Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs in the United States, 2004-2008

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, USA.
Journal of Pain & Palliative Care Pharmacotherapy 09/2010; 24(3):293-7. DOI: 10.3109/15360288.2010.503730
Source: PubMed


This report, adapted from the lead article in the June 10, 2010, issue of Morbidity and Mortality Weekly Reports, describes the alarming increase in overdose deaths involving prescription drugs. Oxycodone, hydrocodone, and methadone were the drugs most highly implicated. Data were derived from the federal Drug Abuse Warning Network (Dawn). Other drugs commonly used in managing pain patients, including benzodiazepines and muscle relaxants, also were implicated.

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    • "Our results indicate, as expected from earlier work, that oxycodone and hydrocodone products, the opioids most commonly used to control pain in the medical and dental fields [19] [37] [41], are likewise the most highly abused opioids [2] [7] [12] [21] [27] [37] [42] [45]. Given that it has been shown that there is a direct relationship between the number of opioid prescriptions by health care providers and the magnitude of diversion to the illicit marketplace [6] [13] [29], accessibility is certainly a major feature attracting non-therapeutic users to these drugs. "
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    ABSTRACT: The purpose of the present study was to identify the factors that influence the selection of hydrocodone and oxycodone as primary drugs of abuse in opioid-dependent subjects (n=3520) entering one of 160 drug treatment programs around the country. Anonymous, self-administered surveys and direct qualitative interviews were used to examine the influence of demographic characteristics, drug use patterns, and decision-related factors on primary opioid selection. Our results showed that oxycodone and hydrocodone were the drugs of choice in 75% of all patients. Oxycodone was the choice of significantly more users (44.7%) than hydrocodone (29.4%) because the quality of the high was viewed to be much better by 54% of the sample, compared to just 20% in hydrocodone users, who cited acetaminophen as a deterrent to dose escalation to get high and hence, its low euphoric rating. Hydrocodone users were generally risk-averse women, elderly people, noninjectors, and those who prefer safer modes of acquisition than dealers (ie, doctors, friends, or family members). In contrast, oxycodone was a much more attractive euphorigenic agent to risk-tolerant young, male users who prefer to inject or snort their drugs to get high and are willing to use more aggressive forms of diversion. Prevention and treatment approaches, and pain physicians, should benefit from these results because it is clear that not all drug abusers share the same characteristics, and the decision to use one drug over another is a complex one, which is largely attributable to individual differences (eg, personality, gender, age, and other factors).
    Pain 12/2013; 154(12):2639-48. DOI:10.1016/j.pain.2013.07.025 · 5.21 Impact Factor
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    • "It is concerning that a US government study identified significant numbers of middle school-aged and high school-aged teenagers in the US as having abused hydrocodone with acetaminophen, presumably because of its easy availability.5 A study of emergency department visits in the US from 2004 to 2008 showed that hydrocodone, along with oxycodone and methadone, caused the highest number of emergency department visits among the opioids.6 However, an estimate of the abuse risk of hydrocodone adjusted for the volume of prescribing suggested that hydrocodone has one of the lowest rates of abuse for its volume of prescribing.7 "
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    ABSTRACT: Hydrocodone is a semisynthetic opioid, which has been used for decades as a short-acting analgesic combined with acetaminophen (or less commonly ibuprofen). Several long-acting, non-acetaminophen-containing hydrocodone formulations are undergoing trials in the US under the auspices of the US Food and Drug Administration, and may be available shortly. This article reviews some of the advantages (including drug familiarity and lack of acetaminophen toxicity) and potential disadvantages (including altered use patterns and high morphine equivalent dosing) of such a medication formulation. We also discuss the abuse potential of long-acting versus short-acting opioids in general and hydrocodone specifically, as well as the metabolism of hydrocodone.
    Journal of Pain Research 01/2013; 6:53-7. DOI:10.2147/JPR.S33062
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    • "These trends continued in 2009.51 Recently, an alarming increase in deaths due to overdoses of prescription drugs (mainly opioid analgesics) has been reported, and the drugs most often implicated were oxycodone, hydrocodone, and methadone.52 Efforts to manage pain more aggressively using opioid analgesics may have inadvertently contributed to increases in opioid-related adverse consequences.52,53 "
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    ABSTRACT: Background The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority. Objective This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence) in primary care settings and emergency departments, as well as current screening tools and brief interventions. Methods MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings. Conclusion Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.
    04/2012; 3(1):25-34. DOI:10.2147/SAR.S30057
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