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Howell BA, Black AC, Grau LE, Lin HJ, Greene C, Lee H, Heimer R, Hawk KE, D'Onofrio G, Fiellin DA, Becker WC. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis. Drug Alcohol Depend 2023; 244:109788. [PMID: 36738634 PMCID: PMC9975083 DOI: 10.1016/j.drugalcdep.2023.109788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Opioid overdoses are a leading cause of preventable death in the United States. There is limited research linking decedents' receipt of controlled substances and presence of controlled substances on post-mortem toxicology (PMT). METHODS We linked data on opioid-detected deaths in Connecticut between May 3, 2016, and December 31, 2017 from the Office of the Chief Medical Examiner, Department of Consumer Protection, and Department of Mental Health and Addiction Services. Exposure was defined as receipt of an opioid or benzodiazepine prescription within 90 days prior to death. Our primary outcome was concordance between medication received and metabolites in PMT. RESULTS Our analysis included 1412 opioid-detected overdose deaths. 47 % received an opioid or benzodiazepine 90 days prior to death; 36 % received an opioid and 27 % received a benzodiazepine. Concordance between receipt of an opioid or benzodiazepine and its presence in PMT was observed in 30 % of opioid-detected deaths. Concordance with an opioid was present in 17 % of opioid-detected deaths and concordance with a benzodiazepine was present in 21 % of opioid-detected deaths. Receipt of an opioid or benzodiazepine and concordance with PMT were less common in fentanyl or heroin-detected deaths and more common in pharmaceutical opioid-detected deaths. DISCUSSION Our results suggest medically supplied opioids and benzodiazepines potentially contributed to a substantial number, though minority, of opioid-detected deaths during the study period. Efforts to reduce opioid and benzodiazepine prescribing may reduce risk of opioid-detected deaths in this group, but other approaches will be needed to address most opioid-detected deaths that involved non-pharmaceutical opioids.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, the United States of America; Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America.
| | - Anne C Black
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
| | - Lauretta E Grau
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Storrs, CT, the United States of America; Department of Mental Health and Addiction Services, Hartford, CT, the United States of America
| | - Christina Greene
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Hana Lee
- U.S. Food and Drug Administration, Silver Spring, MD, the United States of America
| | - Robert Heimer
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America
| | - Kathryn E Hawk
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - Gail D'Onofrio
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Yale School of Public Health, New Haven, CT, the United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, the United States of America
| | - William C Becker
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, the United States of America; Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, the United States of America; VA Connecticut Healthcare System, West Haven, CT, the United States of America
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Scorsone KL, Haozous EA, Hayes L, Cox KJ. Ending the Chase: Experiences of Rural Individuals with Opioid Use Disorder. Subst Use Misuse 2021; 56:1224-1231. [PMID: 33871309 DOI: 10.1080/10826084.2021.1914109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The US remains in the midst of an opioid overdose epidemic. Given that rural populations have higher rates of opioid-related morbidity and mortality, it is important to understand the factors that perpetuate opioid use and facilitate recovery in rural communities. Purpose: To explore experiences of individuals living with opioid use disorder (OUD) and to analyze these experiences within a broader sociocultural context. Methods: Using a descriptive, qualitative design, we interviewed twenty purposefully sampled participants. We used thematic content analysis to identify themes and patterns. Results: As participants became dependent, the chase for opioids was to avoid the pain of withdrawal. Waking up sick became an everyday experience, leading to a lifestyle of hustling. The pursuit of opioids resulted in physical, social, emotional, and legal consequences that fed a cycle of stigmatization. In recovery, participants learned to embrace a new way of thinking, allowing them to make new choices. The strong influence of family and community in their lives was a key factor in their resiliency and opioid use experiences. Conclusions: Individuals with OUD are impacted by intersecting social, physical, economic and policy factors that reinforce the expansion of the opioid epidemic rurally. This study provided a voice to rural individuals with opioid use disorder, a group often underrepresented in the literature, providing an understanding of their struggles and the unique sociocultural dynamics that exist in rural northern New Mexico. The complex sociocultural relationships to family and community represent important adaptive factors that could support individual healing and community transformation.
