Under the counter: the diffusion of narcotic analgesics to the inner city street

The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis

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.

Health and social problems associated with prescription opioid misuse among a diverse sample of substance-using MSM

This study examines associations between prescription opioid misuse and demographics, substance use, sexual behavior, and related health and social problems. Baseline data were collected between 2008 and 2010 from 515 high risk men who have sex with men, ages 18-55, in the Miami-Ft. Lauderdale metropolitan area who reported heavy substance use and HIV risk in the past 90 days. Prescription opioid misuse was associated with other substance use, drug injection, substance dependence, and history of arrest. Implications, limitations, and directions for future study are discussed.

From oxycodone to heroin: two cases of transitioning opioid use in young Australians

INTRODUCTION AND AIMS

The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths.

DESIGN AND METHODS

Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia.

RESULTS

Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use.

DISCUSSION AND CONCLUSIONS

These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions.

Alternate routes of administration and risk for HIV among prescription opioid abusers

Route of administration is an important contributor to the adverse health consequences of prescription medication abuse. The current study examines characteristics associated with non-oral routes of administration among a large sample of prescription opioid abusers and explores needle-related human immunodeficiency virus (HIV) risk behaviors as well. In the study, 791 opioid abusers completed a one-time structured interview, including complete histories of illicit and prescription drug abuse and route of drug administration. The most common method of pill use was oral (91%), followed by intranasal (53.1%), injection (23.8%), and smoking (14.5%). The youngest prescription opioid abusers, ages 18-24, displayed significantly higher odds of using alternate routes of administration and of reusing nonsterile needles for injection. HIV prevention programming should be developed for young prescription opioid injectors.

Addressing the intersecting problems of opioid misuse and chronic pain treatment

Misuse of prescription opioid medications has continued as a major public health problem in the United States. Review of major epidemiologic databases shows that the prevalence of opioid misuse rose markedly through the 1990s and the early part of the current decade. In this same period of time, the number of prescriptions for chronic noncancer pain increased markedly, and the intersection of these two public health problems remains a concern. Further, despite some leveling off of the overall rate of prescription opioid misuse in the past several years, surveillance data show high and increasing mortality associated with these drugs. Analysis of the 2006 National Survey of Drug Use and Health indicates the increasing prevalence of prescription opioid misuse is associated more with an increase in the general availability of these medications than misuse of the medications by those who were directly prescribed them. National Institute on Drug Abuse initiatives to address the prescription opioid problem include programs to stimulate research in the basic and clinical sciences, and to educate physicians and other health personnel.