Archive for the ‘ Prescription Drugs ’ Category

Is Kratom an opioid alternative?

A delayed U.S. Drug Enforcement Administration ban on kratom would stifle scientific understanding of the herb’s active chemical components and documented pharmacologic properties if implemented, according to a special report published today in The Journal of the American Osteopathic Association.

The report cited the pharmacologically active compounds in kratom, including mitragynine, 7-hydroxymitragynine, paynantheine, speciogynine and 20 other substances, as one basis for further study. It also emphasized the extensive amount of anecdotal evidence and current scientific research that indicates kratom may be safer and less addictive than current treatments for pain and opioid withdrawal.

Kratom Does Not Depress Respiration

“There’s no question kratom compounds have complex and potential useful pharmacologic activities and they produce chemically different actions from opioids,” said author Walter Prozialeck, chairman of the Department of Pharmacology at Midwestern University Chicago College of Osteopathic Medicine. “Kratom doesn’t produce an intense euphoria and, even at very high doses, it doesn’t depress respiration, which could make it safer for users.”

Kratom (Mitragyna speciosa) is indigenous to Southeast Asia, where the plant was used for centuries to relieve fatigue, pain, cough and diarrhea and aid in opioid withdrawal. Currently sold in the United States as an herbal supplement, kratom drew DEA scrutiny after poison control centers noted 660 reports of adverse reactions to kratom products between January 2010 and December 2015.

Source of Adverse Reactions Unclear

“Many important medications, including the breast cancer treatment tamoxifen, were developed from plant research,” said Prozialeck.

“While the DEA and physicians have valid safety concerns, it is not at all clear that kratom is the culprit behind the adverse effects,” said Anita Gupta, DO, PharmD and special advisor to the FDA.

A Non-Pharmaceutical Remedy?

Dr. Gupta, an osteopathic anesthesiologist, pain specialist and licensed pharmacist, has treated a number of patients who’ve used kratom. “Many of my patients are seeking non-pharmaceutical remedies to treat pain that lack the side effects, risk, and addiction potential of opioids,” she said.

Kratom is currently banned in states including Alabama, Florida, Indiana, Arkansas, Wisconsin and Tennessee. The DEA is scheduled to decide whether to place kratom on its list of Schedule 1 drugs, a classification for compounds thought to have no known medical benefit. Marijuana, LSD and heroin are Schedule 1 drugs, which prevents the vast majority of U.S.-based researchers from studying those substances.

December 2nd, 2016  in Prescription Drugs No Comments »

Prescription painkillers source of addiction for most women

Painkillers prescribed by doctors are the starting point for an opioid addiction for more than half of female methadone clinic patients, and they need different treatment from men with addiction, says a study led by McMaster University researchers.

The results, published in the open access journal Biology of Sex Differences today, show that more than half (52%) of women and a third (38%) of men reported doctor-prescribed painkillers as their first contact with opioid drugs, a family of drugs which include prescription medicines such OxyContin and codeine, as well as illicit drugs such as heroin.

The study of 503 patients attending Ontario methadone clinics identified significant gender differences between the men and women attending the clinics. Compared to men, women were found to have more physical and psychological health problems, more childcare responsibilities, and were more likely to have a family history of psychiatric illness.

Rising Number of Women Seeking Treatment

Men were more likely than women to be working and more likely to smoke cigarettes. Rates of cannabis use were relatively high (47%) among both men and women.

“Most methadone treatment is based on studies with few or no women at all. We found men and women who are addicted to opioids have very different demographics and health needs, and we need to better reflect this in the treatment options that are available,” said Monica Bawor, first author of the paper and a recent PhD neuroscience graduate of McMaster.

“A rising number of women are seeking treatment for opioid addiction in Canada and other countries yet, in many cases, treatment is still geared towards a patient profile that is decades out of date — predominantly young men injecting heroin, and with few family or employment responsibilities.”

