-compulsive disorders, phobias, sleep related problems associated with insomnia and for the management of alcohol and GHB withdrawal. Zolpidem, zopiclone and zaleplon, commonly known as Z-drugs are non-benzodiazepine hypnotic drug with pharmacology similar to BDZs. Despite their usefulness, BDZs and Z-drugs present a potential for abuse and dependence. Moreover, the non-medical use of BDZs is a well-known phenomenon and represents an increasingly widespread public health problem since is associated with an elevated risk of serious health consequences or fatal overdose, especially among specific group of users. The spectrum of BDZs and Z-drugs misuse is extended by new synthetic BDZs, which may pose high risks to users, since the majority have never undergone clinical trials or tests and consequently their pharmacology and toxicology is largely unknown.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | | | - Renata Beck
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico "AUO Riuniti", Foggia, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
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Ashworth N, Kain N, Wiebe D, Hernandez-Ceron N, Jess E, Mazurek K. Reducing prescribing of benzodiazepines in older adults: a comparison of four physician-focused interventions by a medical regulatory authority. BMC FAMILY PRACTICE 2021; 22:68. [PMID: 33832432 PMCID: PMC8034172 DOI: 10.1186/s12875-021-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The inappropriate and/or high prescribing of benzodiazepine and 'Z' drugs (BDZ +) is a major health concern. The purpose of this study was to determine whether physician or pharmacist led interventions or a simple letter or a personalized prescribing report from a medical regulatory authority (MRA) was the most effective intervention for reducing BDZ + prescribing by physicians to patients 65 years of age or older. METHODS This was a four-armed, one year, blinded, randomized, parallel-group, investigational trial in Alberta, Canada. Participants were fully licensed physicians (n = 272) who had prescribed 4 times the defined daily dose (4 + DDD) or more of any BDZ + to an older patient at least once in the 3rd quarter of 2016. All physician-participants were sent a personalized prescribing profile by the MRA. They were then randomized into four groups that received either nothing more, an additional personal warning letter from the MRA, a personal phone call from an MRA pharmacist or a personal phone call from an MRA physician. The main outcomes were prescribing behavior change of physicians at one year in terms of: change in mean number of older patients receiving 4 + DDD BDZ + and mean dose BDZ + prescribed per physician. To adjust for multiple statistical testing, we used MANCOVA to test both main outcome measures simultaneously by group whilst controlling for any baseline differences. RESULTS All groups experienced a significant fall in the total number of older patients receiving 4 + DDD of BDZ + by about 50% (range 43-54%) per physician at one year, and a fall in the mean dose of BDZ + prescribed of about 13% (range 10-16%). However, there was no significant difference between each group. CONCLUSIONS A personalized prescribing report alone sent from the MRA appears to be an effective intervention for reducing very high levels of BDZ + prescribing in older patients. Additional interventions by a pharmacist or physician did not result in additional benefit. The intervention needs to be tested further on a more general population of physicians, prescribing less extreme doses of BDZ + and that looks at more clinical and healthcare utilization outcomes.
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Affiliation(s)
- Nigel Ashworth
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada.
| | - Nicole Kain
- Department of Medicine, University of Alberta, Edmonton, Canada
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Delaney Wiebe
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Nancy Hernandez-Ceron
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Ed Jess
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Karen Mazurek
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Kelly BC, Vuolo M. Social network ties to nightlife and healthcare professionals and prescription drug misuse among young adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 66:48-56. [PMID: 30703607 DOI: 10.1016/j.drugpo.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study. METHODS We analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes - frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate. RESULTS Ties to party promoters (p < .05) and bouncers (p < .01) were positively associated with all three outcomes. A single outcome each was associated with ties to DJs (problems, p < .01), musicians (frequency, p < .05), and bartenders (escalation, p < .05). The total number of network ties in the nightlife domain was positively associated with all three outcomes, with each additional tie increasing frequency (20.3%, p < .001), odds of escalation (OR = 42.9%, p < .01), and problems (12.5%, p < .01). The number of sources, peer norm context, and social bonding were explanatory mechanisms for all three outcomes for nightlife networks. Specific occupational ties and the total number of ties to healthcare professionals were not associated with any outcome. CONCLUSION Embeddedness in nightlife networks is related to patterns of prescription drug misuse, and some of this association can be explained by multiple mechanisms of social networks. By contrast, ties to healthcare professionals are not associated with patterns of misuse among such young adults.
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Affiliation(s)
- Brian C Kelly
- Purdue University, Dept. of Sociology, 700 W State St., West Lafayette, IN, 47907, United States.
