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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    • "Recent research shows an increase in prescription drug diversion in the United States [5] [10] [35]. This is associated with a variety of issues, such as increased emergency room visits [5] [36], overdose and overdose-related deaths [9,37–39], crime [10] [40], healthcare treatment and costs [5] [19] [41], and drug prevention and interception expenses [42]. Despite these concerns, diversion remains an understudied problem [11] [15] [16] [35] [43]. "
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    ABSTRACT: Objective: Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors. Methods: Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions. Results: While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion. Conclusion: Findings suggest that predictive characteristics vary according to diverter group.
    Full-text · Article · Dec 2015
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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).
    Full-text · Article · Dec 2013 · Pain
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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.
    Full-text · Article · Jan 2013 · Journal of Pain Research
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