Injecting Drug Use Declined

The study highlights the changing profile of people addicted to opioids. Compared to results from studies in the 1990s, the average age of patients being treated for opioid addiction is older (38 compared to 25 years), with opioid use starting at a later age (25 rather than 21 years). Injecting drug use has reduced by 60%, and there has been a 50% reduction in rates of HIV in opioid users as a result.

At the same time, there has been a 30% increase in the number of patients becoming addicted to opioids through doctor-prescribed painkillers, usually for chronic pain management. In Canada, the number of opioid painkiller prescriptions has doubled in the last two decades, and according to the World Health Organization (WHO), Canada consumes more opioid painkillers than any other country.

Women Prescribed Painkillers More Often?

Senior author Dr. Zena Samaan added that the reasons are not clear why women are disproportionately affected by opioid dependence originating from prescription painkillers.

“It may be that they are prescribed painkillers more often because of a lower pain threshold or because they are more likely to seek medical care than men,” said Samaan, an associate professor of psychiatry and behavioural neurosciences at the Michael G. DeGroote School of Medicine.

“For whatever reason, this is a growing problem in Canada and in other countries, such as the U.S., and addiction treatment programs need to adapt to the changing profile of opioid addiction.”

November 11th, 2015  in Prescription Drugs No Comments »

Opiate addiction spreading, becoming more complex

The growing availability of heroin, combined with programs aimed at curbing prescription painkiller abuse, may be changing the face of opiate addiction in the U.S., according to sociologists.

While heroin abuse is still relatively rare, the use of the drug is not only increasing, but it is now being coupled with the abuse of prescription painkillers, said Shannon Monnat, assistant professor of rural sociology, demography, and sociology, Penn State. She added that the heroin-prescription drug combination is also hitting groups that were not traditionally viewed as widespread opiate users.

Painkiller and Heroin Use Increasing

“One of the things we’ve found is that the simultaneous use of heroin and prescription painkillers together has increased dramatically among whites and especially among young white men,” said Monnat, who worked with Khary K. Rigg, assistant professor of mental health law and policy, University of Southern Florida.

Monnat described the recent trend as a domino effect of addiction that began in the 1980s and 1990s when the over-prescription of painkillers led to an increase in addiction to those drugs.

“Over the last several years there have been more restrictions put in place, including prescription-drug monitoring programs and the introduction of a tamper-proof opioid, making it difficult to crush, liquefy and inject the substance,” said Monnat. “What this has done is restrict access to prescription painkillers for people who previously became addicted to them. These people sometimes transition into heroin, which has become incredibly cheap and easily accessible.”

Number of Addicts Increasing

Some addicts who were introduced to heroin also turn to abusing both painkillers and heroin at the same time. While most opiate addicts are still addicted to only painkillers, the number of addicts using heroin and the number of users who are addicted to both painkillers and heroin are increasing faster than painkiller-only abusers.

“You don’t eliminate the addiction simply by eliminating access to the drug,” said Monnat. “People who are addicted to the morphine substance will find a substitute.”

The three groups of opiate abusers are distinct demographically, socioeconomically and psychologically, Monnat added. While heroin abuse is typically characterized as being a problem in black, poor and urban areas, an increasing number of heroin and painkiller-heroin addicts are white, employed and live in rural and small urban areas.

Painkiller Addicts Least Disadvantaged

The researchers, who released their findings in Addictive Behaviors, currently online, said that people who are addicted to painkillers alone tend to be the most socially connected of the three groups. Painkiller addicts are also the least socioeconomically disadvantaged and have better physical and mental health.

Professionals who treat drug addiction should recognize the unique needs of each group of addicts, according to the researchers.

Addicts At Risk

“It’s not enough to know whether someone is just using a prescription painkiller, but the practitioner would also want to know if they are using heroin,” Monnat said. “The use of heroin puts the patient at risk of all kinds of other complications, such as HIV and sexual risk-taking behaviors and a very high risk of overdose.”

