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

Motivations for Misusing Opioids Among African Americans

BACKGROUND

A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations.

METHODS

This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida.

RESULTS

Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia).

CONCLUSIONS

This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.

Patterns of polydrug use among Black Americans who misuse opioids

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender-Diverse Populations: A Scoping Review

Purpose: Research on opioid misuse, opioid use disorder (OUD), and overdose (i.e., opioid outcomes) among lesbian, gay, bisexual, transgender, queer, and other populations within the LGBTQ umbrella (LGBTQ+) remains sparse. The purpose of this scoping review was to characterize the state of the research on opioid outcomes among LGBTQ+ populations, and identify gaps in the extant literature and areas for future research. Methods: We conducted a scoping review of peer-reviewed, English language articles published between 2011 and 2020 that examined opioid outcomes among LGBTQ+ populations in the CINAHL, Embase, PubMed, and PsycINFO databases. We extracted data from articles that focused on opioid outcomes within their specific aims or purpose. We include a general summary for articles that secondarily described opioid outcomes among LGBTQ+ populations. Results: Of 113 published studies that examined opioid outcomes among LGBTQ+ populations, 10% (n = 11) were specifically designed to focus on this topic. Across studies, bisexual populations, particularly women, were at highest risk for opioid misuse and OUD. Few studies examined opioid outcomes by more than one dimension of sexual orientation (n = 3, 27%), race and/or ethnicity (n = 3, 27%), or age (n = 5, 45%). Only two included transgender or gender diverse samples; only one explicitly measured gender identity. Conclusions: Future research is needed to understand the impact of the opioid epidemic on LGBTQ+ people, particularly transgender and other gender diverse individuals, and the intersectional role of race, ethnicity, and age in opioid disparities among LGBTQ+ individuals. Additional research could contribute to the development of much-needed affirming OUD treatment and other services for LGBTQ+ people.

Health harms of non-medical prescription opioid use: A systematic review

ISSUES

Non-medical prescription opioid use (NMPOU) contributes substantially to the global burden of morbidity. However, no systematic assessment of the scientific literature on the associations between NMPOU and health outcomes has yet been undertaken.

APPROACH

We undertook a systematic review evaluating health outcomes related to NMPOU based on ICD-10 clinical domains. We searched 13 electronic databases for original research articles until 1 July 2021. We employed an adaptation of the Oxford Centre for Evidence-Based Medicine 'Levels of Evidence' scale to assess study quality.

KEY FINDINGS

Overall, 182 studies were included. The evidence base was largest on the association between NMPOU and mental and behavioural disorders; 71% (129) studies reported on these outcomes. Less evidence exists on the association of NMPOU with infectious disease outcomes (26; 14%), and on external causes of morbidity and mortality, with 13 (7%) studies assessing its association with intentional self-harm and 1 study assessing its association with assault (<1%).

IMPLICATIONS

A large body of evidence has identified associations between NMPOU and opioid use disorder as well as on fatal and non-fatal overdose. We found equivocal evidence on the association between NMPOU and the acquisition of HIV, hepatitis C and other infectious diseases. We identified weak evidence regarding the potential association between NMPOU and intentional self-harm, suicidal ideation and assault.

DISCUSSION AND CONCLUSIONS

Findings may inform the prevention of harms associated with NMPOU, although higher-quality research is needed to characterise the association between NMPOU and the full spectrum of physical and mental health disorders.

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

This review summarizes current evidence related to perioperative opioid prescription fulfillment and use and discusses the role of personalized anesthesia care in mitigating opioid-related harms without compromising analgesia.

Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life

BACKGROUND

The misuse of prescription medications is an understudied topic among the non-Hispanic Black population in the U.S. Even less is known about the prevalence and correlates of misuse among African Americans and Afro-Caribbeans, despite documented differences in their substance use behaviors.

OBJECTIVES

We aimed to examine the prevalence and correlates of lifetime prescription drug misuse among African Americans and Afro Caribbeans using data from the National Survey of American Life.

METHODS

A national household probability sample of non-institutionalized African Americans and Afro Caribbeans from the Collaborative Psychiatric Epidemiology Surveys was used. Pooled and ethnicity-stratified logistic regressions were estimated.

RESULTS

Findings showed no significant differences between African Americans (6.36%) and Afro-Caribbeans (5.71%) in lifetime prescription drug misuse. Several correlates were found to be associated with misuse among only African American or Afro-Caribbean respondents.