| | - Mike Vuolo
- The Ohio State University, Dept. of Sociology, United States
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Affiliation(s)
- Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - James Lee-Davey
- Department of Psychological Medicine, East London NHS Foundation Trust, Royal London Hospital, UK
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Hulme S, Bright D, Nielsen S. The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Drug Alcohol Depend 2018; 186:242-256. [PMID: 29626777 DOI: 10.1016/j.drugalcdep.2018.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The non-medical use (NMU) of pharmaceutical drugs is an increasing public health concern. This systematic review consolidates current knowledge about how pharmaceutical drugs are obtained for NMU and the processes and people involved in diversion. METHODS Peer-reviewed and grey literature databases were searched for empirical studies published between 1996 and 2017 that examined the source or diversion of pharmaceutical opioids, sedatives or stimulants for NMU in countries with reported misuse problems. Pooled prevalence meta-analyses using random effects models were used to estimate the prevalence of medical and non-medical sourcing reported by end-users, and gifting, selling and trading by various populations. RESULTS This review synthesizes the findings of 54 cross-sectional studies via meta-analyses, with a remaining 95 studies examined through narrative review. Pharmaceutical drugs are primarily sourced for NMU from friends and family (57%, 95% CI 53%-62%, I2 = 98.5, n = 30) and despite perceptions of healthcare professionals to the contrary, illegitimate practices such as doctor shopping are uncommon (7%, 95% CI 6%-10%, I2 = 97.4, n = 29). Those at risk of diversion include patients displaying aberrant medication behaviors, people with substance use issues and students in fraternity/sorority environments. Sourcing via dealers is also common (32%, 95% CI 23%-41%, I2 = 99.8, n = 25) and particularly so among people who use illicit drugs (47%, 95% CI 35%-60%, I2 = 99.1, n = 15). There is little to no organized criminal involvement in the pharmaceutical black market. CONCLUSION Pharmaceutical drugs for NMU are primarily sourced by end-users through social networks. Future research should examine how dealers source pharmaceutical drugs.
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Affiliation(s)
- Shann Hulme
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia.
| | - David Bright
- School of Social Sciences, UNSW Australia, High Street, Kensington, NSW, 2052, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia
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Peteet BJ. Psychosocial risks of prescription drug misuse among U.S. racial/ethnic minorities: A systematic review. J Ethn Subst Abuse 2017; 18:476-508. [PMID: 29173117 DOI: 10.1080/15332640.2017.1381662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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.
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Abstract
Benzodiazepine (BZD) abuse has reached epidemic levels and results in poor outcomes, particularly when combined with concomitant central nervous system depressants. BZDs are abused most commonly in combination with opioids and alcohol. Emergency department visits and related deaths have soared in recent years. In the absence of other medications or illicit substances, BZDs are rarely the sole cause of death. Prescription drug abuse has received more attention in recent years, yet much remains unknown about BZD abuse. BZDs have low abuse potential in most of the general population. A subset is at elevated risk of abuse, especially those with a history of a substance use disorder. Education, prevention, and identification are vital in reducing BZD abuse.
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Affiliation(s)
- Allison Schmitz
- Clinical Pharmacy Specialist, Fargo VA Health Care System, Fargo, North Dakota,
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Tjagvad C, Skurtveit S, Bramness JG, Gjersing L, Gossop M, Clausen T. Misuse of prescription drugs and overdose deaths. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1077280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harris S, Nikulina V, Gelpí-Acosta C, Morton C, Newsome V, Gunn A, Hoefinger H, Aikins R, Smith V, Barry V, Downing MJ. Prescription Drug Diversion: Predictors of Illicit Acquisition and Redistribution in Three U.S. Metropolitan Areas. AIMS Public Health 2015; 2:762-783. [PMID: 26690813 PMCID: PMC4683601 DOI: 10.3934/publichealth.2015.4.762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors. METHODS Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions. RESULTS While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion. CONCLUSION Findings suggest that predictive characteristics vary according to diverter group.
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Affiliation(s)
- Shana Harris
- Department of Anthropology, University of Central Florida, 4000 Central Florida Boulevard, Howard Phillips Hall 309, Orlando, FL 32816-1361, USA
| | - Valentina Nikulina
- Psychology Department, Queens College, City University of New York, 6530 Kissena Boulevard, SB A344, Queens, NY 11367-1597, USA
| | - Camila Gelpí-Acosta
- Social Science Department, LaGuardia Community College, City University of New York, 31-10 Thomson Avenue, Long Island City, NY 11101, USA
| | - Cory Morton
- School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA
| | - Valerie Newsome
- National Development and Research Institutes, 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Alana Gunn
- Department of Social Work, Binghamton University, P.O. Box 6000, Binghamton, NY 13902-6000
| | - Heidi Hoefinger
- Science Department, Berkeley College, 3 East 43 Street New York, NY 10017, USA
| | - Ross Aikins
- Graduate School of Education, University of Pennsylvania, 3700 Walnut Street Philadelphia, PA 19104, USA
| | - Vivian Smith
- Sociology and Criminology Department, Cabrini College, 610 King of Prussia Road, Radnor, PA 19087-3698, USA
| | - Victoria Barry
- Department of Pediatrics, Harlem Hospital Center, 506 Malcolm X Boulevard, New York, NY 10037, USA
| | - Martin J Downing
- Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY 10013, USA
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Prevalencia de consumo de hipnosedantes en población ocupada y factores de estrés laboral asociados. GACETA SANITARIA 2014; 28:369-75. [DOI: 10.1016/j.gaceta.2014.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/24/2014] [Accepted: 04/11/2014] [Indexed: 11/19/2022]
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Rigg KK, DeCamp W. Explaining Prescription Opioid Misuse Among Veterans: A Theory-Based Analysis Using Structural Equation Modeling. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21635781.2014.917011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reisfield GM, Webster LR. Benzodiazepines in Long-Term Opioid Therapy. PAIN MEDICINE 2013; 14:1441-6. [DOI: 10.1111/pme.12236] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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