Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years.

Importance: US adults born from 1965 to 1996 had high exposure to controlled medications, yet little is known about how this exposure has affected them over time. Prescription drug misuse (PDM) has increased among adults in the past 2 decades, with related increases in emergency department visits, overdoses, and deaths. Objectives: To identify 32-year PDM trajectories involving opioids, stimulants, and sedatives or tranquilizers and to examine associations between these PDM trajectories and substance use disorder (SUD) symptoms in adulthood as well as between baseline characteristics and PDM trajectories. Design, Setting, and Participants: This cohort study included 11 cohorts of adolescents who were followed up longitudinally from age 18 years (study start, 1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study, which included a national multistage random sample of US 12th grade students. Baseline surveys (modal age 18) were self-administered in classrooms. Ten follow-ups were conducted by mail. Data analysis was conducted from December 2020 to October 2021. Main Outcomes and Measures: Sociodemographic variables were measured at baseline. PDM and SUD symptoms were measured at baseline and every follow-up. Latent profile analysis (LPA) was used to create PDM trajectory profiles. Associations between these PDM trajectories, SUD symptoms, and baseline sociodemographic characteristics were examined. Results: The sample of 26 575 individuals was 50.8% (95% CI, 50.2%-51.4%) female and 79.3% (95% CI, 78.8%-79.8%) White. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. In adjusting for attrition, 45.7% (95% CI, 44.9%-46.4%) of the respondents reported past-year PDM at least once during the 32-year reporting period. Among those who reported PDM, the prevalence of poly-PDM was 40.3% (95% CI, 39.3%-41.3%). Based on LPA, the number of class-specific PDM trajectories ranged from 4 (prescription opioids) to 6 (prescription stimulants). For the class-combined analyses, we identified 8 PDM trajectories consisting of early peak trajectories (eg, age 18 years), later peak trajectories (eg, age 40 years), and a high-risk trajectory (eg, high frequency PDM at multiple ages). All PDM trajectories were associated with increased odds of developing SUD symptoms in middle adulthood, especially the later peak and high-risk trajectories compared with early peak trajectories (eg, peak at age 40 years: adjusted odds ratio [aOR], 5.17; 95% CI, 3.97-6.73; high-risk: aOR, 12.41; 95% CI, 8.47-18.24). Baseline characteristics associated with a high-risk trajectory were binge drinking (aOR, 1.69; 95% CI, 1.13-2.54), cigarette smoking (aOR, 2.30; 95% CI, 1.60-3.29), and marijuana use (aOR, 3.78; 95% CI, 2.38-6.01). More recent cohorts (eg, 1985-1986) had a higher risk of belonging to later peak PDM trajectories (ages 40 and 45 years) than the 1976-1978 cohort (age 40 years peak: aOR, 2.49; 95% CI, 1.69-3.68). Conclusions and Relevance: In this cohort study, adults with later peak PDM trajectories were at increased risk of SUD symptoms in middle adulthood. These findings suggest the need to screen for PDM and SUD from adolescence through middle adulthood.

Trends in Opioid Use Among Cancer Patients in the United States: 2013-2018.

Background: In response to the US opioid epidemic, the Centers for Disease Control and Prevention updated their guideline on prescription opioids for chronic pain management in March 2016. The aim of this study was to provide detailed analysis of trends in opioid claims among cancer patients in the United States during 2013-2018. Methods: We analyzed pharmaceutical dispensing data from Symphony Health's Integrated Dataverse database, which covers approximately 80% of the US population. We examined annual trends in dispensed opioids in cancer patients during 2013-2018. We examined quarterly trends of the prevalence, mean number of days, and dose (stated as morphine milligram equivalents) of opioid dispensing in cancer patients. Results: Dispensing records of an average of over 3.7 million cancer patients contributed to the study annually in 2013-2018. The annual prevalence of opioid dispensing claims declined from 40.2% in 2013 to 34.5% in 2018. Annual declines occurred across cancer sites, and particularly among patients with metastatic cancer (decline of 19.8%), breast cancer (18.2%), and lung cancer (13.8%). By quarter, the prevalence of opioid claims declined statistically significantly from 26.6% in Q1 2013 to 21.2% in Q4 2018; this decline was more pronounced after Q3 2016 (2-sided P = .004). Both quarterly trends in mean days and morphine milligram equivalents of opioids supplied showed a gradual decline from 2013 to 2018, with a slightly larger decline after 2016. Conclusions: We observed a decline in opioid use among cancer patients, particularly after 2016, coinciding with the publication of the Centers for Disease Control and Prevention's guideline on prescription opioids for chronic pain management.

