Elsevier

Addictive Behaviors

Volume 36, Issue 12, December 2011, Pages 1282-1287
Addictive Behaviors

Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City

https://doi.org/10.1016/j.addbeh.2011.07.046Get rights and content

Abstract

Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005–06 (n = 1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p < 0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs.

Introduction

Non-medical prescription drug use has been defined as, “…use without a prescription of the individual's own or simply for the experience or feeling the drugs cause” (SAMHSA, 2009). In recent years, non-medical prescription drug use has reached epidemic proportions in the United States. Data suggest that the incidence of non-medical use of prescription opioids alone increased from 628,000 in 1990 to 2.7 million in 2000 an increase of more than 400% (Sigmon, 2006). Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, there were 7.0 million (2.8%) persons aged 12 or older who reported non-medical prescription drug use in the past month (SAMHSA, 2009) representing a slight increase from 2008 (6.2 million or 2.5%) (SAMHSA, 2009). The increases in non-medical prescription drug use may be due in part to rising prescription rates of opioids for non-disease-based pain (Pawl, 2008) as well as increased availability on the street.

Non-medical use of prescription drugs can result in adverse health outcomes including respiratory distress, withdrawal symptoms, feelings of hostility, irregular heartbeat and in some extreme cases, death (NIDA, 2005, SAMHSA, 2007) and can have legal, economic and social costs. In 2002, it was estimated that non-medical prescription drug use cost the US $181 billion including both medical costs as well as law enforcement expenses (Davis & Johnson, 2008).

Non-medical prescription drug use has been characterized in college students (McCabe, 2008, McCabe et al., 2004), populations suffering from chronic pain (Kirsh & Smith, 2008), the general population (Blazer and Wu, 2009, Novak et al., 2009, SAMHSA, 2009) and vulnerable populations including sex workers(Surratt, Inciardi, & Kurtz, 2006); adolescent arrestees (Alemagno, Stephens, Shaffer-King, & Teasdale, 2009) and drug-dependent populations (Brands et al., 2004, Davis and Johnson, 2008, Fischer et al., 2005, Fischer, Rehm, et al., 2006, Green et al., 2009, Inciardi et al., 2007, Obadia et al., 2001, Rosenblum et al., 2007, Sigmon, 2006, Vlahov et al., 2007). Among vulnerable populations including injection drug users (IDUs), the adverse health consequences of non-medical prescription drug use may worsen the already high burden of poverty, disease and social disadvantage. Further, among IDUs where polysubstance use may be common, the risk of drug overdose may be exacerbated by concomitant use of prescription drugs. The risk for overdose is further heightened given that some users perceive prescription drugs to be more pure, safe, respectable, legal and less likely to induce withdrawal symptoms than illicit drugs (Inciardi et al., 2007). Some have even suggested that prescription drugs may be preferred by IDUs as there is a lower likelihood of getting arrested for possession (versus illicit opioids); the formulation is standard and provides consistent results; the effect is easier on the body and provides a false sense of well-being (Cicero et al., 2005, Firestone and Fischer, 2008).

We characterized the prevalence and correlates of non-medical prescription drug use in a cohort of former and current IDUs in Baltimore, Maryland, USA.

Section snippets

Study population and procedures

The study population derives from the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing, longitudinal study on the natural history of HIV infection among IDUs in Baltimore (Vlahov et al., 1991). The study was approved by the Johns Hopkins University Institutional Review Board and all participants provided written informed consent. The initial recruitment for this study was conducted in 1988–1989; 2946 IDUs from the Baltimore metropolitan area were enrolled, 707 of whom were

Participant characteristics

Characteristics of study participants (N = 1320) are summarized in Table 1. The mean age was 46 (SD: 8 years; Range 20–69 years). Nearly 67% were male and 85% were African-American. Twenty-three percent had no legal income and one quarter reported having been homeless in the past 6 months. Nearly, 27% exhibited depressive symptoms. Twenty-eight percent were HIV positive. A quarter of participants reported having moderate or severe pain that interfered with daily activities. More than half reported

Discussion

We observed a high prevalence of non-medical prescription drug use in this population. Our results are similar to national surveys of injection drug users in Australia that reported illicit drug use, defined as drugs obtained through a prescription in someone else's name(IDRS, 2010). They reported the following prevalence of non-medical use of prescription drugs within last 6 months : 13%(prescription stimulants), 28%(oxycodone), 40% (benzodiazepines) and 4%(other opiates) in the six months

Role of funding source

Funding for this study was provided by Public Health Grants from the National Institute on Drug Abuse (DA12568 and DA04334); the funding agency had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Gregory D Kirk and Shruti H Mehta wrote the study protocol. Nidhi Khosla, Hee Soon Juon, and Jacqueline Astemborski undertook the statistical analysis. Nidhi Khosla reviewed the literature and wrote the first draft of the manuscript. Hee Soon Juon, Gregory D Kirk and Shruti Mehta provided critical input in data analysis and interpretation. All authors contributed to and have approved the final manuscript.

Conflict of interest

No Conflict declared.

Acknowledgments

The authors thank Lisa McCall for project management and the ALIVE study staff and participants without whom this work would not be possible.

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