Article

Prescription Opioid Misuse Characteristics of Earliest and Most Recent Memory of Hydromorphone Use

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Abstract

: Prescription opioid use is highly prevalent and a major physician concern. However, little is known about how individuals initiate into use of these medications or how they use them later in life. Hydromorphone is a medication of particular interest given its subjective similarities to heroin and tendency to be misused by illicit opioid users. The purpose of this study was to evaluate the characteristics of initial, and more recent, hydromorphone use occasions as remembered by a population of individuals in treatment for their opioid use. : Seventy-eight clients enrolled in low-threshold methadone maintenance treatment were interviewed regarding their earliest and most recent uses of hydromorphone. : Hydromorphone was first used after trying many different substances (eg, tobacco, alcohol, hallucinogens, powder cocaine). Two-thirds of the sample reported initially using hydromorphone without a prescription. Participants who initially used hydromorphone without a prescription reported using for different reasons (ie, to get high, curiosity vs manage pain), via different routes of administration (ie, injection vs orally), and were more likely to co-use other substances, than those whose earliest hydromorphone use was prescribed. However, these 2 subgroups did not differ greatly during their most recent use occasion (ie, the majority reported using to avoid withdrawal, via injection; almost 50% reported co-use with other substances). : There was considerable variability in characteristics of hydromorphone use initiation among individuals enrolled in low-threshold methadone maintenance treatment. However, later use of hydromorphone was remarkably consistent across individuals and shares many characteristics previously documented for heroin use. Additional investigations into hydromorphone are warranted, particularly given previous findings regarding the prevalence of nonmedical use of this drug and its similarities to heroin.

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... Research methodologies, including medical chart [17], surveys [18], qualitative [19,20] and observational studies [21], have been used to explore prescription drug misuse. In recent decades, the growing availability of routinely collected health information has increased opportunities to undertake population-based surveillance of prescription drugs. ...
... The median STROBE score was 27 (range 19-33; IQR 23-29) out of a possible 36. Many studies did not report basic cohort details, including sex (20), age (18) and/or cohort size (8). Studies did not identify how they managed any bias (26), loss to follow up (39), missing data (39) or sensitivity analyses (38). ...
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Prescription drug misuse is a growing public health concern globally. Routinely collected data provide a valuable tool for quantifying prescription drug misuse. To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. The MEDLINE, EMBASE, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar databases were searched for relevant articles published between 1 January 2000 and 31 July 2013. A total of 10,803 abstracts were screened and 281 full-text manuscripts were retrieved. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria-an aim/method investigating prescription drug misuse in adults and a measure of misuse derived exclusively from prescription/dispensing data. Four proxies of prescription drug misuse were commonly used across studies: number of prescribers, number of dispensing pharmacies, early refills and volume of drugs dispensed. Overall, 89 unique measures of misuse were identified across the 52 studies, reflecting the heterogeneity in how measures are constructed: single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported 0.01-93.5 %), variations and factors associated with prescription drug misuse. Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.
... A study of college students found that the primary reason for prescription stimulant misuse was academic performance enhancement; however, benzodiazepines were misused primarily to get high (Stone and Merlo, 2010). Furthermore, a study of non-health care professionals in treatment for prescription opioid use disorders reported getting high, curiosity, and pain management as their primary reasons for initial misuse of prescription opioids, and preventing withdrawal as the primary reason for recent use (Fulton et al., 2012). This provides additional evidence that health care professionals who misuse prescription drugs may represent a special subpopulation of substance users, who may use substances for various reasons and may require different methods of prevention and intervention to be most effective. ...
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For almost a century, heroin addiction has been a core element of the illicit drug use problem in Canada.1,2 According to recent data, there are an estimated 125 000 injection drug users in Canada, most of whom use heroin and cocaine.3 Heroin addiction is associated with a variety of harms, including death, morbidity and crime. There are many examples of these harms: the number of overdose-related deaths in British Columbia rose dramatically from 39 to 331 between 1988 and 1993;4 the majority of new cases of hepatitis C in Canada are related to illicit drug use;5 and most heroin addicts are involved in regular criminal activity.6 Considerable public resources are expended on heroin addiction. Canadian law enforcement agencies direct substantial expenditures to prevent heroin importation and distribution — albeit with limited success.7,8 On the health care side, the number of people receiving methadone maintenance treatment (the primary treatment response for heroin addiction) has increased 5 times since the mid-1990s, to about 25 000 spaces across Canada.9–11 Furthermore, alternative treatment options are in development, including buprenorphine maintenance and medical heroin treatment.3,12,13 In the past several years, there have been isolated reports of substantially increased levels of prescription opioid abuse in Canada, the United States and other jurisdictions.14–16 However, until now, its impact on usage patterns among street drug users in Canada has been unclear and not systematically documented.
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