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Affiliation(s)
- Krista L Scorsone
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Rueckert-Hartman College for Health Professions, Regis University, Denver, Colorado, USA.,The College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Leslie Hayes
- El Centro Family Health, Española, New Mexico, USA
| | - Kim J Cox
- The College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
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Green JL, Dailey-Govoni T, Butler SF. Real-World Data on Nonmedical Use of Tramadol from Patients Evaluated for Substance Abuse Treatment in the NAVIPPRO Addiction Severity Index-Multimedia Version (ASI-MV ®) Network. Drug Saf 2020; 44:235-244. [PMID: 33175336 PMCID: PMC7847458 DOI: 10.1007/s40264-020-01012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Drug safety studies regarding comparative risk of different opioid compounds are important as providers and regulatory agencies in the United States continue to balance pain management with an ongoing opioid epidemic. OBJECTIVE The aim of this study was to evaluate nonmedical use (NMU) and diversion of tramadol and comparator opioids using real-world data from the Addiction Severity Index-Multimedia Version (ASI-MV®). METHODS A cross-sectional study design was used to evaluate past 30-day tramadol and comparator opioid NMU among adults assessed for substance abuse treatment using the ASI-MV from 2010 to 2018. Population and drug utilization-adjusted rates were studied, as well as patient characteristics, route of administration, and diversion. RESULTS Past 30-day NMU of one or more prescription opioid was reported in 125,048 (22.6%) of ASI-MV assessments (2010-2018); 46.5% reported oxycodone, 43.2% hydrocodone, 8.1% morphine, and 7.2% tramadol. Male respondents ranged from 43.2% in the tramadol group to 51.8% in the oxycodone group. Majority (~ 76%) were Caucasian in all groups, with 86.9% Caucasian in the morphine group. Prevalence of past 30-day tramadol NMU was significantly lower than that of morphine, oxycodone, and hydrocodone for both population and utilization-adjusted rates. Rate of snorting of tramadol was 4-7 times lower than comparator opioids and injection was 14-34 times lower than morphine and oxycodone. Tramadol was most likely to be obtained via the patient's own prescription while the comparator opioids were more often obtained via dealers or family/friends. CONCLUSION Tramadol had a significantly lower rate of NMU than comparator opioids and was less likely to be diverted or used via higher-risk non-oral routes. These findings support previous evaluations by WHO and the United States Drug Enforcement Agency that concluded that tramadol has a low potential for abuse.
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Affiliation(s)
- Jody L Green
- Inflexxion, A Division of Integrated Behavioral Health, Irvine, CA, USA.
| | | | - Stephen F Butler
- Inflexxion, A Division of Integrated Behavioral Health, Irvine, CA, USA
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Ford JA, Pomykacz C, Szalewski A, Esteban McCabe S, Schepis TS. Friends and relatives as sources of prescription opioids for misuse among young adults: The significance of physician source and race/ethnic differences. Subst Abus 2019; 41:93-100. [PMID: 31295073 DOI: 10.1080/08897077.2019.1635955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Corey Pomykacz
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Alec Szalewski
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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5
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Rudolph AE, Young AM, Havens JR. Using Network and Spatial Data to Better Target Overdose Prevention Strategies in Rural Appalachia. J Urban Health 2019; 96:27-37. [PMID: 30465260 PMCID: PMC6391296 DOI: 10.1007/s11524-018-00328-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This analysis uses network and spatial data to identify optimal individuals to target with overdose prevention interventions in rural Appalachia. Five hundred and three rural persons who use drugs were recruited to participate in the Social Networks among Appalachian People Study (2008-2010). Interviewer-administered surveys collected information on demographic characteristics, risk behaviors (including overdose history), network members, and residential addresses. We restricted the sample to individuals with at least one confirmed relationship to another study participant (N = 463). Using dyadic analyses (N = 1428 relationships), we identified relationship-level correlates of relationships with network members who have previously overdosed. We then examined individual- and network-level factors associated with (1) having at least one first-degree alter (i.e., network member) with a prior overdose and (2) each additional network member with a prior overdose (N = 463 study participants). Overall, 28% of the sample had previously overdosed and 57% were one-degree away from someone who previously overdosed. Relationships with those who had overdosed were characterized by closer residential proximity. Those with at least one network member who previously overdosed were more geographically central and occupied more central network positions. Further, the number of network members with an overdose history increased with decreasing distance to the town center, increasing network centrality, and prior enrollment in an alcohol detox program. Because fatal overdoses can be prevented through bystander intervention, these findings suggest that strategies that target more central individuals (both geographically and based on their network positions) and those who have previously enrolled in alcohol detox programs with overdose prevention training and naloxone may optimize intervention reach and have the potential to curb overdose fatalities in this region.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. .,Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA.
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Palombi LC, St Hill CA, Lipsky MS, Swanoski MT, Lutfiyya MN. A scoping review of opioid misuse in the rural United States. Ann Epidemiol 2018; 28:641-652. [PMID: 29921551 DOI: 10.1016/j.annepidem.2018.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | | | | | - Michael T Swanoski
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - M Nawal Lutfiyya
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN.