The researchers used data from the 2010-2013 National Survey on Drug Use and Health. Respondents in the survey were grouped in three categories: heroin only users, prescription painkiller only users, and combination heroin and prescription painkiller users. Prescription painkiller-only users were the largest group, with 9,516 respondents. Combination heroin and prescription painkiller users were the next largest group, with 506 respondents, followed by 179 heroin-only respondents.

August 18th, 2015  in Prescription Drugs No Comments »

Boys more likely to abuse over-the-counter meds

As crackdowns get tougher on alcohol, tobacco sales, and illicit drugs, there’s a growing trend among youth to turn to another source to get high: their parent’s medicine cabinet. A new University of Cincinnati study suggests adolescent males are at a higher risk of reporting longtime use of over-the-counter drugs, compared with their female peers.
Early results of the study by Rebecca Vidourek, a UC assistant professor of health promotion, and Keith King, a University of Cincinnati professor of health promotion, will be presented on Oct. 29, at the 140th annual meeting of the American Public Health Association in San Francisco.
The study examined over-the-counter (OTC) drug use among 7th-12th grade students in 133 schools across Greater Cincinnati. The data was collected by the Coalition for a Drug Free Greater Cincinnati as part of the 2009-2010 Pride Survey on adolescent drug use in America. The survey was distributed to more than 54,000 students.
Early analysis found that 10 percent of the students reported abusing over-the-counter drugs. “Findings from this study highlight and underscore OTC drugs as an increasing and significant health issue affecting young people,” says Vidourek, who adds that commonly abused OTC medications include cough syrup containing Dextromethorphan (DXM), and decongestants. The researchers say that high rates of OTC use were also found among male and female junior high school students.
Vidourek says that OTC abuse can result in unintentional poisoning, seizures and physical and psychological addictions.
The researchers say that youth who reported involvement in positive activities, such as school clubs, sports, community and church organizations, were less likely to report abusing OTC medications. Teens more likely to report taking OTC drugs were also more likely to report that they had attended parties with the drugs or had friends who abused OTC drugs.

As crackdowns get tougher on alcohol, tobacco sales, and illicit drugs, there’s a growing trend among youth to turn to another source to get high: their parent’s medicine cabinet. A new University of Cincinnati study suggests adolescent males are at a higher risk of reporting longtime use of over-the-counter drugs, compared with their female peers.

Early results of the study by Rebecca Vidourek, a UC assistant professor of health promotion, and Keith King, a University of Cincinnati professor of health promotion, will be presented on Oct. 29, at the 140th annual meeting of the American Public Health Association in San Francisco.

54,000 Students Surveyed

The study examined over-the-counter (OTC) drug use among 7th-12th grade students in 133 schools across Greater Cincinnati. The data was collected by the Coalition for a Drug Free Greater Cincinnati as part of the 2009-2010 Pride Survey on adolescent drug use in America. The survey was distributed to more than 54,000 students.

Early analysis found that 10 percent of the students reported abusing over-the-counter drugs. “Findings from this study highlight and underscore OTC drugs as an increasing and significant health issue affecting young people,” says Vidourek, who adds that commonly abused OTC medications include cough syrup containing Dextromethorphan (DXM), and decongestants. The researchers say that high rates of OTC use were also found among male and female junior high school students.

Unintentional Poisoning, Addiction

Vidourek says that OTC abuse can result in unintentional poisoning, seizures and physical and psychological addictions.

The researchers say that youth who reported involvement in positive activities, such as school clubs, sports, community and church organizations, were less likely to report abusing OTC medications. Teens more likely to report taking OTC drugs were also more likely to report that they had attended parties with the drugs or had friends who abused OTC drugs.

November 5th, 2012  in Prescription Drugs No Comments »

OxyContin change has many switching to heroin

A change in the formula of the frequently abused prescription painkiller OxyContin has many abusers switching to a drug that is potentially more dangerous, according to researchers at Washington University School of Medicine in St. Louis.

The formula change makes inhaling or injecting the opioid drug more difficult, so many users are switching to heroin, the scientists report in the New England Journal of Medicine.