CONCLUSIONS

While research has shown prescription drug misuse is an issue among Blacks overall, our results show that the role of ethnicity must not be overlooked, especially when tailoring prevention and intervention programs. Limitations of this study are discussed.

Effect of Sex on the Association Between Nonmedical Use of Opioids and Sleep Disturbance Among Chinese Adolescents: A Cross-Sectional Study

Sleep disturbance and non-medical prescription opioid use (NMPOU) are currently growing public health concerns, and sex differences may result in differential exposure to frequency of NMPOU or sleep disturbance. This study aimed to explore the association between the frequency of lifetime or past-year NMPOU and sleep disturbance and to evaluate whether there was any sex difference in this association among Chinese adolescents. A cross-sectional study was performed in seven randomly selected Chinese provinces through the 2015 School-Based Chinese Adolescents Health Survey. A total of 159,640 adolescents were invited to participate and among them, 148,687 adolescents' questionnaires were completed and qualified for this study (response rate: 93.14%). All analyses were performed for boys and girls separately. There were significant sex differences in the prevalence of lifetime or past-year opioid misuse and sleep disturbance (p < 0.05). Among girls, frequent lifetime NMPOU (adjusted odds ratio [aOR] = 2.09, 95% CI = 1.80-2.44) and past-year NMPOU (aOR = 2.16, 95% CI = 1.68-2.77) were positively associated with sleep disturbance. Among boys, these associations were also statistically significant, while the magnitudes of associations between frequent lifetime NMPOU or past-year NMPOU and sleep disturbance were greater in girls than those in boys. There is a significant sex difference in the prevalence of lifetime or past-year NMPOU and sleep disturbance. Furthermore, exposure to more frequent lifetime or past-year NMPOU is associated with a greater risk of sleep disturbance, especially among girls. Taking into account the sex difference for lifetime or past-year NMPOU may help to decrease the risk of sleep disturbance.

Prescription Opioid Use in a Population-Based Sample of Young Black Men Who Have Sex with Men: A Longitudinal Cohort Study

Background: Prescription opioid use (POU) among young adults is increasing. This represents a major public health concern due to the increased risks of opioid use misuse and opioid-related overdose. Limited research has examined the POU among young black men who have sex with men (YBMSM), a diverse group experiencing continued increases in HIV incidence over the past decade. Objective: This study aims to examine the prevalence and both the individual and network characteristics of POU among YBMSM. Methods: Data were from a longitudinal cohort study of 16-29 year old YBMSM (N = 514) between 2013 and 2016 in Chicago. Bivariate and multivariable associations were estimated using general estimating equations (GEE). Results: Approximately 4.2% of YBMSM reported POU in the past 12 months with a cumulative incidence rate of 4.1% over the 18-month follow-up period. YBMSM having criminal justice involvements, experiencing violence, or using any illicit drug other than marijuana in the past 12 months were more likely to report POU in the past 12 months. The presence of a mother figure, however, was associated with a decreased risk of POU in the past 12 months, while engaging in condomless anal sex with their named sexual partners was associated with an increased risk of POU in the past 12 months. Conclusions: This is one of the first studies to describe POU among a population-based sample of YBMSM. The high incidence rate of POU among YBMSM is alarming, and it underscores the need for further analysis on POU among this key population.

Association between childhood maltreatment and non-medical prescription opioid use among Chinese senior high school students: The moderating role of gender

BACKGROUND

Non-medical prescription opioid use (NMPOU) and childhood maltreatment are currently serious problems among adolescents worldwide, and childhood maltreatment may be associated with the increased rates of NMPOU. This study examined the specific associations between particular types of childhood maltreatment and lifetime NMPOU and assessed whether gender has a moderating effect on these associations.

METHODS

A 3-stage, stratified cluster, randomized sampling method was used to collect data from 11,194 high school students in Chongqing.

RESULT

The prevalence of the lifetime NMPOU among senior high school students in Chongqing was 7.7%. Physical abuse (AOR = 1.11, 95% CI = 1.07-1.14), emotional abuse (AOR = 1.05, 95% CI = 1.03-1.08), sexual abuse (AOR = 1.04, 95% CI = 1.01-1.07), physical neglect (AOR = 1.06, 95% CI = 1.04-1.09), and emotional neglect (AOR = 1.03, 95% CI = 1.02-1.04) were all positively associated with lifetime NMPOU. The moderating effects of gender on emotional abuse (P = 0.004) and sexual abuse (P = 0.019) were statistically significant in the adjusted model of lifetime NMPOU. According to the stratification analyses in which the male and female students were analyzed separately, female students who previously experienced emotional/sexual abuse had a higher prevalence of lifetime NMPOU.