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Dunn KE, Barrett FS, Yepez-Laubach C, Meyer AC, Hruska BJ, Petrush K, Berman S, Sigmon SC, Fingerhood M, Bigelow GE. Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural versus an Urban Setting. J Subst Abuse Treat 2018; 71:1-7. [PMID: 27672239 DOI: 10.1016/j.jsat.2016.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Opioid use is highly prevalent in the United States and there has been an increased incidence in the rate of opioid-related overdose. While evidence suggests there are substantial differences in opioid use among rural versus urban settings, the rate of overdose and corresponding frequency of opioid overdose risk behaviors and overdose knowledge between rural and urban settings have not been examined. METHODS Individuals with opioid use disorder from rural (N=98) and urban (N=247) settings completed a self-report survey regarding their lifetime history of overdose and overdose risk behaviors. Participants also completed the Brief Opioid Overdose Knowledge (BOOK) questionnaire, a 12-item self-report measure of opioid overdose knowledge. RESULTS Overall, 35.6% of participants had experienced an overdose, and prevalence of overdose was significantly higher (p<.01) among rural (45.9%) vs. urban (31.6%) participants, though fewer rural participants reported past 30-day risk behaviors. There were few differences observed between the subset of rural and urban participants who had experienced an overdose, and fewer rural participants with a history of overdose reported past 30-day risk behaviors. Both rural and urban participants performed poorly on the BOOK, though the percent of correct responses was lowest among rural participants with a history of overdose. CONCLUSION Results demonstrate higher rates of overdose among rural opioid users, though rural participants were less likely to report recent risk behaviors. Results also suggest that knowledge regarding key factors related to opioid overdose is severely lacking, particularly among rural opioid users, which could be a potential target for future intervention efforts.
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Affiliation(s)
- Kelly E Dunn
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences
| | - Frederick S Barrett
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences
| | - Claudia Yepez-Laubach
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences
| | | | | | - Kathy Petrush
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Medicine
| | - Suzan Berman
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Medicine
| | - Stacey C Sigmon
- University of Vermont, Department of Psychiatry; University of Vermont, Department of Psychology
| | - Michael Fingerhood
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Medicine
| | - George E Bigelow
- Johns Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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10
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Tjäderborn M, Jönsson AK, Sandström TZ, Ahlner J, Hägg S. Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden. Drug Alcohol Depend 2016; 161:77-85. [PMID: 26875672 DOI: 10.1016/j.drugalcdep.2016.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 12/20/2022]
Abstract
AIMS To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a psychoactive prescription drug, and to identify associated factors. METHODS Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. RESULTS In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non-prescribed use. CONCLUSIONS Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.
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Affiliation(s)
- Micaela Tjäderborn
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Tatiana Zverkova Sandström
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Ahlner
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Staffan Hägg
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
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Haynes A, Kleinschmidt K, Forrester MB, Young A. Trends in analgesic exposures reported to Texas Poison Centers following increased regulation of hydrocodone. Clin Toxicol (Phila) 2016; 54:434-40. [PMID: 26919555 DOI: 10.3109/15563650.2016.1148720] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT In October 2014, the Drug Enforcement Administration reclassified hydrocodone to schedule II, increasing regulations on use. The impact of rescheduling hydrocodone on opioid exposures is unclear, especially in states with special restrictions required for prescribing schedule II agents. OBJECTIVE To assess whether changes in exposures to prescription opioid analgesics and heroin as reported to poison centers occurred in the 6 months after hydrocodone rescheduling. We hypothesized that hydrocodone exposures would decrease, while less tightly regulated opioids, such as codeine and tramadol, would increase. MATERIALS AND METHODS This study compares opioid analgesic exposures reported to Texas Poison Centers before and after this change in a state that requires special prescription pads for Schedule II agents. Cases included all opioid analgesic exposures reported to a statewide poison center network, comparing exposures from 6 months before to 6 months after heightened regulations. Specific opioids with large changes in reported exposures were further characterized by patient age and exposure intent. RESULTS Hydrocodone exposures decreased from 1567 to 1135 (28%, p = 0.00017), decreasing for all ages. Codeine exposures increased significantly from 189 to 522 (176%, p = 0.00014), including a 263% increase for age >20 years. Codeine misuse increased 443% and adverse drug events 327%. Oxycodone exposures increased from 134 to 189 (39%, p = 0.0143), increasing only among patients age >20 years. Reported heroin exposures increased from 156 to 179 (15%, p = 0.2286) and tramadol from 666 to 708 (6%, p = 0.0193). Other opioid exposures changed little or had limited reports. DISCUSSION The increased regulation of hydrocodone was followed temporally by a decrease in reported hydrocodone exposures, but also increases in codeine, oxycodone and tramadol exposures. This may reflect a shift in prescribing practices, changes in street availability of hydrocodone or decreased drug diversion. CONCLUSION The increased regulation was temporally associated with decreased hydrocodone exposures reported to Texas Poison Centers.
