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Bruzelius E, Palamar JJ, Fitzgerald ND, Cottler LB, Carr TC, Martins SS. Law enforcement fentanyl seizures and overdose mortality in US counties, 2013-2020. Drug Alcohol Depend 2024; 262:111400. [PMID: 39079225 DOI: 10.1016/j.drugalcdep.2024.111400] [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: 10/20/2023] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND The spread of illicitly manufactured fentanyl is driving steep increases in US overdose deaths. Fentanyl seizures are correlated with state-level opioid-related mortality; however, more granular seizure surveillance information has the potential to better inform overdose prevention and harm reduction efforts. METHODS Using data on fentanyl pill and powder seizures from High Intensity Drug Trafficking Areas (HIDTA), we tested associations between seizure prevalence and overdose mortality, from 2013 to 2020. The primary exposure-seizure burden-was constructed by identifying counties having high (above the median) prevalence of pill, powder, or combined pill/powder seizure burden per 100,000 population. Poisson models accounted for county demographic, law enforcement and time trends. RESULTS During the timeframe, there were 13,842 fentanyl seizures in 606 US counties. In adjusted models, counties with a high burden of pill or powder fentanyl seizures, or both (combined pills/powder) exhibited higher total overdose mortality than non-high burden counties (pills adjusted prevalence ratio [aPR]: 1.10 [95 % confidence interval [CI]: 1.08, 1.12]; powder aPR 1.12 [CI: 1.11, 1.13]; combined pills/powder aPR: 1.27 [CI: 1.25, 1.29]). A similar pattern of associations with fentanyl seizure burden was noted for overdose deaths involving synthetic opioids (pills [aPR]: 0.99 [CI: 0.96, 1.02]; powder aPR 1.29 [CI: 1.27, 1.30]; combined pills/powder aPR 1.55 [CI: 1.52, 1.58]). CONCLUSIONS Law enforcement data on fentanyl seizures predicts drug overdose mortality at the county-level. Integrating these data with more traditional epidemiologic surveillance approaches has the potential to inform community overdose response efforts.
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Affiliation(s)
- Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.
| | - Joseph J Palamar
- Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Nicole D Fitzgerald
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine University of Florida, Gainesville, FL, United States
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine University of Florida, Gainesville, FL, United States
| | - Thomas C Carr
- College of Public Affairs, Center for Drug Policy and Prevention, University of Baltimore, United States; Office of National Drug Control Policy, Washington-Baltimore High Intensity Drug Trafficking Areas Program, Center for Drug Policy and Prevention, University of Baltimore, United States
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
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Palamar JJ, Fitzgerald N, Carr TH, Cottler LB, Ciccarone D. National and regional trends in fentanyl seizures in the United States, 2017-2023. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104417. [PMID: 38744553 DOI: 10.1016/j.drugpo.2024.104417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Rates of synthetic opioid-related deaths over time and across regions have been compared within the US, but other indicator data could help inform prevention and harm reduction as well. We compared regional trends in fentanyl seizures to examine potential shifts in illicit fentanyl availability. METHODS Annual trends in fentanyl seizures were examined using data from High Intensity Drug Trafficking Areas for the US overall and by region from 2017 through 2023. Multiple measures included the number of seizures, the number of powder seizures, the number of pill seizures, the total weight of seizures, the number of pills seized, and the percentage of the number of pill seizures relative to the number of total seizures. RESULTS The percentage of seizures in pill form in the US increased from 10.3 % in 2017 to 49.0 % in 2023 (adjusted annual percentage change [AAPC]=25.2, 95 % CI: 17.6, 33.2), with 115.6 million individual pills seized in 2023. Pill weight related to total seizure weight also increased from 0.4 % to 54.5 % (AAPC=112.6, 95 % CI: 78.6, 153.2). In 2023, the plurality of seizures was in the West, in seven out of eight of our measures, with 77.8 % of seizures in the West being in pill form. Although the Midwest had lower prevalence of seizures than the West, there were notable increases in the Midwest in the number of pill seizures (AAPC=142.2, 95 % CI: 91.9, 205.8) and number of pills seized (AAPC=421.0, 95 % CI: 272.7, 628.4). Total weight of fentanyl seized increased the most in the West (AAPC=84.6, 95 % CI: 72.3, 97.8). CONCLUSIONS The number and size of fentanyl seizures is increasing in the US, with the majority of seizures, especially in pill form, in the West. Continued monitoring of regional shifts in the fentanyl supply can help inform targeted prevention and public health response.
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Affiliation(s)
- Joseph J Palamar
- NYU School of Medicine, Department of Population Health, New York, NY.
| | - Nicole Fitzgerald
- University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States
| | - Thomas H Carr
- Office of National Drug Control Policy, Washington-Baltimore High Intensity Drug Trafficking Areas Program, United States; College of Public Affairs, Center for Drug Policy and Prevention, University of Baltimore, United States
| | - Linda B Cottler
- University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States
| | - Daniel Ciccarone
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA
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McCabe SE, Schulenberg JE, Wilens TE, Schepis TS, McCabe VV, Veliz P. Transitions in Prescription Benzodiazepine Use and Misuse and in Substance Use Disorder Symptoms Through Age 50. Psychiatr Serv 2023; 74:1154-1162. [PMID: 37143335 PMCID: PMC10867819 DOI: 10.1176/appi.ps.20220247] [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] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Prescription benzodiazepines are among the most commonly used and misused controlled medications. The authors aimed to examine transitions from medical use of prescription benzodiazepines to prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms during adulthood. METHODS Eleven national cohorts of U.S. 12th graders (N=26,575) were followed up from ages 18 (1976-1986) to 50 (2008-2018). Prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms were examined with prevalence estimates and multivariable logistic regression. RESULTS By age 35, 70.9% of respondents had not used or misused prescription benzodiazepines, 11.3% reported medical use only, 9.8% indicated both medical use and misuse, and 14.1% reported misuse only. In analyses adjusted for demographic and other characteristics, adults reporting only medical use of prescription benzodiazepines by age 35 had higher odds of later prescription benzodiazepine misuse (adjusted OR [AOR]=2.17, 95% CI=1.72-2.75) and prescription opioid misuse (AOR=1.40, 95% CI=1.05-1.86) than respondents ages 35-50 who never used prescription benzodiazepines. More frequent medical use of prescription benzodiazepines by age 35 was associated with increased risk for substance use disorder symptoms at ages 40-50. Any history of prescription benzodiazepine misuse by age 35 was associated with higher odds of later prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms, compared with no misuse. CONCLUSIONS Prescription benzodiazepine use or misuse may signal later prescription drug misuse or substance use disorders. Medical use of prescription benzodiazepines by age 35 requires monitoring for prescription drug misuse, and any prescription benzodiazepine misuse warrants an assessment for substance use disorder.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - John E Schulenberg
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Timothy E Wilens
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Ty S Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor (all authors); Institute for Social Research (S. E. McCabe, Schulenberg, Veliz) and Department of Psychiatry (V. V. McCabe), University of Michigan, Ann Arbor; Department of Psychiatry, Massachusetts General Hospital, Boston (Wilens); Department of Psychology, Texas State University, San Marcos (Schepis)
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4
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Fuss C, Romm KF, Crawford ND, Harrington KRV, Wang Y, Ma Y, Taggart T, Ruiz MS, Berg CJ. Psychosocial Correlates of Opioid Use Profiles among Young Adults in a Longitudinal Study across 6 US Metropolitan Areas. Subst Use Misuse 2023; 58:981-988. [PMID: 37082785 PMCID: PMC10645480 DOI: 10.1080/10826084.2023.2201839] [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] [Indexed: 04/22/2023]
Abstract
Background: Examining opioid use profiles over time and related factors among young adults is crucial to informing prevention efforts. Objectives: This study analyzed baseline data (Fall 2018) and one-year follow-up data from a cohort of 2,975 US young adults (Mage=24.55, 42.1% male; 71.7% White; 11.4% Hispanic). Multinomial logistic regression was used to examine: 1) psychosocial correlates (i.e. adverse childhood experiences [ACEs], depressive symptoms, parental substance use) of lifetime opioid use (i.e. prescription use vs. nonuse, nonmedical prescription [NMPO] use, and heroin use, respectively); and 2) psychosocial correlates and baseline lifetime use in relation to past 6-month use at one-year follow-up (i.e. prescription use vs. nonuse and NMPO/heroin use, respectively). Results: At baseline, lifetime use prevalence was: 30.2% prescription, 9.7% NMPO, and 3.1% heroin; past 6-month use prevalence was: 7.6% prescription, 2.5% NMPO, and 0.9% heroin. Compared to prescription users, nonusers reported fewer ACEs and having parents more likely to use tobacco, but less likely alcohol; NMPO users did not differ; and heroin users reported more ACEs and having parents more likely to use cannabis but less likely alcohol. At one-year follow-up, past 6-month use prevalence was: 4.3% prescription, 1.3% NMPO, and 1.4% heroin; relative to prescription users, nonusers were less likely to report baseline lifetime opioid use and reported fewer ACEs, and NMPO/heroin users were less likely to report baseline prescription opioid use but more likely heroin use. Conclusions: Psychosocial factors differentially correlate with young adult opioid use profiles, and thus may inform targeted interventions addressing different use patterns and psychosocial risk factors.
