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Rogers AH, Garey L, Bakhshaie J, Viana AG, Ditre JW, Zvolensky MJ. Anxiety, Depression, and Opioid Misuse Among Adults With Chronic Pain: The Role of Anxiety Sensitivity. Clin J Pain 2021; 36:862-867. [PMID: 32769415 DOI: 10.1097/ajp.0000000000000870] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The opioid epidemic is a significant public health problem largely driven by opioid prescriptions for chronic pain. Among those with chronic pain, anxiety and depressive symptoms have been linked to opioid misuse, and individual differences in anxiety and depressive symptoms among adults with chronic pain may be important for better understanding pain. Yet, little work has examined mechanisms that may link anxiety and depressive symptoms to opioid misuse among adults with chronic pain. Anxiety sensitivity (AS), or the fear of anxiety-related physical sensations, may be one candidate construct that has been linked independently to anxiety and depressive symptoms as well as opioid misuse. METHODS The current survey-based study examined the indirect association of AS in the relation between anxiety and depressive symptoms and opioid misuse among 429 adults with chronic pain currently using prescription opioid medication (73.9% female, Mage=38.32 y, SD=11.07). RESULTS Using structural equation modeling, it appears that AS is a potential construct in the interrelation between anxiety and depressive symptoms and opioid misuse. However, an alternative model found equally strong empirical support, as mental health symptoms may serve as an explanatory factor between AS and opioid misuse. DISCUSSION Bi-directional effects are apt to be involved among the studied variables. Prospective research is needed to replicate the study results and isolate the temporal patterning between the studied constructs. Nonetheless, the data overall highlight the importance of both AS and anxiety and depressive symptoms in terms of understanding opioid misuse among adults with chronic pain.
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Affiliation(s)
| | | | | | | | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Michael J Zvolensky
- Department of Psychology.,HEALTH Institute, University of Houston.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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2
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Layne KA, Dargan PI, Dines AM, Leaper C, Yates C, Hovda KE, Heyerdahl F, Archer JRH, Giraudon I, Wood DM. Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus. Br J Clin Pharmacol 2020; 87:1668-1675. [PMID: 32503085 DOI: 10.1111/bcp.14408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 01/09/2023] Open
Abstract
Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments with a large proportion requiring admission to hospital for ongoing care.
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Affiliation(s)
- Kerry A Layne
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, UK
| | - Craig Leaper
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - John R H Archer
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
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Rogers AH, Kauffman BY, Bakhshaie J, McHugh RK, Ditre JW, Zvolensky MJ. Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:470-478. [PMID: 30896985 DOI: 10.1080/00952990.2019.1569670] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions. Anxiety sensitivity, a transdiagnostic vulnerability factor defined as the fear of anxiety-related physical sensations, may be one important mechanism in elevated opioid misuse among persons with chronic pain. Objective: Therefore, the current cross-sectional study examined anxiety sensitivity (and construct sub-facets) as a predictor of opioid misuse among adults with chronic pain. Method: Adults reporting chronic pain and prescription opioid use completed an online survey. Results: Anxiety sensitivity was associated with multiple aspects of opioid misuse, including current opioid misuse, severity of opioid dependence, and number of opioids used to get high. The magnitude of effects ranged from medium to large. Associations between anxiety sensitivity and opioid misuse were observed over and above the variance accounted for by age, sex, income, education, perceived health, and pain severity. Conclusion: These findings suggest that anxiety sensitivity may be an important treatment target among adults with chronic pain who misuse opioids. Future research should continue to explore the explanatory relevance of anxiety sensitivity in opioid misuse among individuals with chronic pain.
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Affiliation(s)
- Andrew H Rogers
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Brooke Y Kauffman
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology, University of Houston , Houston , TX , USA
| | | | - Joseph W Ditre
- c Department of Psychology, Syracuse University , Syracuse , NY , USA
| | - Michael J Zvolensky
- a Department of Psychology, University of Houston , Houston , TX , USA.,d Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,e HEALTH Institute, University of Houston , Houston , TX , USA
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Dasgupta N, Schwarz J, Hennessy S, Ertefaie A, Dart RC. Causal inference for evaluating prescription opioid abuse using trend-in-trend design. Pharmacoepidemiol Drug Saf 2019; 28:716-725. [PMID: 30714239 DOI: 10.1002/pds.4736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE One response to the opioid crisis in the United States has been the development of opioid analgesics with properties intended to reduce non-oral use. Previous evaluations of abuse in the community have relied on population averaged interrupted time series Poisson models with utilization offsets. However, competing interventions and secular trends complicate interpretation of time-series analyses. An alternative research design, trend-in-trend, accounts for heterogeneity in per capita opioid dispensing and unmeasured time-varying confounding, which provides a causal evaluation, provided that underlying assumptions are met. METHODS Trend-in-trend can be modeled using a logistic regression framework. In logistic regression, exposure was any product-specific outpatient dispensing by three-digit ZIP code and calendar quarter, for 22 opioids. The outcome was any product-specific abuse case ascertained from poison centers and drug treatment programs, covering 94% of the US population, between July 2009 and December 2016. Product-specific odds ratios compared places without dispensing with places with any dispensing; the causal contrast represents the odds of product-specific abuse in the community given exposure. RESULTS Dispensing of new and low-volume opioids varied considerably across the country, with no region showing high of all products. Of 22 opioids analyzed, the three with approved labeling as intended to deter abuse ranked near the lowest in both absolute (population-adjusted rates: 1.7, 0.9, and 8.2 per million people per quarter, respectively) and relative measures (trend-in-trend ORs: 1.96, 1.79, 1.69, respectively). CONCLUSIONS Postmarketing studies of prescription opioid abuse may benefit by evolving from unadjusted surveillance rates to a causal inference approach.