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Affiliation(s)
- Ashley Haynes
- a Emergency Medicine/Division of Toxicology , University of Texas Southwestern , Dallas , TX , USA
| | - Kurt Kleinschmidt
- a Emergency Medicine/Division of Toxicology , University of Texas Southwestern , Dallas , TX , USA
| | | | - Amy Young
- a Emergency Medicine/Division of Toxicology , University of Texas Southwestern , Dallas , TX , USA
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12
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Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors. Drug Alcohol Depend 2016; 158:132-8. [PMID: 26653341 PMCID: PMC4698068 DOI: 10.1016/j.drugalcdep.2015.11.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonmedical use of opioids has become increasingly problematic in recent years with increases in overdoses, treatment admissions, and deaths. Use also appears to be contributing to heroin initiation, which has increased in recent years. Further research is needed to examine which adolescents are at highest risk for nonmedical use of opioids and heroin and to explore potential links between nonmedical opioid use and heroin use. METHODS Data were analyzed from a nationally representative sample of American high school seniors in the Monitoring the Future study (2009-2013, Weighted N=67,822). We examined associations between frequency and recency of nonmedical use of opioids and heroin. Sociodemographic correlates of use of each drug were also examined. RESULTS 12.4% of students reported lifetime nonmedical opioid use and 1.2% reported lifetime heroin use. As frequency of lifetime nonmedical opioid use increased, so too did the odds for reporting heroin use, with over three-quarters (77.3%) of heroin users reporting lifetime nonmedical opioid use. Recent (30-day) nonmedical opioid use was a robust risk factor for heroin use and almost a quarter (23.2%) of students who reported using opioids ≥40 times reported lifetime heroin use. Black and Hispanic students were less likely to report nonmedical opioid or heroin use than white students, but they were more likely to report heroin use in absence of nonmedical opioid use. DISCUSSION Recent and frequent nonmedical opioid use are risk factors for heroin use among adolescents. Prevention needs to be targeted to those at highest risk.
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Frank JW, Binswanger IA, Calcaterra SL, Brenner LA, Levy C. Non-medical use of prescription pain medications and increased emergency department utilization: Results of a national survey. Drug Alcohol Depend 2015; 157:150-7. [PMID: 26564754 PMCID: PMC4663179 DOI: 10.1016/j.drugalcdep.2015.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/06/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are no population-based studies of emergency department (ED) utilization by individuals using prescription pain medications non-medically. We examined whether non-medical use of prescription pain medications was independently associated with increased ED utilization. METHODS We conducted a retrospective analysis of a nationally representative sample of the non-institutionalized, civilian U.S. population in the National Survey on Drug Use and Health, 2008-2013. We used multivariable logistic regression to examine the association between past year ED utilization and non-medical use of prescription pain medications, defined as use of medications "not prescribed for you or that you took only for the experience or feeling they caused". RESULTS An estimated 10.5 million adults annually reported past year non-medical use (NMU) of prescription pain medications, and 39%, or 4.1 million adults annually, also reported one or more past year ED visits. After adjustment for sociodemographic and clinical characteristics, adults with past year NMU of prescription pain medications had increased odds of past year ED utilization (adjusted odds ratio 1.32; 95% confidence interval 1.24-1.41). In secondary analyses, individuals with more frequent NMU had increased odds of ED utilization in unadjusted analyses, but this association was attenuated with adjustment for the source of prescription pain medication (i.e., physician, friend/family, other source). CONCLUSIONS Non-medical use of prescription pain medications is associated with increased ED utilization. Further work is needed to identify the optimal role of ED settings in providing screening, education, and treatment referral for individuals using prescription pain medications non-medically.
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Affiliation(s)
- Joseph W Frank
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States.