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Affiliation(s)
- Caroline Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, Department of Pediatrics, College of Medicine,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Natalie D Crawford
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin R V Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Ma
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara Taggart
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- GW Cancer Center, George Washington University, Washington, DC, USA
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Holt LJ, Looby A, Schepis TS. Sources for prescription stimulant misuse: A person-centered approach to understanding links to substance use and psychiatric impairment. Exp Clin Psychopharmacol 2023; 31:498-506. [PMID: 35816563 PMCID: PMC9926480 DOI: 10.1037/pha0000586] [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] [Indexed: 01/20/2023]
Abstract
Prescription stimulant misuse (PSM) is most prevalent among college students and is associated with numerous negative academic and psychosocial outcomes. A large body of literature has identified predictors of PSM in this population, however few studies have utilized a person-centered approach to examine how the sources from which students procure prescription stimulants are associated with substance-related and psychiatric impairment. We used latent class analysis (LCA) to classify a geographically and racially/ethnically diverse sample of U.S. undergraduates (N = 538) who misused prescription stimulants into groups based on their endorsement of nine sources of medication. We selected a five-group classification from the LCA with classes of peer/dealer, given by friend, own prescription, lower multiple sources (i.e., relatively infrequent endorsement of multiple sources), and any source. Compared to the reference group (given by friend), the own prescription class was less likely to report marijuana use, simultaneous alcohol and marijuana use, alcohol or marijuana consequences, and nonoral routes of administration. On the other hand, the own prescription class was more likely to screen positive for anxiety, anger, and suicidality. Similarly, the lower multiple sources group was more likely to screen positive for depression, anxiety, anger, and suicidality. Prevention and intervention efforts focused on PSM may be tailored differently for students who are misusing their own medication and/or endorsing multiple sources. Specifically, these students may need broader assistance with comorbid psychiatric conditions, particularly suicidality, while students who obtain stimulants from peers or a dealer may benefit more from substance-focused interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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McHugh RK, Votaw VR, Trapani EW, McCarthy MD. Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health. Front Psychiatry 2023; 14:1129447. [PMID: 36970272 PMCID: PMC10033696 DOI: 10.3389/fpsyt.2023.1129447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundBenzodiazepines and non-benzodiazepine hypnotics (z-drugs) are commonly prescribed for their anxiolytic and hypnotic properties, though they can also be misused. In studies examining the epidemiology of prescription drug misuse, these medication classes are commonly combined, rendering inadequate knowledge of their patterns of misuse. The objective of this study was to characterize the population prevalence, conditional dependence, and sociodemographic and clinical correlates of the misuse of benzodiazepines and z-drugs.MethodsData from the National Survey on Drug Use and Health from 2015 to 2019 were used to estimate population-level prevalence and characteristics of benzodiazepine and z-drug misuse. Groups were derived based on past-year misuse of benzodiazepines alone, z-drugs alone, or both drug types. Unadjusted regression analyses were used to compare groups on characteristics of interest.ResultsExposure to benzodiazepines and/or z-drugs via prescription or misuse was common; however, only 2% of the population was estimated to have misused a benzodiazepine in the past year, and less than 0.5% misused z-drugs. People who misused only z-drugs were generally older, more likely to have health insurance, more educated, and had less severe psychiatric symptoms. This group was also more likely to report misuse to cope with sleep difficulty. Although concurrent substance use was highly prevalent in all groups, people who misused z-drugs alone generally reported less concurrent substance use than the other groups.ConclusionThe misuse of z-drugs is less common than benzodiazepines, and people who misuse only z-drugs appear to generally have lower clinical severity. Nonetheless, a substantial subgroup of people exposed to z-drugs report concurrent, past-year use of other substances. Further research on z-drug misuse, including consideration of whether it should be grouped with other anxiolytic/hypnotic drugs, is needed.
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Affiliation(s)
- R. Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- *Correspondence: R. Kathryn McHugh,
| | - Victoria R. Votaw
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Emma W. Trapani
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
| | - Megan D. McCarthy
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
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Rigg KK, Strickland S. Patterns of opioid misuse initiation among African-Americans. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2173050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
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Appiah L, John D, Owoade DR, Mendenhall J, Appiah D. Factors Influencing Racial and Ethnic Differences in Prescription Opioid Misuse Among Young Adolescents in the USA, 2009-2019. J Racial Ethn Health Disparities 2023; 10:32-42. [PMID: 34845676 DOI: 10.1007/s40615-021-01194-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prescription opioid misuse (POM) is an important public health concern. Not many studies have evaluated factors influencing racial and ethnic differences in POM exclusively in young adolescents. We evaluated factors influencing the racial and ethnic differences in POM in a nationally representative sample of 8th- and 10th-grade (12-15 years old) US adolescents. METHODS Data were from 107,786 adolescents who participated in the 2009-2019 Monitoring the Future survey. Logistic regression and mediation analysis were used to identify risk factors for POM and evaluate mediators of the association of race and ethnicity on the frequency of POM in the past year. RESULTS From 2009 to 2019, the prevalence of POM in the past year decreased from 3.2% to 1.8% (p = 0.032), with significant differences in POM trends by race and ethnicity. Overall, the prevalence was higher among non-Hispanic White adolescents (3.2%) than Hispanic (2.5%) and non-Hispanic Black adolescents (1.6%), p < 0.001. After adjustment for demographic, substance use, lifestyle, and family-related factors, the odds of POM were lower among Black (odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.66-0.98) and Hispanic adolescents (OR = 0.64, CI: 0.55-0.74) compared to White adolescents. Illicit drug use and misuse of other prescription drugs together explained 77.2% and 47.3% of the racial and ethnic disparities in POM among Black and Hispanic adolescents, respectively. CONCLUSION In this study, significant racial and ethnic differences in the trends of POM were observed. Illicit drug use and misuse of other prescription drugs substantially explained the racial and ethnic disparities in POM among young adolescents.
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Affiliation(s)
- Linda Appiah
- College of Education, Texas Tech University, Lubbock, TX, USA
| | - Dijo John
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX, 79430, USA
| | - Damilola R Owoade
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA
| | - Janet Mendenhall
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX, USA
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX, 79430, USA.
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Schepis TS, McCabe SE, Ford JA. Prescription drug and alcohol simultaneous co-ingestion in U.S. young adults: Prevalence and correlates. Exp Clin Psychopharmacol 2022; 30:797-808. [PMID: 34410796 PMCID: PMC8857307 DOI: 10.1037/pha0000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Jason A. Ford
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Department of Sociology, University of Central Florida, Orlando, Florida
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Veliz PT, Schulenberg JE, Zdroik J, Werner KS, McCabe SE. The Initiation and Developmental Course of Prescription Drug Misuse Among High School Athletes During the Transition Through Young Adulthood. Am J Epidemiol 2022; 191:1886-1896. [PMID: 35944169 PMCID: PMC10144610 DOI: 10.1093/aje/kwac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to examine the extent to which involvement in high-contact, semicontact, or noncontact sports during the 12th grade is associated with the initiation and developmental course of prescription drug misuse (PDM) between ages 17/18 years and 27/28 years. Data were collected from a national multicohort panel sample of US 12th-graders (cohorts 2006-2017; n = 4,772) from the Monitoring the Future Study who were followed for a decade, through age 27/28 years. Approximately 31% of high school seniors indicated PDM at baseline (age 17/18 years). While past-year PDM remained relatively stable between ages 17/18 years and 27/28 years, participation in both noncontact (adjusted odds ratio = 1.40, 95% confidence interval: 1.02, 1.91) and contact (adjusted odds ratio = 1.57, 95% confidence interval: 1.08, 2.28) sports in the 12th grade increased the odds of initiating prescription stimulant misuse during the 10 years following high school as compared with respondents who did not participate in these types of sports in the 12th grade. To our knowledge, this is the first national study to have assessed how sports participation during high school is associated with the initiation and developmental course of PDM from adolescence to young adulthood. These findings reinforce the need for PDM screening during adolescence, as nearly 1 in 3 high school seniors engage in PDM. Increased prescription stimulant misuse following high school warrants ongoing monitoring during young adulthood, especially among athletes.
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Affiliation(s)
- Philip T Veliz
- Correspondence to Dr. Philip T. Veliz, Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109 (e-mail: )
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Dahlem CH, Schepis TS, McCabe SE, Rank AL, Teter CJ, Kcomt L, McCabe VV, Voepel-Lewis T. Prescription Opioid Misuse in Older Adult Surgical Patients: Epidemiology, Prevention, and Clinical Implications. J Addict Nurs 2022; 33:218-232. [PMID: 37140410 PMCID: PMC10162467 DOI: 10.1097/jan.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT The United States and many other developed nations are in the midst of an opioid crisis, with consequent pressure on prescribers to limit opioid prescribing and reduce prescription opioid misuse. This review addresses prescription opioid misuse for older adult surgical populations. We outline the epidemiology and risk factors for persistent opioid use and misuse in older adults undergoing surgery. We also address screening tools and prescription opioid misuse prevention among vulnerable older adult surgical patients (e.g., older adults with a history of an opioid use disorder), followed by clinical management and patient education recommendations. A significant plurality of older adults engaged in prescription opioid misuse obtain opioid medication for misuse from health providers. Thus, nurses can play a critical role in identifying those older adults at a higher risk for misuse and deliver quality care while balancing the need for adequate pain management against the risk for prescription opioid misuse.