Three-Year Study

For nearly three years, the investigators have been collecting information from patients entering treatment for drug abuse. More than 2,500 patients from 150 treatment centers in 39 states have answered survey questions about their drug use with a particular focus on the reformulation of OxyContin.

The widely prescribed pain-killing drug originally was thought to be part of the solution to the abuse of opioid drugs because OxyContin was designed to be released into the system slowly, thus not contributing to an immediate “high.” But drug abusers could evade the slow-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, getting an immediate rush as large amounts of oxycodone entered the system all at once.

In addition, because OxyContin was designed to be a slow-release form of the generic oxycodone, the pills contained large amounts of the drug, making it even more attractive to abusers. Standard oxycodone tablets contained smaller amounts of the drug and did not produce as big a rush when inhaled or injected.

Then in 2010, a new formulation of the drug was introduced. The new pills were much more difficult to crush and dissolved more slowly. The idea, according to principal investigator Theodore J. Cicero, PhD, was to make the drug less attractive to illicit users who wanted to experience an immediate high.

“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” says Cicero, a professor of neuropharmacology in psychiatry. “In that sense, the new formulation was very successful.”

Huge Surge in Heroin Use

The researchers still are analyzing data, but Cicero says they wanted to make their findings public as quickly as possible. The new report appears as a letter to the editor in the journal. Although he found that many users stopped using OxyContin, they didn’t stop using drugs.

“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like OxyContin in that it also is inhaled or injected,” he says. “We’re now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas. Unable to use OxyContin easily, which was a very popular drug in suburban and rural areas, drug abusers who prefer snorting or IV drug administration now have shifted either to more potent opioids, if they can find them, or to heroin.”

Since the researchers started gathering data from patients admitted to drug treatment centers, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrent formulation to 12.8 percent now.

When users answered a question about which opioid they used to get high “in the past 30 days at least once,” OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled.

In addition to answering a confidential questionnaire when admitted to a drug treatment program, more than 125 of the study subjects also agreed to longer phone interviews during which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.

“When we asked if they had stopped using OxyContin, the normal response was ‘yes,'” Cicero says. “And then when we asked about what drug they were using now, most said something like: ‘Because of the decreased availability of OxyContin, I switched to heroin.'”

Weak Spots in the Drug Levee

These findings may explain why so many law enforcement officials around the country are reporting increases in heroin use, Cicero says. He compares attempts to limit illicit drug use to a levee holding back floodwaters. Where the new formulation of OxyContin may have made it harder for abusers to use that particular drug, the “water” of illicit drug use simply has sought out other weak spots in the “levee” of drug policy.

“This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials and the public, so they can be aware of what’s happening,” he says. “Heroin is a very dangerous drug, and dealers always ‘cut’ the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may become more common.”

July 12th, 2012  in Prescription Drugs No Comments »

Opioids associated with highest risk of death

People with an opioid addiction had the highest risk of death when compared with rates for alcohol and other drugs, according to a new study by the Centre for Addiction and Mental Health (CAMH).

For those dependent on opioids, the risk of death was 5.71 times higher than healthy individuals in the population of the same age, gender and race. Those with methamphetamine use disorders were next highest with a 4.67-fold risk, followed by those with addictions to cannabis (3.85), alcohol (3.83) and cocaine (2.96). Alcohol dependence was related to the highest number of deaths overall.

Mortality Rates Among Drug Users

The study, available online in the journal Drug and Alcohol Dependence, is the largest North American study to compare mortality rates among different drug users with the longest follow-up. It tracked records of more than 800,000 individuals hospitalized with drug dependence between 1990 and 2005. Of this group, more than 188,000 died during this period.

The findings mean that if 10 individuals in the general population died, then over the same period there would be 57 deaths among people dependent on opioids, which includes prescription opioids as well as heroin.

“One reason for undertaking this study was to examine whether methamphetamine posed a particular threat to drug users, as it has been called ‘America’s most dangerous drug,'” says CAMH Scientist Dr. Russell Callaghan, who led the study. Globally, methamphetamine and similar stimulants are the second most commonly used class of illicit drugs.