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO 80231, United States
| | - Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, United States
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, United States; Departments of Psychiatry, Physical Medicine and Rehabilitation, and Neurology, University of Colorado, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, United States
| | - Cari Levy
- VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States; Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 400, Aurora, CO 80045, United States
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Srinivas NR. Differential Consequences of Tramadol in Overdosing: Dilemma of a Polymorphic Cytochrome P450 2D6-Mediated Substrate. J Pain Palliat Care Pharmacother 2015; 29:272-5. [PMID: 26367475 DOI: 10.3109/15360288.2015.1047555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tramadol is a centrally acting opioid analgesic that is prone to polymorphic metabolism via cytochrome P450 (CYP) 2D6. The generation of the active metabolite, O-desmethyltramadol, which occurs through the CYP 2D6 pathway, significantly contributes to the drug's activity. However, dosage adjustments of tramadol are typically not practiced in the clinic when treating patients who are homozygous extensive metabolizers, heterozygous extensive metabolizers, or poor metabolizers. In the event of a tramadol overdose, the consequences may be influenced importantly by the genotype or phenotype status of the subject. Depending on the individual subject's CYP 2D6 status, one may see excessive miotic-related toxicity driven by the excessive availability of O-desmethyltramadol or one may manifest mydriatic-related toxicity driven by the excessive availability of tramadol. This report provides pharmacokinetic perspectives in situations of tramadol overdosing.
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Abstract
PURPOSE OF REVIEW Public health concern regarding the nonmedical use of prescription stimulants among youth has generated the need for increased understanding of diversion, which is the illegal sharing and selling of prescription drugs. Although our understanding of nonmedical use of stimulants has increased, the same cannot be said of diversion behavior among youth. RECENT FINDINGS The aim of this article is to use data from the National Monitoring of Adolescent Prescription Stimulants Study, which assessed prescription stimulant use among 10-18 years old across 10 US cities to report on prescription stimulant diversion among those who misused those medications. Findings indicate that more than one half (52%) of youth had engaged in one of the three forms of diversion (incoming only, outgoing only and both incoming and outgoing diversion). Engaging in incoming diversion only and both incoming and outgoing diversion increased with age and nonmedical use of prescription stimulants. All forms of diversion increased with marijuana use and among 16-18 years old with a friend's use of prescription stimulant. SUMMARY Findings provide an understanding of the subtypes of diversion and risk correlates of youth prescription stimulant diverter's that has value in preventing prescription stimulant diversion.
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Chirikov VV, Shaya FT, Howell CD. Contextual analysis of determinants of late diagnosis of hepatitis C virus infection in medicare patients. Hepatology 2015; 62:68-78. [PMID: 25754171 DOI: 10.1002/hep.27775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 03/04/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Patient- and county-level characteristics associated with advanced liver disease (ALD) at hepatitis C virus (HCV) diagnosis were examined in three Medicare cohorts: (1) elderly born before 1945; (2) disabled born 1945-1965; and (3) disabled born after 1965. We used Medicare claims (2006-2009) linked to the Area Health Resource Files. ALD was measured over the period of 6 months before to 3 months after diagnosis. Using weighted multivariate modified Poisson regression to address generalizability of findings to all Medicare patients, we modeled the association between contextual characteristics and presence of ALD at HCV diagnosis. We identified 1,746, 3,351, and 592 patients with ALD prevalence of 28.0%, 23.0%, and 15.0% for birth cohorts 1, 2, and 3. Prevalence of drug abuse increased among younger birth cohorts (4.2%, 22.6%, and 35.6%, respectively). Human immunodeficiency virus coinfection (prevalence ratio [PR] = 0.63; 95% confidence interval [CI]: 0.50-0.80; P = 0.001), dual Medicare/Medicaid eligibility (PR = 0.89; 95% CI: 0.80-0.98; P = 0.017), residence in counties with higher median household income (PR = 0.82; 95% CI: 0.71-0.95; P = 0.008), higher density of primary care providers (PR = 0.84; 95% CI: 0.73-0.98; P = 0.022), and more rural health clinics (PR = 0.90; 0.81-1.01; P = 0.081) were associated with lower ALD risk. End-stage renal disease (PR = 1.41; 95% CI: 1.21-1.63; P = 0.001), alcohol abuse (PR = 2.57; 95% CI: 2.33-2.84; P = 0.001), hepatitis B virus (PR = 1.32; 95% CI: 1.09-1.59; P = 0.004), and Midwest residence (PR = 1.22; 95% CI: 1.05-1.41; P = 0.010) were associated with higher ALD risk. Living in rural counties with high screening capacity was protective in the elderly, but associated with higher ALD risk among the disabled born 1945-1965. CONCLUSIONS ALD prevalence patterns were complex and were modified by race, elderly/disability status, and the extent of health care access and screening capacity in the county of residence. These study results help inform treatment strategies for HCV in the context of coordinated models of care.
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Affiliation(s)
- Viktor V Chirikov
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.,University of Maryland School of Medicine, Baltimore, MD
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