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Affiliation(s)
- Chin Hwa Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Ty S. Schepis
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron L. Rank
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Regional One Physicians, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christian J. Teter
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pharmacy, Research Pharmacy Core, McLean Hospital, Belmont, Massachusetts, USA
- Marblehead NeuroPsychiatric Rx, LLC, Marblehead, Massachusetts, USA
| | - Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Vita V. McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Terri Voepel-Lewis
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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12
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Sattler S, van Veen F, Hasselhorn F, Mehlkop G, Sauer C. An experimental test of Situational Action Theory of crime causation: Investigating the perception-choice process. SOCIAL SCIENCE RESEARCH 2022; 106:102693. [PMID: 35680355 DOI: 10.1016/j.ssresearch.2021.102693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/06/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Criminal action, according to Situational Action Theory (SAT), is a two-stage process consisting of a perception and a choice process. This Germany-wide vignette study (N = 3,088, participants recruited offline) provides an explicit and extensive test of these processes. It experimentally varied the informal moral context, deterrence (sanctions and detection risk), and possible gains of selling prescription drugs illegally in a 2x2x2×2 between-subject design. Personal morality and self-control were measured. Double-hurdle models show that personal morality served as a filter for the perception of criminal alternatives. Law-conforming moral context information, high self-control, and deterrence lowered the crime willingness. Thereby, this study underlines the usefulness of an explicit modeling of the dual-process of criminal conduct, in which certain antecedents only play a role in a certain process. While several findings corroborate assumptions from SAT, an influence of the informal moral context was only found in the choice process, not in the perception process.
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Affiliation(s)
- Sebastian Sattler
- Institute of Sociology and Social Psychology, University of Cologne, Germany; Faculty of Sociology, Bielefeld University, Germany; Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Canada.
| | - Floris van Veen
- Faculty of Economics, Law and Social Sciences, University of Erfurt, Germany.
| | - Fabian Hasselhorn
- Institute of Sociology and Social Psychology, University of Cologne, Germany.
| | - Guido Mehlkop
- Faculty of Economics, Law and Social Sciences, University of Erfurt, Germany; Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Germany.
| | - Carsten Sauer
- Faculty of Sociology, Bielefeld University, Germany.
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Prescription Stimulants in College and Medical Students: A Narrative Review of Misuse, Cognitive Impact, and Adverse Effects. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stimulants are effective in treating attention-deficit/hyperactivity disorder (ADHD). Psychiatrist Charles Bradley first made this discovery in 1937 when he found that children treated with amphetamines showed improvements in school performance and behavior. Between 1995 and 2008, stimulants to treat ADHD increased six-fold among American adults and adolescents at an annual rate of 6.5%. Stimulants without a prescription, known as nonmedical use or misuse, have also increased. The highest rates of nonmedical prescription drug misuse in the United States are seen most notably in young adults between 18 and 25 years, based on data from the Substance Abuse and Mental Health Services Administration in 2021. Aside from undergraduate students, nonmedical prescription stimulant use is prevalent among medical students worldwide. A recent literature review reported the utilization of stimulants without a prescription in 970 out of 11,029 medical students. The percentages of medical students across the country misusing stimulants varied from 5.2% to 47.4%. Academic enhancement, reported in 50% to 89% of college students with stimulant misuse, is the most common reason for nonmedical stimulant use. With the increasing use of stimulants among adolescents and adults, it is unclear what long-term outcomes will be since little data are available that describe differences in how side effects are experienced for prescribed and non-prescribed users. The present narrative review focuses on these adverse effects in this population and the reasonings behind misuse and nonmedical use.
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14
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Palamar JJ, Ciccarone D, Rutherford C, Keyes KM, Carr TH, Cottler LB. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend 2022; 234:109398. [PMID: 35370014 PMCID: PMC9027012 DOI: 10.1016/j.drugalcdep.2022.109398] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. METHODS We examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl. RESULTS There was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p < 0.001) and in the number of pill seizures (from 68 to 635, β = 0.96, p < 0.01). The proportion of pills to total seizures more than doubled from 13.8% in 2018 Q1 to 29.2% in 2021 Q4 (β = 0.92, p < 0.001). Weight of powder fentanyl seizures increased from 298.2 kg in 2018 Q1 to 2416.0 kg in 2021 Q4 (β = 1.12, p = 0.01); the number of pills seized increased from 42,202 in 2018 Q1 to 2,089,186 in 2021 Q4 (β = 0.90, p < 0.001). CONCLUSIONS Seizures of drugs containing fentanyl have been increasing in the US. Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as oxycodone or alprazolam are at risk for unintentional exposure to fentanyl.
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Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA,Correspondence to: New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA. (J.J. Palamar)
| | - Daniel Ciccarone
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, USA
| | - Caroline Rutherford
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Katherine M. Keyes
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Thomas H. Carr
- College of Public Affairs, Center for Drug Policy and Prevention, University of Baltimore, United States,Office of National Drug Control Policy, Washington, Baltimore High Intensity Drug Trafficking Areas Program, United States, Center for Drug Policy and Prevention, University of Baltimore, United States
| | - Linda B. Cottler
- NDEWS, University of Florida, United States,University of Florida, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, United States
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15
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State-Level Prevalence and Associates of Opioid Dependence in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073825. [PMID: 35409508 PMCID: PMC8997413 DOI: 10.3390/ijerph19073825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Traditionally, opioid-related disease burden was primarily due to heroin use. However, increases in extra-medical (or non-medicinal use of prescription opioids; NMPOs) use has precipitated the current overdose epidemic in North America. We aim to examine the state-level prevalence of heroin and NMPO dependence and their associations with opioid-related mortality and state-level socio-demographic profiles. Data were pooled from the 2005-2014 National Survey on Drug Use and Health (NSDUH). We examine opioid-related mortality from CDC WONDER (Cause of Death database) by the past year prevalence of DSM-IV heroin and NMPO dependence, by age and sex, and their associations with state-level socio-demographic characteristics from census data. State-level rates of heroin dependence were associated with opioid-related death rates in young and mid-aged adults, while rates of NMPO dependence were associated with opioid-related death rates across all ages. The prevalence of heroin dependence was positively associated with state-level GDP/capita and urbanity. State-level NMPO dependence prevalence was associated with higher unemployment, lower GDP/capita, and a lower high-school completion rate. The prevalence of heroin and NMPO dependence are associated with a broad range of geographical and socio-demographic groups. Taking a wider view of populations affected by the opioid epidemic, inclusive interventions for all are needed to reduce opioid-related disease burden.
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16
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Francis AR, Weyandt LL, Anastopoulos AD, DuPaul GJ, Shepard E. Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD. J Atten Disord 2022; 26:779-793. [PMID: 34189993 DOI: 10.1177/10870547211027650] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.
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17
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Wadhahi AA, Garvey L, Edward KL, Beasley C. The lived experience of adherence to asthma medication in young adults (18-34 years). J Asthma 2021; 59:2475-2490. [PMID: 34902272 DOI: 10.1080/02770903.2021.2018706] [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: 10/19/2022]
Abstract
BACKGROUND Adherence to asthma medications is commonly poor and is the primary cause for anticipated worsening health outcomes for patients with asthma. Worldwide, qualitative investigations that examine the adherence of young adults (18-34 years) to their asthma medication are limited. METHOD This study used a phenomenological research approach to explicate the experience of asthma medication adherence as described by young adults. Data were collected using semi-structured in-depth video interviews conducted with participants aged between 18 and 34 years to elicit their lived experience with adherence to asthma medication. Data from the interviews were transcribed and analyzed using the Edward and Welch (1) extension of Colaizzi's approach to phenomenology. RESULTS Results yielded four main themes related to the phenomenon of adherence that emerged from the analysis. The themes were: Having a plan; Having knowledge about your medication and asthma triggers; Being responsible with asthma medication; and Health belief. CONCLUSION According to the findings, for young people adhering to asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief. If young adults with asthma received individualized written asthma plans and have adequate knowledge about this plan, developing the correct health belief is likely to result. Hence, this can lead to a greater responsibility to manage their asthma to the recommended adherence level.