High Risk of Death

“The risk is high, but opioids are associated with a higher risk. We also wanted to compare mortality risks among several major drugs of abuse, as this comparison hasn’t been done on this scale before.”

Alcohol dependence affected the highest number of individuals, with 166,482 deaths and 582,771 hospitalizations over the study period. In the methamphetamine group, there were 4,122 deaths out of 74,139 hospitalizations, and for opioids, 12,196 deaths out of 67,104 hospitalizations.

Specific causes of mortality were not examined in this study, so the deaths may not be directly caused by drugs but due to related injuries, infectious disease or unrelated reasons. The researchers are now exploring mortality causes for each drug group, which may also point to reasons why women had a higher risk of death for alcohol, cocaine and opioids than males.

“These are not occasional, recreational drug users, but people who have been hospitalized for drug dependence,” notes co-author Dr. Stephen Kish, Senior Scientist at CAMH.

To calculate mortality rates, Dr. Callaghan and colleagues examined hospital records of all California inpatients with a diagnosis of methamphetamine, alcohol, opioid, cannabis or cocaine-related disorders from 1990-2005. They excluded records with evidence of multiple drug use disorders. The inpatient records were then matched to death records from the California Vital Statistics Database. Rates were adjusted by age, sex and race to the California population in 2000.

Risk Greater for Marijuana Users

“One surprising finding was the high rate of death among cannabis users,” says Dr. Callaghan. “There could be many potential reasons, including the fact that they may have other chronic illnesses such as psychiatric illnesses or AIDS, which can also increase the risk of death.”

The findings point to the importance of brief interventions for people receiving medical care for drug dependence on other related risks such as infectious diseases or injuries, says Dr. Callaghan.

April 26th, 2012  in Prescription Drugs No Comments »

Suboxone most effective in treating painkiller addiction

Individuals addicted to prescription painkillers are more likely to succeed in treatment with the aid of the medication buprenorphine-naloxone (Suboxone), report McLean Hospital and Harvard Medical School researchers in today’s online edition of the Archives of General Psychiatry.

“Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence,” is the first large-scale study to address treatment of prescription opioid addiction.

Addicted to Painkillers

According to lead author Roger Weiss, MD, Chief of the Division of Alcohol and Drug Abuse at McLean Hospital, most studies examining treatments for opioid dependence have been done with heroin-dependent patients at methadone clinics, resulting in the lack of data on treatment for patients addicted to prescription painkillers, especially in the offices of primary care doctors.

“Despite the tremendous increase in the prevalence of addiction to prescription painkillers, little research has focused on this patient population,” said Weiss, a professor of Psychiatry at Harvard Medical School. “This is notable because recent data tell us that the use of prescription painkillers for non-medical reasons is 20 times more common than heroin and 50 percent more people seek treatment for prescription drug abuse than for heroin.”

600 Patients Studied

Part of the National Institute on Drug Abuse (NIDA) Clinical Trials Network, this is the first randomized large scale clinical trial for the treatment of prescription opioid abuse, involving 10 sites nationwide and more than 600 treatment-seeking outpatients dependent on prescription opioids and either taking more than prescribed or using them illicitly. Each participant received Suboxone—a combination of buprenorphine, which alleviates opioid withdrawal and craving, and naloxone, which prevents abuse if the drug is not taken orally as prescribed—in conjunction with Standard Medical Management, in which physicians evaluated treatment effectiveness and recommended abstinence and self-help participation. Fifty percent of study participants also received additional more intensive individual addiction counseling.

According to Weiss, 49 percent of patients benefitted from Suboxone during a 12-week course of the medication. However, once the medication was discontinued, patients had a high rate of relapse. Monitored in four week increments, individuals showed an increasing rate of relapse the longer they remained off Suboxone. Another interesting finding, noted Weiss was that neither having chronic pain, nor participation in intensive addiction counseling affected the participant’s success rate.