LIMITATIONS

The study sample only contained school students and cross-sectional design limited our ability to make causal inferences.

CONCLUSION

Childhood maltreatment was positively associated with lifetime NMPOU, and gender had a moderating effect on the associations between childhood maltreatment and lifetime NMPOU. Early identification of and intervention for childhood maltreatment victims, particularly female victims, may help reduce the lifetime risk of NMPOU.

Opioid Abuse as Maladaptive Coping to Life Stressors in U.S. Adults

The Threat Appraisal and Coping Theory suggests that when individuals face life stressors, especially if they have poor self-esteem, they may rely on maladaptive coping behaviors that ease distress but worsen their condition over time. The present study compared five life stressors (health, money, work, family, romance) for their association with opioid use, then examined poor self-esteem as a mediator of these associations. Study participants included 1,047 U.S. adults gathered in a quota sample by SurveyMonkey (54.3% women; 53.3% 45+ years of age; 76.7% White; 60.2% with US$50,000 or higher income; 11.1% using opioids). Participants completed online surveys to report demographics, five life stressors, self-esteem, and indications of opioid use as measured with the PROMIS Questionnaire. Pearson correlation found poor self-esteem associated with high opioid use; multiple regression found health, family, and romance stressors associated with high opioid use ( R2 = .089); and multiple regression found health, money, family, and romance stressors associated with poor self-esteem ( R2 = .283). Then, bootstrapping mediational analyses examined the sequence of HIGH LIFE STRESSORS → POOR SELF-ESTEEM → HIGH OPIOID USE, finding that poor self-esteem was a significant mediator between each life stressor (health, money, family, romance) and increased risk for opioid use. The present sample included mostly individuals with a White ethnic identity and high incomes, so future research should examine these patterns with more diverse samples. In addition, the amount of opioids consumed, present motivations for use, the sequence of events leading to present use, exposure to substance-abuse treatment, and where individuals presently are on the use-recovery process could moderate associations found between life stressors and opioid use.

Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates

OBJECTIVE

Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse.

METHOD

Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use.

RESULTS

Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization and mental health covariates but attenuated completely after controlling for other illicit drug use. The effect for unsure males attenuated when victimization variables were included, but the effect for gay males remained significant through the final model. Controlling for other illicit drug use, mental health variables remained significant correlates for females whereas only forced sex was significant for males.

CONCLUSION

These results suggest experiences of victimization and mental health partially account for the disparities in prescription drug misuse between SMA and heterosexual adolescents, and their effects may differ by sex. A combination of structural, individual coping, and universal drug prevention approaches should be used to make the largest impact on reducing these disparities.

Prevalence and Correlates of Prescription Drug Misuse Among a Racially Diverse Sample of Young Sexual Minority Men

PURPOSE

Sexual minority men (SMM) are at greater risk than heterosexual men for misusing prescription psychotropic medications. However, community prevalence estimates of prescription drug misuse among young SMM are lacking. The current study described lifetime and past-6-month stimulant, painkiller, and depressant/tranquilizer misuse in a large, racially diverse sample of 967 SMM aged 16-29 in Chicago, Illinois, and investigated demographic and other substance use associations.

METHODS

Data came from the baseline visit of the RADAR longitudinal cohort study. Associations were examined using bivariate and multivariable logistic regression.

RESULTS

A quarter of the sample reported ever misusing any prescription drug, and 14.2% reported recent misuse. Lifetime class-specific misuse was 16.9% for stimulants, 11.0% for painkillers, and 11.4% for depressants/tranquilizers; recent misuse was 8.0%, 5.7%, and 6.2%, respectively. In multivariable analysis, Non-Hispanic black participants had lower odds of lifetime stimulant and depressant/tranquilizer misuse and recent stimulant misuse than non-Hispanic white participants, and bisexual participants had greater odds of lifetime and recent painkiller and depressant/tranquilizer misuse than gay participants. Generally, using other substances was associated with greater odds of prescription drug misuse. Having ever been prescribed a psychotropic medication was associated with higher odds of lifetime painkiller misuse after controlling for covariates.

CONCLUSION

These results provide critical information on a growing public health problem among young SMM. Future research should explore why differential rates of misuse exist across subgroups. New interventions emphasizing the risk of prescription drugs, discouraging drug sharing, and bolstering refusal and coping skills should be developed and evaluated.