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Affiliation(s)
- Amal Al Wadhahi
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Loretta Garvey
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
| | - Karen-Leigh Edward
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia.,School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Carolyn Beasley
- Department of Media and Communication, School of Social Sciences, Media, Film and Education, Swinburne University of Technology, Melbourne, Australia
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Al Rawwad T, Schrader PK, Brooks A, Duong L, Thornton D. Do nursing and pharmacy students practice what they preach on safe drug storage and disposal? A cross-sectional study. NURSE EDUCATION TODAY 2021; 107:105143. [PMID: 34583239 DOI: 10.1016/j.nedt.2021.105143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research has confirmed a lack of knowledge regarding the risks of unused medications including diversion, misuse, or accidental overdose among health care professionals (Abdulmajeed, 2020). Nurses and pharmacists are often who patients interact with the most regarding medications; therefore, early education on proper storage and disposal is vital (Bowen, Rotz, Patterson, & Sen, 2017; Celio, Ninane, Bugnon, & Schneider, 2018). OBJECTIVES The study's objective is to explore safe drug storage and disposal knowledge, attitudes, and practices of professional pharmacy (Pharm.D.) and nursing students. DESIGN This research is an exploratory cross-sectional study from May to September 2019. METHODS An anonymous online survey was administered to a purposive sample of Pharm.D. and nursing students who were 18 years and older and enrolled in the site's accredited Pharm.D. and nursing programs (N = 210). Responses were analyzed using descriptive statistics. RESULTS Common disposal methods reported by students of their personal medications such as pills and liquids included discarding medications with the household trash (range 30% to 55%) and medication disposal products/bag (range 19% to 28%). More than half of the participants (50.4%) had unused prescription medication at home, 35% kept the medication for later use, and almost 20% of the participants reported sharing personal medications with others. CONCLUSION Although the majority of student participants had adequate knowledge of the appropriate methods for safe drug disposal, few reported using them for their own personal medications. The findings suggest there is a disconnect between the participants' knowledge of the appropriate methods of safe drug storage and disposal in a professional setting and their own practices. Further research is needed to explore and address the reasons for this disconnect. Additionally, findings from this research will assist in the development of and/or the improvement of interdisciplinary educational materials among pharmacy and nursing students.
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Affiliation(s)
- Tamara Al Rawwad
- School of Social Work, University of Texas Rio Grande Valley, 1201 W. University Drive, Edinburg, TX 78539, United States of America.
| | - Patrici K Schrader
- College of Nursing, University of Houston at Sugar Land, 14000 University Blvd., Sugar Land, TX 77479, United States of America.
| | - Andrea Brooks
- College of Nursing, University of Houston at Katy, 22400 Grand Cir. Room: 306H, Katy, TX 77449, United States of America.
| | - Lillian Duong
- University of Houston College of Pharmacy, United States of America.
| | - Douglas Thornton
- College of Pharmacy, University of Houston, Health 2 Building-Room 4055, Houston, TX 77204-5000, United States of America.
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19
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Westmoreland DA, Goldshear JL, Carrico AW, Grov C. Associations of prescription stimulant misuse with subsequent methamphetamine use among a U.S. cohort of HIV-vulnerable sexual and gender minorities who have sex with men. Drug Alcohol Depend 2021; 226:108841. [PMID: 34271513 PMCID: PMC8358820 DOI: 10.1016/j.drugalcdep.2021.108841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prescription stimulants and methamphetamine have similarities in chemical structure and impact on biological functioning. However, there is limited literature on prescription stimulant misuse among sexual and gender minorities as well as how prescription misuse may impact later methamphetamine use. METHODS We used data collected from a HIV prevention cohort to describe (e.g., frequencies, percentages) prescription stimulant use/misuse and methamphetamine use at baseline and 12-month follow-up (n = 4857). We then used multivariable logistic regression models to determine the impact of baseline prescription stimulant misuse and methamphetamine use on 12-month prescription stimulant misuse and methamphetamine use. RESULTS At baseline, 10.2 % of participants misused prescription stimulants and 12 % of participants used methamphetamine in the past 3 months, while at 12-month follow-up 11.6 % of participants misused prescription stimulants and 11.2 % of participants used methamphetamine in the past 3 months. Multivariable regression analyses indicated that participants who misused prescription stimulants (in the absence of methamphetamine) at baseline had 2.51 (95 % CI: 1.44-3.59, ref. no stimulant or methamphetamine use) times the odds of using methamphetamine at 12-month follow-up. DISCUSSION Findings suggest that prescription stimulant use is a risk factor for continued meth use. Therefore, earlier and targeted public health interventions could reduce methamphetamine use by disrupting the progression from prescription stimulant misuse to methamphetamine use through early screening and interventions for prescription stimulant misuse.
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Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Jesse L. Goldshear
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA; Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
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20
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Young HN, Pathan F, Reeves JH, Knight KN, Chen F, Cox ED, Moreno MA. Using a theoretical approach to predict college students' non-medical use of prescription drugs - a survival analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:470-477. [PMID: 31662045 PMCID: PMC7188581 DOI: 10.1080/07448481.2019.1680556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
This study assesses students' non-medical use of prescription drugs (NMUPD) from college entrance to graduation, and examines factors that predict NMUPD. Participants: The study was conducted between May 2011 and September 2015 with 338 students. Methods: Longitudinal cohort study design was used to examine NMUPD across time, and NMUPD-related attitudes and subjective norms. Five yearly interviews were conducted to collect data. Cox proportional hazards regression analysis was used to examine time to NMUPD. Results: Thirty-five percent of study participants reported NMUPD; the majority of those initiated non-medical use before their third year in college. Analyses indicated that more positive attitudes towards NMUPD (HR = 1.73, p < 0.001), increased subjective norms regarding NMUPD (HR = 1.01, p < 0.01), and gender (male) (HR= 1.89, p < 0.001) were significantly associated with sooner NMUPD. Conclusions: Findings suggest that NMUPD prevention efforts that target mutable factors such as attitudes and subjective norms should be implemented early during students' college careers.
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Affiliation(s)
- Henry N. Young
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Farah Pathan
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Jaxk H. Reeves
- Statistics Department, University Of Georgia, Athens, GA, USA
| | | | - FuNing Chen
- Statistics Department, University Of Georgia, Athens, GA, USA
| | - Elizabeth D. Cox
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan A. Moreno
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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21
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Chua KP, Brummett CM, Bohnert A. Estimates From Heterogeneous Studies of Opioid-Related Morbidity. JAMA Pediatr 2021; 175:531-532. [PMID: 33523123 DOI: 10.1001/jamapediatrics.2020.5617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
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22
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King ER, Repa LM, Garland SN. Factors associated with permissive attitudes of university students towards prescription medication misuse. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1905091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Eleanor R. King
- Department of Psychology, Memorial University, St. John's, Canada
| | - Lily M. Repa
- Department of Psychology, Memorial University, St. John's, Canada
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Morris MR, Hoeflich CC, Nutley S, Ellingrod VL, Riba MB, Striley CW. Use of psychiatric medication by college students: A decade of data. Pharmacotherapy 2021; 41:350-358. [PMID: 33583071 DOI: 10.1002/phar.2513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Given the rising prevalence of psychiatric symptomatology among college students, this analysis aims to identify temporal trends in psychiatric medication usage. METHODS This analysis used data from the Healthy Minds Study Survey administered between 2007 and 2019, yielding a sample of 320,817 university students. Survey data were examined via descriptive analyses. RESULTS Over the last decade from 2007 to 2018-2019, there was an increase in use of nearly all classes of psychiatric medications, with reported antidepressant medication (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], etc.) use increasing from 8.0% to 15.3%, anti-anxiety medication (benzodiazepines, buspirone, etc.) from 3.0% to 7.6%, psychostimulants from 2.1% to 6.3%, antipsychotics from 0.38% to 0.92%, and mood stabilizers from 0.8% to 2.0% (all p < 0.0001), respectively. In addition, the use of more than one category of medication at a time has increased, from 28.2% in 2007 to 40.8% in 2018-2019 (p < 0.0001). The proportion of students who received their most recent prescription for psychiatric medication from primary care providers has risen from 49.1% in 2007 to 58.8% in 2018-2019 (p < 0.0001), while the proportion receiving these prescriptions from psychiatric providers did not increase significantly and stands at 36.1% in 2018-2019. The percentage of students taking psychiatric medication without a prescription varied from year to year, starting at 11.9% in 2007 and ending at 7.7% in 2018-2019 (p < 0.0001). The proportion of students who discussed their use of psychiatric medication with their doctor or other health professional three or more times in the previous year has increased from 39.2% in 2007 to 49.5% in 2018-2019 (p < 0.0001). CONCLUSIONS The proportion of college students who have taken psychiatric medications of all categories has risen in the last decade; these students are increasingly likely to be on more than one kind of psychiatric medication and be treated by healthcare providers at a greater frequency. Despite the growing complexity of student treatment, the proportion of students receiving psychiatric medication management by psychiatric providers has not changed, while the proportion receiving services in primary care settings has increased.