Suboxone and Recovery

“We were surprised by some of these findings because there was an overall assumption that this population—those who have had little to no exposure to heroin—would do better in terms of not needing long-term medication intervention,” said Weiss. “It is clear that given the prescription drug abuse epidemic, we need to continue to look at the viability of longer-term use of Suboxone and whether it can continue to provide sustained recovery from addiction to pain medications.”

According to the National Survey on Drug Use and Health, an estimated 1.9 million people in the United States meet abuse or dependence criteria for prescription pain relievers. In addition, the Centers for Disease Control and Prevention report that annually, more people die from prescription painkiller overdoses than from heroin and cocaine combined.

November 11th, 2011  in Prescription Drugs No Comments »

Internet Linked to Prescription Drug Abuse Increase?

ncreasing access to rogue online pharmacies – those which dispense medications without a doctor’s prescription – may be an important factor behind the rapid increase in the abuse of prescription drugs. In a report in the journal Health Affairs, investigators from Massachusetts General Hospital (MGH) and the University of Southern California (USC) find that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.

Internet Growth a Factor

“We know we face a growing problem with prescription drug abuse in the United States. One need only look at statistics for college campuses, where prescription drugs are fast replacing illegal substances, to see the magnitude of the problem,” says Dana Goldman, PhD, director of the Schaeffer Center for Health Policy and Economics at USC, the study’s senior author. “Our findings suggest that Internet growth may partly explain the increase in prescription drug abuse, since it is well known that these drugs are easily available online.” Goldman is also the Norman Topping/National Medical Enterprises Chair in Medicine and Public Policy at USC.

In their report, Goldman and lead author Anupam B. Jena, MD, PhD, of the MGH Department of Medicine, note that the recent marked rise in the abuse of prescription narcotic painkillers – drugs like Percocet and Oxycontin – corresponds with an increase in the presence of online pharmacies, many of which do not adhere to regulations requiring a physician’s prescription. Drugs that are frequently abused – painkillers, stimulants, sedatives and tranquilizers – often can be purchased from rogue sites that may be located outside the U.S. The current study was designed to examine the potential link between online availability and prescription drug abuse, an association that has been suspected but not investigated in depth.

Increase in High-Speed Access

Using data available from the Federal Communications Commission, the researchers first compiled statistics on access to high-speed Internet service in each state during the years studied. Since actual rates of prescription drug abuse would be difficult if not impossible to calculate, they used information on admissions to substance abuse treatment facilities from a database maintained by the U.S. Substance Abuse and Mental Health Administration.

Changes in both measures over the seven years were analyzed on a per-state basis, and treatment admissions were categorized by the particular types of abused substances involved.

No Increase in Illegal Drug Use

The analysis indicated that each 10 percent increase in the availability of high-speed Internet service in a state was accompanied by an approximately 1 percent increase in admissions for prescription drug abuse. The increases were strongest for narcotic painkillers, followed by anti-anxiety drugs, stimulants and sedatives. During the same period admissions to treat abuse of alcohol, heroin or cocaine, substances not available online, showed minimal growth or actually decreased.

“The lack of an increase in abuse of drugs not available on the Internet suggests that an overall growth in drug-seeking behavior cannot explain the rise in prescription drug abuse,” Jena says. “Further studies need to better evaluate how easily commonly abused prescription drugs can be purchased online and explore the importance to the problem of foreign Internet pharmacies, which are outside the jurisdiction of the U.S. government.”

May 18th, 2011  in Prescription Drugs No Comments »

Doctors lax in monitoring potentially addicting drugs

Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a new study by researchers at Albert Einstein College of Medicine of Yeshiva University.

The study, published in the Journal of General Internal Medicine, found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence. The findings are especially concerning considering that prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers nonmedically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).

Missed Prevention Opportunity

“Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings,” said lead author Joanna Starrels, M.D., M.S. , assistant professor of medicine at Einstein. “The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring.”

The researchers studied administrative and medical records of more than 1,600 primary care patients for an average of two years while they received regular prescription opioids for chronic, non-cancer pain. They looked at whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills.