Sexual Violence in the Context of Drug Use Among Young Adult Opioid Users in New York City

Drug and alcohol use have been associated with increased risk for sexual violence, but there is little research on sexual violence within the context of drug use among young adult opioid users. The current mixed-methods study explores young adult opioid users' sexual experiences in the context of their drug use. Forty-six New York City young adults (ages 18-32) who reported lifetime nonmedical use of prescription opioids (POs) completed in-depth, semistructured interviews, and 164 (ages 18-29) who reported heroin and/or nonmedical PO use in the past 30 days completed structured assessments that inquired about their drug use and sexual behavior and included questions specific to sexual violence. Participants reported frequent incidents of sexual violence experienced both personally and by their opioid using peers. Participants described sexual violence, including sexual assault, as occurring within a context characterized by victimization of users who were unconscious as a result of substance use, implicit and explicit exchanges of sex for drugs and/or money that increased risk for sexual violence, negative sexual perceptions ascribed to drug users, and participants' own internalized stigma. Recommendations to reduce sexual violence among young adult opioid users include education for users and service providers on the risk of involvement in sexual violence within drug using contexts and efforts to challenge perceptions of acceptability regarding sexual violence.

Prescription opioid use, illicit drug use, and sexually transmitted infections among participants from a community engagement program in North Central Florida

INTRODUCTION

The purpose of this analysis was to determine the intersection between prescription opioid use, illicit drug use and STIs amongst Alachua County participants.

METHODS

Cross-sectional data come from 2,194 Alachua County community members interviewed by Community Health Workers (CHWs) from HealthStreet, a community engagement program of the University of Florida. Demographic characteristics, health risk factors and health conditions were obtained.

RESULTS

Among participants, 9.3% reported ever having an STI, 40% reported lifetime use of prescription opioids, and 53% reported ever using an illicit drug. Persons who reported using an illicit drug or an illicit drug plus prescription were 2.89 and 4.12 times as likely to report one or more STIs respectively, compared to those who never used these drugs. Prescription opioid use alone was not statistically related to STIs though female gender (AOR 3.75), lower education (AOR 1.45) and food insecurity (AOR 1.52) were.

DISCUSSION

Those who report a history illicit drug use with or without prescription opioid use are at increased risk for STIs and could benefit from prevention programs. Those with factors that are proxies for other disparities (lower education, food insecurity) are especially important targets for intervention among women.

Prescription Drug Misuse and Sexual Risk Behaviors Among Young Men Who have Sex with Men (YMSM) in Philadelphia

This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N = 191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6 % engaged in UAI. After adjusting for socio-demographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.

Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18-32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed "clean" (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users.

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

BACKGROUND

The nonmedical use of prescription opioids (POs) is a major public health concern, causing extensive morbidity and mortality in North America. Canada has the second highest consumption rate of POs globally and data indicate nonmedical PO use (NPOU) is growing among key populations and increasingly available in street-level drug markets. Despite accumulating evidence documenting the rise of NPOU, few studies have systematically examined NPOU in Canada among key vulnerable populations, such as sex workers. This study prospectively evaluated the prevalence and correlates of NPOU within a Vancouver cohort of sex workers over three-years follow-up.

METHODS

Data were drawn from an open prospective cohort, AESHA (An Evaluation of Sex Workers Health Access) in Metro Vancouver, Canada (2010-2013). Women were recruited through outreach from outdoor street locations and indoor venues. Bivariate and multivariable logistic regression using Generalized Estimating Equations (GEE) were used to examine social and structural correlates of NPOU over 36 months.

RESULTS

Of the 692 sex workers at baseline, close to one-fifth (n=130, 18.8%) reported NPOU (injection or non-injection) in the last six months. In multivariable GEE analyses, factors independently correlated with recent NPOU were: exchanging sex while high (AOR 3.26, 95%CI 2.29-4.64), police harassment/arrest (AOR 1.83, 95%CI 1.43-2.35), intimate partner injects drugs (AOR 1.66, 95%CI 1.11-2.49), and recent physical/sexual intimate partner violence (AOR 1.65, 95%CI 1.21-2.24).

CONCLUSION

Our results demonstrate that nearly one-fifth of sex workers in Metro Vancouver report NPOU. Factors independently statistically associated with NPOU included exchanging sex while high, police harassment/arrest, a drug injecting intimate partner and recent physical/sexual intimate partner violence. The high prevalence of NPOU use among sex workers underscores the need for further prevention and management strategies tailored to this key population. The correlates of NPOU uncovered here suggest that structural interventions may be further implemented to ameliorate this growing concern.