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Affiliation(s)
- Marcia R Morris
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carolin C Hoeflich
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Sara Nutley
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Vicki L Ellingrod
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle B Riba
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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Iloabuchi C, Aboaziza E, Zhao X, Thornton JD, Dwibedi N. College Students' Perceptions About Prescription Drug Misuse Among Peers. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:29-38. [PMID: 33841623 PMCID: PMC8025926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prescription drug misuse is an escalating public health problem that is prevalent among college students. Various factors, such as sex, age, race, mental health conditions, and fraternity and sorority membership, increase the risk for prescription drug misuse. Peer influences may also pose significant risks for starting prescription drug misuse, because peers are the primary source of misused prescription drugs among college students. OBJECTIVES To examine college students' beliefs about prescription drug misuse among their peers and to understand their beliefs about the available and potential intervention efforts to reduce prescription drug misuse. METHOD We conducted a cross-sectional survey of 312 college students aged 18 to 30 years who were enrolled in a large midwestern US university. The survey included questions about the responders' demographic characteristics, beliefs, and perceptions regarding prescription drug misuse among their peers and potential reduction programs for prescription drug misuse. RESULTS The respondents' mean age was 21 years, and most (65%) respondents were women. A majority (90%) of the respondents were enrolled in the university as full-time students. More than 60% of the respondents reported knowing someone with prescription drug misuse in the past 12 months. Fraternity or sorority members were more likely to report peer prescription drug misuse than nonmembers (83% vs 60%, respectively; P = .017). Stimulants were the most misused drug class, accounting for 75% of all reported peer prescription drug misuse. Approximately 60% of the misused prescription drugs were sourced from peers, which included friends, roommates, and classmates. A total of 73% of respondents said that prescription drug misuse was a problem among college students and 67% agreed that interventions were needed to reduce prescription drug misuse. The perceived need for interventions varied by peer prescription drug misuse. A total of 90% of students whose peers did not misuse prescription drugs said that interventions were needed, but only 67% of those with peer prescription drug misuse thought that interventions were needed. CONCLUSION Our findings indicate that peer prescription drug misuse is very common among college students, and the most misused drug class is stimulants. Survey respondents perceived that the current interventions used to address prescription drug misuse are not very effective or may not be targeting the right population. Peer prescription drug misuse influences college students' perceptions about the risks and harms of prescription drug misuse, as well as the need for interventions.
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Affiliation(s)
- Chibuzo Iloabuchi
- PhD Candidate, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown
| | - Eiman Aboaziza
- PhD Candidate, Department of Clinical & Translational Science, West Virginia University, Morgantown
| | | | - J Douglas Thornton
- Assistant Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX
| | - Nilanjana Dwibedi
- Associate Professor, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown
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Ford JA, McCabe SE, Schepis TS. Sources of prescription opioids and tranquilizers for misuse among U.S. young adults: differences between high school dropouts and graduates and associations with adverse outcomes. J Addict Dis 2021; 39:54-65. [PMID: 32921294 PMCID: PMC7927204 DOI: 10.1080/10550887.2020.1814122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.
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Affiliation(s)
- Jason A. Ford
- Department of Sociology, University of Central Florida
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Social Research, University of Michigan
- Center for Human Growth and Development, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
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Nicholson HL, Wheeler PB. Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life. Subst Use Misuse 2021; 56:962-970. [PMID: 33769198 DOI: 10.1080/10826084.2021.1901928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Harvey L Nicholson
- Department of Sociology and Criminology & Law, University of Florida, Florida, USA
| | - Paris B Wheeler
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky, USA
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Butler SF, Faraone SV, Rostain AL, Newcorn JH, Antshel KM, Robbins RS, Green JL. Non-medical Use of Prescription Stimulants Among College Students: Non-oral Routes of Administration, Risk Factors, Motivations, and Pathways. Front Psychiatry 2021; 12:667118. [PMID: 34483980 PMCID: PMC8415354 DOI: 10.3389/fpsyt.2021.667118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Non-medical use (NMU) of prescription stimulant medications is a continuing public health concern. Stimulant medications prescribed for attention-deficit/hyperactivity disorder (ADHD) are widely available on college campuses, and, as a consequence, college students may have multiple opportunities to engage in prescription stimulant NMU. This online self-report survey examined prescription stimulant NMU among college students, including: (1) patterns of non-oral route of administration (ROA); (2) motivations for non-oral ROAs; and (3) retrospectively recalled pathways of initiation. Method: The survey sample was created from a pool of 3,379 respondents, who were matched to a sampling frame constructed from the 18-26-year-old, college student sample of the 2016 American Community Survey (ACS). About 14% (n = 486) from the overall pool were identified as college students with self-reported prescription stimulant NMU, all of whom completed the survey. The survey covered user characteristics, prescription and illicit substance use, age of first NMU, motivations for NMU, sources of procurement, and ROAs used. Results: Among 486 students reporting prescription stimulant NMU, 43% had a lifetime diagnosis of ADHD. More than 90% reported polysubstance use, with 55% using illicit substances other than marijuana. Slightly more than 2 in 5 (43.3%) reported using illicit substances prior to prescription stimulant NMU, 24.6% used both at the same age, and 32.0% engaged in NMU of prescription stimulants prior to using illicit substances. Prescription stimulant NMU preceded prescription opioid NMU 45% of the time. More than a quarter of those engaged in prescription stimulant NMU (27.9%) initiated prescription stimulants alone or at the same age as other drugs. Most prescription stimulant NMU was oral, however 23.0% reported any non-oral use: snorting (20.4%), smoking (6.0%)and/or injection (3.5%). Non-oral use was associated with being male, obtaining medication from a dealer, use to get high, and/or a substance use disorder diagnosis. Conclusions: Prescription stimulant NMU often occurs in the larger context of other substance use among college students. Injection, an under-researched route for prescription stimulants, was associated with male gender, history of substance use and higher likelihood of illicit substance use. Nearly a quarter of college student survey respondents reported use with non-oral routes, which is associated with other high-risk behaviors. Efforts to reduce non-oral prescription stimulant NMU in college students are warranted.
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Affiliation(s)
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | | | - Jody L Green
- Inflexxion, an IBH Company, Irvine, CA, United States
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Philbin MM, Greene ER, Martins SS, LaBossier NJ, Mauro PM. Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender. Am J Prev Med 2020; 59:686-696. [PMID: 32981768 PMCID: PMC7577928 DOI: 10.1016/j.amepre.2020.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations. METHODS Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only. RESULTS Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use. CONCLUSIONS Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.
| | - Emily R Greene
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Irfan A, Martin LY, Canner J, Etra J, Gonzalez Salazar AJ, Overton HN, Jelin EB. The impact of post-operative opioid guidelines on prescribing behaviors in the pediatric population. Pediatr Surg Int 2020; 36:1339-1343. [PMID: 32915274 PMCID: PMC7554093 DOI: 10.1007/s00383-020-04739-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Opioid misuse continues to be a major source of morbidity and mortality in the US, in both the adult and pediatric populations. Post-operative opioid prescriptions are often the first exposure children have to opioids and increases their risk of chronic use. There is significant variation in the number of opioids following identical procedures and measures have been taken within the adult population to limit this. However, specific post-operative opioid prescription guidelines are not present in the pediatric population. METHODS Seven common pediatric surgery procedures were selected for inclusion. The recommended number of opioid doses following each procedure was determined by a multi-disciplinary expert panel. All surgery residents were sent an initial survey to determine the number of opioids they would prescribe for each procedure. They were then shown the guidelines and the survey repeated to determine changes in response. RESULTS 35 and 27 general surgery residents took part in and pre- and post-educational surveys respectively. In all procedures, there was a decrease in the mean number of post-operative opioids prescribed. In addition, there was an increase in the number of residents who prescribed within the guidelines and a decrease in the number who overprescribed post-operative opioids. CONCLUSION Pediatric postoperative opioid prescribing guidelines derived from expert opinion increase resident compliance with appropriate dosing; this has the potential to decrease the classic problem of general surgery residents accustomed to treating adults overprescribing opioids to children. These results are promising, and we aim to expand on this work and incorporate these guidelines into our clinical practice. LEVEL OF EVIDENCE III/IV.
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Affiliation(s)
- Ahmer Irfan
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Laura Y Martin
- Department of Pediatric Surgery, Vanderbilt Children's Hospital, Nashville, TN, USA
| | - Joseph Canner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joanna Etra
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Heidi N Overton
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric B Jelin
- Department of Surgery, Division of Pediatric Surgery, Johns Hopkins School of Medicine, Johns Hopkins Children's Center, 1800 Orleans St, Baltimore, MD, 21287, USA.
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Designing Effective Warnings about Addiction on the Patient Information Leaflet of Over-the-Counter Codeine Sold in England to University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155490. [PMID: 32751393 PMCID: PMC7432560 DOI: 10.3390/ijerph17155490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
(1) Background: The harm of misusing over-the-counter (OTC) codeine-containing medicines among university students in England is being increasingly recognized. Based on English university students, this paper aims to study the importance of information design on information communication, explore methods for effective warning design, and investigate university students’ perception of OTC codeine. (2) Methods: The effective warning design is addressed through case studies, answering correctness by the heat map generated from the eye-tracking experiment (ETE), and the total time spent on the tasks. User perceptions are made though online surveys. (3) Results: Information design significantly affects the way user processes information. Therefore, two emphasized warnings displayed in the headline, and the “possible side effect (PSE)” sections and warning signs of addiction presented under the PSE are suggested as effective ways to display warnings. For students’ perception of OTC codeine, 80% of university students are unfamiliar with the substance. After reading the patient information leaflets (PILs), 47% recommended tight regulation on codeine. (4) Conclusions: The misuse of OTC codeine could be a potential problem among English university students. The design of the PIL significantly influences the chance of unintentional medicine misuse. The display of warnings on the PILs of OTC codeine should be redesigned for better understanding.
