Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City
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.
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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.
References (38)
- et al.
Prescription opioid abuse in patients presenting for methadone maintenance treatment
Drug and Alcohol Dependence
(2004) - et al.
Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002–2004
The Journal of Pain
(2005) - et al.
Prescription opioid use, misuse, and diversion among street drug users in New York City
Drug and Alcohol Dependence
(2008) - et al.
Women who abuse prescription opioids: findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database
Drug and Alcohol Dependence
(2009) - et al.
Special issues and concerns in the evaluation of older adults who have pain
Clinics in Geriatric Medicine
(2008) - et al.
Physical pain, common psychiatric and substance use disorders, and the non-medical use of prescription analgesics in the United States
Drug and Alcohol Dependence
(2009) Prescription narcotic drug abuse: “We have met the enemy and they are ourselves”
Surgical Neurology
(2008)- et al.
Prescription opioid abuse among enrollees into methadone maintenance treatment
Drug and Alcohol Dependence
(2007) - et al.
Prescription drug abuse among adolescent arrestees: Correlates and implications
Journal of Correctional Health Care
(2009) - et al.
Nonprescription use of pain relievers by middle-aged and elderly community-living adults: National survey on drug use and health
Journal of the American Geriatrics Society
(2009)
Methamphetamine use in Dayton, Ohio: Preliminary findings from the Ohio Substance Abuse Monitoring Network
Journal of Psychoactive Drugs
A qualitative exploration of prescription opioid injection among street-based drug users in Toronto: Behaviours, preferences and drug availability
Harm Reduct Journal
Illicit opioid use and its key characteristics: a select overview and evidence from a Canadian multisite cohort of illicit opioid users (OPICAN)
Canadian Journal of Psychiatry
Illicit opioid use in Canada: Comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study)
Journal of Urban Health
Changes in illicit opioid use across Canada
CMAJ
Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models
Psychological Bulletin
Australian drug trends
Mechanisms of prescription drug diversion among drug-involved club- and street-based populations
Pain Medicine
Prevalence and patterns of prescription drug misuse among young ketamine injectors
Journal Drug Issues
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