Few Given Urine Tests

Only a small minority (8 percent) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24 percent). Only half of patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk. Although fewer than one-quarter (23 percent) of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills.

“We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders,” said Dr. Starrels. “We hope that these findings will call attention to this important safety concern.”

Prescription Drug Misuse Problem

Prescription drug misuse is a major public health problem. In a 2004 NIDA report , it was estimated that 48 million people over the age of 12 have taken prescription drugs for nonmedical uses in their lifetime – which represents approximately 20 percent of the U.S. population. Opioids, central nervous system depressants and stimulants were the drugs most commonly abused.

“Most primary care physicians are attuned to these problems,” said Dr. Starrels, “but they haven’t put sufficient strategies in place to help reduce risks.” She and her co-authors recommend that physicians adopt the following risk-reduction strategies: standardize a plan of care for all patients on long-term opioids, which includes urine drug testing; schedule regular face-to-face office visits to evaluate patients’ response to opioids and evidence of misuse; and stick to a previously agreed-upon refill schedule.

March 12th, 2011  in Prescription Drugs No Comments »

Prescription drug use more common among rural teens

Rural teens appear more likely than their urban peers to use prescription drugs for non-medical purposes, according to a report posted online today that will appear in the March 2011 print issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The non-medical use of prescription drugs is common among U.S. adolescents, with about one in eight reporting lifetime non-medical use of prescription opioids, according to background information in the article. “During adolescence, non-medical prescription drug use is particularly problematic given its association with use of other illicit drugs such as cocaine and heroin, as well as engagement in problem behaviors such as gambling, increased sexual activity and impulsivity,” the authors write. “Moreover, individuals who use prescription drugs earlier in life have a greater chance of later developing prescription drug dependence.”

Abuse Among Urban Teens

Previous studies have examined substance abuse among urban teens, but their conclusions may not apply to those from rural areas, the authors note. Jennifer R. Havens, Ph.D., M.P.H., of University of Kentucky College of Medicine, Lexington, and colleagues analyzed data from 17,872 12- to 17-year-olds participating in the 2008 National Survey on Drug Use and Health. Of these, 53.2 percent lived in urban areas, 51 percent were male and 59 percent were white.

There were no differences between urban and rural youth in rates of any illicit drug use, including marijuana, cocaine, heroin and hallucinogens. However, 13 percent of rural teens reported ever having used prescription drugs for non-medical purposes, compared with 10 percent of urban teens. When the researchers assessed specific medication types, they found rural teens were also more likely to have used pain relievers (11.5 percent vs. 10.3 percent) or tranquilizers (3.5 percent vs. 2.5 percent) non-medically.

After adjusting for sociodemographic factors, health status and the use of other substances, rural teens remained 26 percent more likely than urban adolescents to say they had used prescription drugs for non-medical purposes. “Data support that one reason for the higher prevalence of non-medical prescription drug use in rural areas may be the lack of availability of drugs such as heroin that are easily accessed in urban areas,” the authors write.

Family Involvement Important

Rural teens were more likely to misuse prescription drugs if they reported poorer health, episodes of depression or other substance abuse. “Residing in a household with two parents was associated with a 32 percent reduction in the odds of non-medical prescription drug use,” the authors write. “These results suggest that interventions aimed at family involvement may be beneficial in preventing or reducing non-medical prescription drug use.” Enrollment in school was also a protective factor.

“The cultural, structural and social realities of rural life can not only affect the prevalence of drug use but also exacerbate its consequences. The isolation and self-reliance of rural communities can negatively affect careseeking behavior, particularly regarding mental health and substance abuse services,” the authors write. “While we were able to identify potential targets for intervention such as increased access to health, mental health and substance abuse treatment, this may be difficult for rural areas where such resources are in short supply or non-existent. Research into the causal mechanisms surrounding initiation of non-medical prescription drug use in rural adolescents is necessary to develop tailored interventions for this population.”

November 7th, 2010  in Prescription Drugs No Comments »