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Klare DL, McCabe SE, Ford JA, Schepis TS. Prescription drug misuse, other substance use, and sexual identity: The significance of educational status and psychological distress in US young adults. Subst Abus 2020; 42:377-387. [PMID: 32692942 DOI: 10.1080/08897077.2020.1784358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim was to examine the effects of sexual identity, educational status, and their interaction on the past-year prevalence of controlled prescription use and prescription drug misuse (PDM) in U.S. young adults, 18-25 years. Methods: Data were from the 2015-2017 National Survey on Drug Use and Health (young adult N = 38,298). Past-year prescription opioid, stimulant and benzodiazepine use and PDM were outcomes, with PDM defined as use without a prescription or in ways not intended by the prescriber. Separate regressions by sex evaluated the relationship between prescription medication use or PDM prevalence and sexual identity, educational status/attainment (college student/graduate versus non-college), their interaction and past-year psychological distress. Results: Sexual identity minority young adults had higher rates of prescription use and PDM than heterosexual young adults. After accounting for educational status, though, bisexual men rarely differed from heterosexual men; after including psychological distress, gay men rarely differed from heterosexual men. Versus heterosexual women, lesbian (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [95% CI] = 1.47-2.30) and bisexual (AOR= 1.78, 95% CI = 1.27-2.50) young adult women had higher rates of prescription opioid misuse, after adjusting for educational status, psychological distress and sociodemographics. Versus heterosexual men, benzodiazepine PDM was elevated in gay men (AOR = 1.91, 95% CI= 1.02-3.58). Educational status was generally associated with lower rates of prescription use and PDM, except for stimulant PDM. Conclusions: Screening for psychological distress and PDM is needed in sexual identity minority young adults, especially for prescription opioid misuse among sexual identity minority women. Culturally-sensitive intervention should be considered for those with elevated psychological distress or signs of PDM. Further research on the sex differences found in the link between psychological distress and sexual identity minority opioid and stimulant PDM is warranted.
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Affiliation(s)
- Dalton L Klare
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas, USA
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Bethell J, Neuman MD, Bateman BT, Ladha KS, Hill A, Li G, Wijeysundera DN, Wunsch H. Association between mothers' postoperative opioid prescriptions and opioid-related events in their children: A population-based cohort study. HEALTH REPORTS 2020; 31:12-19. [PMID: 32672924 PMCID: PMC8201592 DOI: 10.25318/82-003-x202000600002-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Postoperative opioid prescriptions may be associated with risks of unintentional poisoning and drug diversion in other household members. The objective of this study was to explore the association between mothers' postoperative opioid prescriptions and incidence of opioid-related events in their children (aged 1 to 24 years). DATA AND METHODS This retrospective cohort study used individually linked administrative health data from Ontario, Canada. A population-based sample of 170,156 opioid-naïve mothers (aged 15 to 64) (see Figure 1) who underwent surgery between 2013 and 2017 in Ontario was linked through birth records to create a cohort of their 283,550 opioid-naïve children (aged 1 to 24). The association between postoperative opioid analgesic prescriptions filled by mothers within seven days of discharge after surgery and opioid-related events (emergency department presentations or inpatient admissions for opioid poisoning, or mental and behavioural disorders attributable to opioid use) in their children within one year of their mother's discharge was assessed. RESULTS Overall, 60.4% of the children in the cohort had a mother who filled a postoperative opioid prescription. The incidence of opioid-related events in children in the year after a mother's surgery was low overall (n=36/283,550, 0.01%), but higher among children whose mother filled a postoperative opioid prescription (n=29/171,139, 0.02%, vs. n=7/112,411, 0.01%, p=0.02), including in an analysis adjusting for child's age, mother's age, rural residence, neighbourhood income quintile and mother's Charlson comorbidity index score (adjusted odds ratio, 2.42 [95% confidence interval (CI), 1.05 to 5.54], p=0.04). DISCUSSION Postoperative opioid prescriptions for mothers may contribute to opioid-related events in their children. These findings further underscore the importance of safe, effective opioid prescribing, as well as of patient and public education about the use, storage and disposal of these medications.
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Affiliation(s)
- Jennifer Bethell
- Sunnybrook Research Institute, ICES, the Toronto Rehabilitation Institute at the University Health Network, and the Institute of Health Policy Management and Evaluation at the University of Toronto, Toronto, Ontario
| | - Mark D Neuman
- The Department of Anesthesiology and Critical Care, the Center for Perioperative Outcomes Research and Transformation, and the Center for Pharmacoepidemiology Research and Training at the University of Pennsylvania Perelman School of Medicine, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian T Bateman
- The Department of Anesthesia, Perioperative, and Pain Medicine, and the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karim S Ladha
- The Department of Anesthesia at St. Michael's Hospital, and the Department of Anesthesia at the University of Toronto, Toronto, Ontario
| | - Andrea Hill
- Sunnybrook Research Institute, and the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Guohua Li
- The Department of Epidemiology, Mailman School of Public Health, and the Department of Anesthesiology, College of Physicians and Surgeons at Columbia University, and the Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, New York
| | - Duminda N Wijeysundera
- ICES, the Institute of Health Policy Management and Evaluation and the Department of Anesthesia at the University of Toronto, and the Department of Anesthesia at St. Michael's Hospital, Toronto, Ontario
| | - Hannah Wunsch
- Sunnybrook Research Institute, ICES, the Department of Anesthesia at the University of Toronto, the Department of Critical Care Medicine at the Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care Medicine at the University of Toronto, Toronto, Ontario
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Kelly BC, Vuolo M. Nightlife scene involvement and patterns of prescription drug misuse. Drug Alcohol Rev 2020; 39:888-897. [PMID: 32633443 DOI: 10.1111/dar.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Participation in nightlife influences a range of health behaviours. Participants in various nightlife scenes have increasingly adopted prescription drug misuse into their substance use repertoires. DESIGN AND METHODS With 404 young adults recruited via time-space sampling in New York, we examine the relationship of nightlife participation-measured by number of scenes and the number of nights out in nightlife scenes-to prescription drug misuse during the past 3 months. Outcomes included frequency of misuse, escalation to non-oral consumption, polydrug use, social problems and symptoms of dependence. RESULTS Negative binomial regressions indicate nightlife participation is associated with increased frequency of misuse measured by number of scenes (incidence rate ratio = 1.114, P < 0.05) and number of nights out (incidence rate ratio = 1.009, P < 0.001). Logistic regression models show nightlife participation is associated with increased odds of non-oral use (adjusted odds ratio; AOR = 1.334, P < 0.01) and polydrug use (AOR = 1.776, P < 0.001) measured by number of scenes, and non-oral use (AOR = 1.021, P < 0.001) and polydrug use (AOR = 1.023, P < 0.001) as measured by number of nights out. Nightlife participation is not associated with prescription drug problems or symptoms of dependence. Frequency of participation is associated with peer norms favourable to prescription drugs (B = 0.003, P < 0.01). DISCUSSION AND CONCLUSIONS Nightlife participation has implications for prescription drug misuse. While shaping how often and in what manner young people consume prescription drugs, nightlife participation is not associated with harms experienced. Given the significance of the prescription drug trend in many world regions, these results suggest that increasing participation in nightlife shapes patterns of drug use, but in ways that do not lead to reported problems.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, USA
| | - Mike Vuolo
- Department of Sociology, The Ohio State University, Columbus, USA
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Wilens TE, Martelon M, Yule A, Kaminski TA, Burke C, Schepis TS, McCabe SE. Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students. Am J Addict 2020; 29:476-484. [PMID: 32436300 DOI: 10.1111/ajad.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co-occurring substance use disorders (SUD) compared with those without co-occurring SUDs. METHODS Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ2 test, and the Wilcoxon rank-sum test. RESULTS College students who endorsed NMUPS with co-occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use. DISCUSSION AND CONCLUSIONS Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants. SCIENTIFIC SIGNIFICANCE The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476-484).
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Affiliation(s)
- Timothy E Wilens
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - MaryKate Martelon
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Yule
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tamar A Kaminski
- Division of Child Psychiatry, Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Colin Burke
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
| | - Sean E McCabe
- School of Nursing and Institute for Research on Women and Gender, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor, Michigan
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Schepis TS, Klare DL, Ford JA, McCabe SE. Prescription Drug Misuse: Taking a Lifespan Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820909352. [PMID: 32214819 PMCID: PMC7065295 DOI: 10.1177/1178221820909352] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.
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Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Dalton L Klare
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Jason A Ford
- Department of Sociology, University of Central Florida, Orlando, FL, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of MI, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review. Prev Med 2020; 132:105972. [PMID: 31904397 PMCID: PMC7024638 DOI: 10.1016/j.ypmed.2019.105972] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.
