Nonmedical use of opioid analgesics obtained directly from physicians: prevalence and correlates.

Yale University School of Medicine, New Haven, CT 06520-8056, USA.
Archives of internal medicine (Impact Factor: 13.25). 06/2011; 171(11):1034-6. DOI: 10.1001/archinternmed.2011.217
Source: PubMed
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    ABSTRACT: HIV has become a highly treatable disease due to advances in antiretroviral therapy (ART). Additionally, HIV-infected individuals often take opiates, barbiturates, and benzodiazepines to treat co-occurring conditions, including pain and symptoms of HIV. We sought to examine prescription medication misuse by surveying 295 HIV-infected patients receiving ART. Participants answered questions about their demographics, alcohol and other drug use, psychiatric diagnoses, ART adherence and side effects, and quality of life. 11% of our sample acknowledged prescription medication misuse. In regression analysis, prescription medication misusers were more likely to report any drinking to intoxication (OR = 4.31, 95% CI: 1.35-13.76, p = 0.013), reported greater severity of ART side effects (OR = 1.05, 95% CI: 1.01-1.10, p = 0.041), and demonstrated poorer cognitive functioning (OR = 0.97, 95% CI: 0.94-0.99, p = 0.048) compared to those who did not misuse prescription medications. Special care should be taken by medical providers before prescribing medications that may be abused or diverted. Patients should also be screened for aberrant use, even if not prescribed. ART side effects, cognitive deficits, and alcohol abuse may serve as risk factors or indicators of prescription medication misuse, and should be monitored.
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    ABSTRACT: Abstract Background: Unintentional overdose deaths due to nonmedical use of prescription drugs disproportionately impact rural over urban settings in the United States. Sources of these prescriptions may play a factor. Objective: This study examines the relationships between rurality and source of prescription drugs used nonmedically. Methods: Using data from the National Survey on Drug Use and Health 2008-2010 (n = 10 693), we examined bivariate and multivariate associations of socio-demographic and clinical correlates and source (physician or non-physician) of prescription drugs (opioid, sedative, tranquilizer, or stimulant) used nonmedically among urban and rural residents. We also examined the type of prescription drugs used nonmedically among urban and rural residents by source. Results: Among respondents reporting past year nonmedical use of prescription medications, 18.9% of urban residents and 17.5% of rural residents had a physician source for drugs used nonmedically. Likelihood of physician source for urban and rural residents was increased in Hispanic, insured individuals and those with any prescription drug dependence. Rural residents who had a non-physician source were more likely than urban residents with a non-physician source to use hydrocodone (49% vs. 43.3%, p = 0.05), morphine (17.7% vs. 14.0%, p = 0.04), tramadol products (18.1% vs. 11.2%, p = 0.003), and methadone (17.2% vs. 10.9%, p = 0.001). Conclusion: Urban and rural individuals with nonmedical use of prescription drugs are equally likely to obtain these prescriptions from a physician source. Some factors associated with obtaining prescription drugs from a physician source differed between these populations, which may have implications for public health approaches to addressing problems such as overdose.
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    ABSTRACT: Aim Epidemiological data indicate that nonmedical use of prescription stimulants has increased over the past decade. However, little is known regarding the source of the misused stimulants and whether different sources correspond to differences in risk profiles and associated social and health problems Method Data from the 2006 to 2011 National Survey on Drug Use and Health were used. A total of 4,945 participants who used prescription stimulants nonmedically and also reported their source of misused stimulants were categorized by the source: friend/relative, physician and illegal. Logistic regression models compared the socio-demographic, mental health and behavioral problems, and stimulant use-related problems (onset, recency, frequency, severity) according to the source of the misused stimulants Results The most common sources of stimulants were friends/relatives, followed by physicians and illegal sources. Compared to participants reporting friends/relatives as the source, participants reporting an illegal source were more likely to be male, unemployed, have less than a high school education, a history of criminal behavior and an earlier age of use onset. Participants reporting a physician source were more likely to have mental health problems and mental health service use. Higher odds of past-month stimulant use, frequent use (≥10 days per year), drug dependence and substance service use were found in individuals reporting physician and illegal sources Conclusions Identifying the source of misused stimulants may be useful in detecting distinct subgroups of nonmedical prescription stimulant users, which may inform development of tailored prevention and treatment programs and contribute to individual treatment planning.
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