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Affiliation(s)
- Nabarun Dasgupta
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.,Injury Prevention Research Center and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - John Schwarz
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Askhan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Palamar JJ, Shearston JA, Cleland CM. Discordant reporting of nonmedical opioid use in a nationally representative sample of US high school seniors. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:530-538. [PMID: 27315427 PMCID: PMC5055456 DOI: 10.1080/00952990.2016.1178269] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nonmedical opioid use has become a major public health concern due to increases in treatment admissions, overdoses, and deaths. Use has also been linked to heroin initiation. Reliable data on nonmedical opioid use are needed to continue to inform prevention. OBJECTIVE To determine the prevalence and correlates of discordant self-report of nonmedical use of opioids in a national sample. METHODS Utilizing a nationally representative sample of 31,149 American high school seniors in the Monitoring the Future study (2009-2013), discordant responses between self-reported 12-month nonmedical opioid use and self-reported 12-month nonmedical Vicodin and OxyContin use (reporting Vicodin/OxyContin use, but not reporting "opioid" use) were assessed. We also used multivariable logistic regression to determine the characteristics of students who were most likely to provide a discordant response. RESULTS 37.1% of those reporting nonmedical Vicodin use and 28.2% of those reporting nonmedical OxyContin use did not report overall nonmedical opioid use. Prevalence of nonmedical opioid use (8.3%) would increase when factoring in Vicodin, OxyContin, or both, by 2.8%, 1.3%, and 3.3%, respectively. Females were more likely to provide a discordant response to Vicodin and highly religious students were more likely to provide a discordant response regarding OxyContin use. Those who reported cocaine or nonmedical tranquilizer use were at consistently low odds for discordant responses. Nonmedical amphetamine users were at low odds for providing a discordant Vicodin response. CONCLUSION Prevalence of nonmedical opioid use may be underreported on some surveys, particularly among specific subpopulations. Further research on the effect of question order and skip-patterns (e.g., "gate" questions) is needed. Reliable data on nonmedical opioid use are needed to continue to accurately inform prevention.
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Affiliation(s)
- Joseph J. Palamar
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
| | - Jenni A. Shearston
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA
- College of Global Public Health, New York University, New York, NY, USA
| | - Charles M. Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
- College of Nursing, New York University, New York, NY, USA
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6
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Sarabia SE, Martin JI. Are baby boomer women unique? The moderating effect of birth cohort on age in substance use patterns during midlife. J Women Aging 2016; 28:150-60. [PMID: 26901493 DOI: 10.1080/08952841.2014.953899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the relationships of age to use of alcohol, marijuana, and illicit drugs, and misuse of prescription drugs, among midlife women and whether these relationships are modified by birth cohort. Structural Equation Modeling was used to analyze National Survey on Drug Use and Health data, which included 2,035 baby boomer and silent generation cohort women, ages 30 to 55. Midlife women across cohorts reduced alcohol and marijuana use, but not illicit and prescription drug misuse, as they aged. A modifying effect of birth cohort was not supported, but findings did support differential aging effects across substances. Implications are discussed.
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Affiliation(s)
- Stephanie Elias Sarabia
- a School of Social Science and Human Services , Ramapo College of New Jersey , Mahwah , New Jersey , USA
| | - James I Martin
- b Silver School of Social Work , New York University , New York , New York , USA
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7
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Reifler LM, Droz D, Bailey JE, Schnoll SH, Fant R, Dart RC, Bucher Bartelson B. Do prescription monitoring programs impact state trends in opioid abuse/misuse? PAIN MEDICINE 2012; 13:434-42. [PMID: 22299725 DOI: 10.1111/j.1526-4637.2012.01327.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prescription monitoring programs (PMPs) are statewide databases containing prescriber and patient-level prescription data on select drugs of abuse. These databases are used by medical professionals or law enforcement officials to identify patients with prescription drug use patterns indicative of abuse or providers engaging in illegal activities. Most states have implemented PMPs in an attempt to curb prescription drug abuse and diversion. However, assessment of their impact on drug abuse is only beginning. This study aimed to evaluate the relationship between PMPs and opioid misuse over time in two drug abuse surveillance data sources. METHODS Data from the RADARS® System Poison Center and Opioid Treatment surveillance databases were used to obtain measures of abuse and misuse of opioids. Repeated measures negative binomial regression was applied to quarterly surveillance data (from 2003 to mid-2009) to estimate and compare opioid abuse and misuse trends. PMP presence was modeled as a time varying covariate for each state. RESULTS Results support an association between PMPs and mitigated opioid abuse and misuse trends. Without a PMP in place, Poison Center intentional exposures increased, on average, 1.9% per quarter, whereas opioid intentional exposures increase 0.2% (P = 0.036) per quarter with a PMP in place. Opioid treatment admissions increase, on average, 4.9% per quarter in states without a PMP vs 2.6% (P = 0.058) in states with a PMP. In addition to the time trend, population and a measure of drug availability were also significant predictors. A secondary analysis that classified PMP based upon ideal characteristic showed consistent though not significant results. CONCLUSIONS Two observational data sources offer preliminary support that PMPs are effective. Future efforts should evaluate what PMP characteristics are most effective and which opioids are most impacted.
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Affiliation(s)
- Liza M Reifler
- Rocky Mountain Poison and Drug Center, Denver, Colorado 80204, USA
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8
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Khosla N, Juon HS, Kirk GD, Astemborski J, Mehta SH. Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City. Addict Behav 2011; 36:1282-7. [PMID: 21868170 DOI: 10.1016/j.addbeh.2011.07.046] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 05/20/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
Abstract
Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005-06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs.
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Affiliation(s)
- Nidhi Khosla
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
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