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Schuler MS, Dick AW, Stein BD. Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015-2017 National Survey on Drug Use and Health. J Gen Intern Med 2020; 35:792-799. [PMID: 31792871 PMCID: PMC7080910 DOI: 10.1007/s11606-019-05559-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/22/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prescription opioid misuse among older adults has received little attention to date. Potential age variation in characteristics of and motivations for prescription opioid misuse has not been fully characterized yet has important implications for preventing diversion and misuse. OBJECTIVE To examine (1) age-specific patterns of source of misused prescription opioid pain relievers and motives for misuse and (2) age-specific and source-specific associations with opioid use disorder (OUD), heroin use, benzodiazepine misuse, and OUD treatment utilization. DESIGN Cross-sectional study using 3 waves (2015-2017) of the National Survey on Drug Use and Health (68% average response rate) PARTICIPANTS: Respondents aged 12 and older with past-year prescription opioid pain reliever misuse (n = 8228) MAIN MEASURES: Source for the most-recently misused prescription pain reliever (categorized as medical, social, or illicit/other), motive for last episode of misuse, OUD, heroin use, benzodiazepine misuse, and OUD treatment. KEY RESULTS Adults 50 and older comprised approximately 25% of all individuals reporting past-year prescription opioid misuse. A social source was most common for individuals under age 50 while a medical source was most common for individuals 50 and older. The most commonly reported motive for misuse was to "relieve physical pain"; the frequency of this response increased across age groups (47% aged 12-17 to 87% aged 65+). Among adults age 50 and older with prescription opioid misuse, 17% met criteria for OUD, 15% reported past-year benzodiazepine misuse, and 3% reported past-year heroin use. CONCLUSIONS Physicians continue to be a direct source of prescription opioids for misuse, particularly for older adults. Ongoing clinical initiatives regarding optimal opioid prescribing practices are needed in addition to effective non-opioid strategies for pain management. Clinical initiatives should also include screening adult and adolescent patients for non-medical use of prescription opioids as well as improving access to OUD treatment for individuals of all ages.
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Davis RE, Bass MA, Wade MA, Nahar VK. Screening for depression among a sample of US college students who engage in recreational prescription opioid misuse. Health Promot Perspect 2020; 10:59-65. [PMID: 32104658 PMCID: PMC7036209 DOI: 10.15171/hpp.2020.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/05/2019] [Indexed: 11/09/2022] Open
Abstract
Background: Among student populations, literature has identified associations between prescription opioid misuse and symptoms of depression such as hopelessness, sadness, and emotional pain. Thus far, existing literature has yet to investigate associations between prescription opioid misuse and depression using validated screening instruments for depression when exploring such associations. The purpose of this study was to utilize a validated screening tool to explore quantifiable presence of depression among college students who engage in recreational prescription opioid misuse (RPOM). Additionally, gender differences in depression and co-occurring substance use are examined. Methods: Students (n = 104) of a large university in the Southeastern United States who reported ROM within the past 6 months completed instrumentation assessing demographics, substance use, as well as, screening tools for depression and possible opioid use disorder (OUD). Results: Positive depression screens were significantly higher among females, however, nearly56% of participants screened positive for major depression. Though high levels of co-occurring substance use were observed among the entire sample, males were significantly more likely to report cocaine use, more frequent use of alcohol and marijuana, as well as, exhibit a positive screen for disordered opioid use, at a rate 5 times that of their female counterparts. Conclusion: Students who engage in RPOM are a particularly heightened-risk subsample of the college population who exhibit high levels of depressive symptomatology and substance use behavior. Targeted programming and further investigations are needed among this specific population. Future studies are encouraged to utilize validated instruments when assessing depression among students.
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Affiliation(s)
- Robert E Davis
- Substance Use and Mental Health Laboratory, Department of Health, Human Performance and Recreation, University of Arkansas, 155 N. Stadium Dr. HPER 310B, Fayetteville, AR 72701, USA
| | - Martha A Bass
- Department of Health, Exercise Science Recreation Management, University of Mississippi, 218 Turner Center, University, MS 38677, USA
| | - M Allison Wade
- Department of Health, Exercise Science Recreation Management, University of Mississippi, 218 Turner Center, University, MS 38677, USA
| | - Vinayak K Nahar
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
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Stoddard SA, Hughesdon K, Khan A, Zimmerman MA. Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth. Public Health Nurs 2020; 37:251-261. [PMID: 31950544 DOI: 10.1111/phn.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/23/2019] [Accepted: 12/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement. INTERVENTION Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation. DESIGN AND SAMPLE Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts. MEASURES Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes. RESULTS Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01). CONCLUSIONS YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.
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Affiliation(s)
- Sarah A Stoddard
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Angubeen Khan
- California Center for Health Policy Research, University of California, Los Angeles, California
| | - Marc A Zimmerman
- University of Michigan School of Public Health, Ann Arbor, Michigan
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Ford JA, Pomykacz C, Ortiz K, McCabe SE, Schepis TS. Educational attainment and prescription drug misuse: The importance of push and pull factors for dropping out. JOURNAL OF CRIMINAL JUSTICE 2020; 66:101636. [PMID: 32863457 PMCID: PMC7449532 DOI: 10.1016/j.jcrimjus.2019.101636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Young adults who do not complete high school are at increased risk for substance use and offending behavior. A limitation of this research is that dropouts are often treated as a homogeneous group, which ignores the various push (e.g., academic failure or disciplinary problems) and pull (e.g., family responsibility or economic need) factors for leaving school. METHODS The current study relies on multiple years of data from the National Survey on Drug Use and Health (2009-2014) and examines several dependent variables, including prevalence of prescription drug misuse, frequent prescription drug misuse, and prescription drug-related substance use disorder symptoms. We assess the importance of push and pull factors for dropping out, and compare dropouts to respondents who completed school. RESULTS Multivariable logistic regression analyses produce two important findings. First, push factors increase the risk of various types of prescription drug misuse compared to pull factors. Additionally, respondents who attend college are at a decreased risk for various types of prescription opioid and sedative/tranquilizer misuse and disorder. DISCUSSION The current research identifies important differences in prescription drug misuse and disorders among dropouts based on the reason they left school. Additionally, college attendance appears to be a strong protective factor.
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Affiliation(s)
- Jason A. Ford
- Department of Sociology, University of Central Florida
| | | | - Kasim Ortiz
- Department of Sociology & Criminology, University of New Mesico
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan
- Institute for Research on Women and Gender, University of Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan
- Center for Human Growth and Development, University of Michigan
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Abstract
The nonmedical use of prescription stimulants has become increasingly pervasive among transitional age youth (TAY), aged 16 years to 26 years. Although therapeutically administered stimulants are regarded as safe and effective in TAY with attention-deficit/hyperactivity syndrome (ADHD), stimulant misuse is of concern due to prevalence, behavioral health and substance use correlates, and negative short-term and long-term outcomes. Although academic motivations primarily drive misuse, it is unclear whether prescription ADHD stimulants enhance cognition. Providers are advised to exercise precautions when prescribing ADHD medications, enhance surveillance for misuse, and screen those with misuse for ADHD and other psychopathology, executive dysfunction, and substance use disorders.
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Affiliation(s)
- Timothy E Wilens
- Child & Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
| | - Tamar Arit Kaminski
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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Peck KR, Parker MA, Sigmon SC. Reasons for non-medical use of prescription opioids among young adults: Role of educational status. Prev Med 2019; 128:105684. [PMID: 30951735 PMCID: PMC6774912 DOI: 10.1016/j.ypmed.2019.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022]
Abstract
Non-medical use of prescription opioids (NMUPO) and related overdoses are disproportionately elevated among young adults. Efforts to understand the underlying reasons for NMUPO are critical for developing more effective prevention and intervention strategies for this group. Given the robust literature on the association between educational status and substance abuse risk, we examined the reasons for NMUPO through the lens of educational attainment among young adults. Data from the 2016 National Survey on Drug Use and Health came from an unweighted sample of 941 young adults aged 18-25 years who reported past-year NMUPO. Self-reported reasons for most recent NMUPO were compared by educational status. The most commonly-endorsed reasons for past-year NMUPO was physical pain relief (47.6%), followed by feel good/get high (19.8%), relax/relieve tension (13.2%) and experiment/see what it feels like (6.8%). Reasons for NMUPO did not differ as a function educational status (p = 0.17). These findings suggest that efforts to prevent and address opioid misuse among young adults should focus on understanding and improving pain management in this vulnerable population.
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Affiliation(s)
- Kelly R Peck
- Vermont Center on Behavior and Health, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA.
| | - Maria A Parker
- Vermont Center on Behavior and Health, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA; Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
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Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: a national longitudinal multicohort study. Lancet Psychiatry 2019; 6:840-850. [PMID: 31521577 PMCID: PMC6939756 DOI: 10.1016/s2215-0366(19)30299-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prescription drug misuse is most prevalent during young adulthood (ages 18-25 years). We aimed to identify prescription drug misuse trajectories for three drug classes (opioids, stimulants, and sedatives or tranquilisers) from adolescence into adulthood, assess the extent to which different trajectories are associated with symptoms of substance use disorder, and identity factors associated with high-risk prescription drug misuse trajectories. METHODS For this longitudinal multicohort study, nationally representative probability samples of 51 223 adolescents in the USA were followed up across eight waves from age 18 years (cohorts 1976-96) to age 35 years. Data were collected via self-administered paper questionnaires. FINDINGS Five prescription drug misuse trajectories were identified and the defining characteristic that differentiated the five trajectories was the age when past-year prescription drug misuse high frequency peaked: rare or no misuse at any age, peak at age 18 years, peak at ages 19-20 years, peak at age 23-24 years, and peak at ages 27-28 years. Similar prescription drug misuse trajectories were identified for each prescription drug class. The later peak misuse trajectory for sedatives and tranquilisers crested at an older age (35 years) than that for the other drug classes. Prescription drug misuse trajectories were all associated with significantly greater odds of having two or more substance use disorder symptoms at age 35 years, especially the later peak trajectories. In controlled analyses, risk factors associated with the high-risk latest peak prescription drug misuse trajectory included high school heavy drinking, cigarette smoking, marijuana use, poly-prescription drug misuse, white race, and not completing a 4-year university degree. INTERPRETATION Prescription drug misuse trajectories are heterogeneous, and any high-frequency prescription drug misuse is a strong risk factor for development of substance use disorders during adulthood, especially later-peak prescription drug misuse trajectories. These findings might help practitioners identify individuals at greatest risk for substance use disorders and target intervention strategies. FUNDING National Institute on Drug Abuse, National Institutes of Health.
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Parker MA. Persistence of extra-medical prescription pain reliever use and alcohol involvement among United States 12-20 year olds. Exp Clin Psychopharmacol 2019; 27:502-509. [PMID: 30869981 PMCID: PMC6785979 DOI: 10.1037/pha0000262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The peak risk of first extramedical use of prescription pain relievers (PPRs) is in mid-adolescence, often after underage drinking has begun. This research aims to investigate discrete classes of similar young people based on their newly incident extramedical use of PPR and alcohol involvement, with empirical evaluation of the underlying structure of identified subgroups and their epidemiological distributions in the United States. The U.S. National Surveys on Drug Use and Health, 2002-2013, sampled, recruited, and assessed 24,789 newly incident extramedical PPR users ages 12-20 years, with self-interviews on PPR, alcohol, and covariates. Latent classes of persistence were formed using PPR and alcohol status variables. Then, age and sex were studied as potentially important predictors of class membership. Analysis-weighted estimates and delta method variances were derived. Three classes were distinguished by extramedical PPR and alcohol use patterns: (a) nonpersistent (79%), (b) intermittent (15%), and (c) persistent (6%). There were no differences across classes by age, but being female was associated with greater odds of being in the intermittent class or persistent class compared to the nonpersistent class. Presenting clinical features of alcohol and/or opioid dependence that have become manifest at or near time of first PPR use can be indicators of persisting in extramedical use of PPR, particularly for young people who have recently started extramedical PPR use. Persistent adolescent and young adult extramedical PPR users require tailored public health prevention and intervention strategies based on their vulnerability to continue use over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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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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Schepis TS, Wilens TE, McCabe SE. Prescription Drug Misuse: Sources of Controlled Medications in Adolescents. J Am Acad Child Adolesc Psychiatry 2019; 58:670-680.e4. [PMID: 30768405 PMCID: PMC6491250 DOI: 10.1016/j.jaac.2018.09.438] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/12/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Adolescent controlled prescription drug misuse (PDM) co-occurs with significant consequences, including lower educational achievement, substance use disorder (SUD) symptoms, and psychopathology. Nonetheless, adolescent PDM sources and the prevalence of other substance use, SUD, and mental health outcomes associated with sources remain poorly understood. METHOD Data were from the 2009 to 2014 National Survey on Drug Use and Health, including 103,920 adolescents (12-17 years of age). Six mutually exclusive sources were used: physician source only, theft/fake prescription only, friend/relative for free only, purchases only, other source only, or multiple sources. Analyses occurred separately for prescription opioids, stimulants, and tranquilizer/sedatives. PDM source prevalence across adolescents and by sex and school enrollment/engagement were estimated. Adjusted odds of past-year DSM-IV substance-specific SUD, marijuana use, any SUD, major depressive disorder (MDD), anxiety diagnosis, mental health treatment, and past-month binge drinking were estimated by source. RESULTS Friends/relatives, for free, was the most common source (29.0%-33.2%), followed by physician sources for opioids (23.9%), purchases for stimulants (23.5%), and tranquilizer/sedatives (22.7%). Few school enrollment/engagement differences existed, but female adolescents were more likely to use multiple sources. Over 70% of adolescents using multiple sources had a past-year SUD. Multiple sources, purchases, and theft/fake prescription were more strongly associated with other substance use than physician source use, and multiple source use was linked with MDD. CONCLUSION Adolescents using multiple sources, purchases and theft/fake prescriptions have elevated rates of other substance use, SUD and MDD and particularly warrant intervention. Also, adolescents with other SUD and MDD should be screened for PDM and misuse sources.
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Affiliation(s)
| | - Timothy E. Wilens
- Massachusetts General Hospital, Boston, and Harvard Medical School, Cambridge, MA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, and the Institute for Research on Women and Gender, University of Michigan, Ann Arbor
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Stoddard SA, Veliz P. Summer School, School Disengagement, and Substance Use During Adolescence. Am J Prev Med 2019; 57:e11-e15. [PMID: 31130462 DOI: 10.1016/j.amepre.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Youth who fall behind academically are at increased risk for school disengagement, school dropout, and substance use. Summer school is an opportunity for youth to complete needed coursework yet has not been utilized as a venue for substance use prevention. To date, little is known about the rates of summer school attendance among adolescents or the relationship between summer school attendance, school disengagement, and substance use. The purpose of this study is to assess the characteristics of summer school attendance over the past 20 years and to examine the associations between summer school attendance, indicators of school disengagement, and recent substance use among eighth-grade students. METHODS Data from the Monitoring the Future cross-sectional study of eighth-grade students (1997-2016; n=111,033) was used to examine the association between summer school attendance and recent substance use (e.g., past 2-week/30-day marijuana use). Bivariate associations controlling for sociodemographics and school disengagement (e.g., truancy) were assessed. Analyses were completed in 2018. RESULTS School disengagement and substance use were associated with summer school attendance; however, when controlling for indicators of school disengagement, summer school attendance was not associated with substance use. Interaction effect models found that summer school attendance weakened the association between indicators of school disengagement and substance use. CONCLUSIONS These findings suggest that students with a high propensity to use substances do attend summer school. Summer school may be a venue to deliver information on the risk of alcohol or other drugs to a population of at-risk students.
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Affiliation(s)
- Sarah A Stoddard
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan.
| | - Philip Veliz
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
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Barman-Adhikari A, Hsu HT, Brydon D, Petering R, Santa Maria D, Narendorf S, Shelton J, Bender K, Ferguson K. Prevalence and correlates of nonmedical use of prescription drugs (NMUPD) among Young adults experiencing homelessness in seven cities across the United States. Drug Alcohol Depend 2019; 200:153-160. [PMID: 31132682 DOI: 10.1016/j.drugalcdep.2019.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nonmedical use of prescription drugs (NMUPD) is an urgent public health concern facing the United States. Young adults experiencing homelessness (YEH) are at increased risk of NMUPD; however, community estimates of NMUPD among YEH are sparse. This current study sought to understand patterns and correlates of NMUPD in a geographically heterogeneous sample of YEH recruited from seven cities across the United States. METHODS From June 2016 to July 2017, 1,426 YEH (aged 18-26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression was utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month NMUPD and NMUPD types (i.e., prescription stimulant, sedative, and opioids). RESULTS Approximately 20% of participants reported past-month NMUPD. Almost 9% reported misusing prescription opioids, 8.7% misused prescription sedatives, and 6% misused prescription stimulants. Multivariable logistic regressions revealed unmet mental health needs were associated with sedative and stimulant misuse but not opioid misuse. Having suicidal thoughts was associated with opioid misuse but not sedative or stimulant misuse. Although no geographical differences emerged for stimulant and sedative misuse, youth from Denver, Phoenix, and San Jose were more likely to engage in opioid misuse relative to youth in Los Angeles. CONCLUSIONS These findings indicate that interventions designed to address NMUPD need to be multifaceted, designed to address other risk behaviors correlated with NMUPD, and target unmet mental health needs.
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Affiliation(s)
- Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St. Denver, CO, 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, 729 Clark Hall, Columbia, MO, 65211, USA.
| | - Daphne Brydon
- Graduate School of Social Work, University of Denver, 2148 S. High St. Denver, CO, 80208, USA.
| | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive St. 1503-1, Los Angeles, CA, 90015, USA.
| | - Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave. Ste. 591, Houston, TX 77030, USA.
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd. #110HA, Houston, TX, 77204-4013, USA.
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, 2180 Third Ave. New York, NY, 10035, USA.
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, 2148 S. High St. Denver, CO, 80208, USA.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, 411 N. Central Ave. #865, Phoenix, AZ 85004-0689, USA.
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Votaw VR, Geyer R, Rieselbach MM, McHugh RK. The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend 2019; 200:95-114. [PMID: 31121495 PMCID: PMC6639084 DOI: 10.1016/j.drugalcdep.2019.02.033] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. METHODS PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. RESULTS The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. CONCLUSIONS Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.
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Affiliation(s)
- Victoria R. Votaw
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, USA,Corresponding author: Victoria R. Votaw, Clinical Psychology Ph.D. Student Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, Albuquerque, NM 87131,
| | - Rachel Geyer
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - Maya M. Rieselbach
- Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Callahan ST. Opioids and the Urgent Need to Focus on the Health Care of Young Adults. Pediatrics 2019; 143:peds.2019-0835. [PMID: 31138665 DOI: 10.1542/peds.2019-0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- S Todd Callahan
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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