Trends in college students' alcohol, nicotine, prescription opioid and other drug use after recreational marijuana legalization: 2008-2018.

BACKGROUND: Young adult college students may be particularly sensitive to recreational marijuana legalization (RML). Although evidence indicates the prevalence of marijuana use among college students increased after states instituted RML, there have been few national studies investigating changes in college students' other substance use post-RML. METHOD: The cross-sectional National College Health Assessment-II survey was administered twice yearly from 2008 to 2018 at four-year colleges and universities. Participants were 18-26 year old undergraduates attending college in states that did (n = 243,160) or did not (n = 624,342) implement RML by 2018. Outcome variables were self-reported nicotine use, binge drinking, illicit drug use, and misuse of prescription stimulants, sedatives, and opioids. Other variables included individual and contextual covariates, and institution-reported institutional and community covariates. Publicly available information was used to code state RML status at each survey administration. RESULTS: Accounting for state differences and time trends, RML was associated with decreased binge drinking prevalence among college students age 21 and older [OR (95% CI) = 0.91 (0.87 - 0.95), p < .0001] and increased sedative misuse among minors [OR (95% CI) = 1.20 (1.09 - 1.32), p = .0003]. RML did not disrupt secular trends in other substance use. CONCLUSIONS: In the context of related research showing national increases in college students' marijuana use prevalence and relative increases following state RML, we observed decreases in binge drinking and increases in sedative use that both depended on age. Findings support some specificity in RML-related changes in substance use trends and the importance of individual factors.

French national health insurance database analysis and field study focusing on the impact of secure prescription pads on zolpidem consumption and sedative drug misuse: ZORRO study protocol.

INTRODUCTION: In recent years, data collected by the French Addictovigilance Network have shown the potential for abuse and addiction associated with zolpidem (the most sold hypnotic drug in France). Since 10 April 2017, new regulations have come into force that require zolpidem to be prescribed on special secure prescription pads, in order to reduce the risk of abuse or misuse. This measure has far-reaching repercussions that are not only limited to the consumption of zolpidem but also extend to the usage of sedative medication on a whole. The objective of the ZOlpidem and the Reinforcement of the Regulation of prescription Orders (ZORRO) study is to evaluate the overall impact of the new regulatory framework requiring zolpidem to be prescribed on special secure prescription pads. Three axes will be evaluated: the number of consumers, the type of consumption (chronic use versus occasional use, problematic consumption versus non-problematic use) and the consumption of other sedative molecules.The study has been registered in the Protocol Registration and Results System under the number NCT03584542 at stage "Pre-results". METHODS AND ANALYSIS: The ZORRO study is an epidemiological, observational, national multicentre, non-controlled, prospective research project supported by the French National Agency for Medicines and Health Products Safety. The evaluation of the impact of the regulatory framework change relative to zolpidem will be done according to two axes: via an epidemiological study of the French National Health Insurance database and by the implementation of field studies of prescribers and consumers of zolpidem. ETHICS AND DISSEMINATION: The Nantes Research Ethics Committee (Groupe Nantais d'Ethique dans le Domaine de la Santé), the Committee for the Protection of the Population and the Committee of Expertise in Research, Studies and Evaluations in the Field of Health approved this study. Results will be presented in national and international conferences and submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03584542; Pre-results.

Advanced visualizations to interpret prescription drug monitoring program information.

OBJECTIVES: Prescription drug monitoring programs (PDMPs) are state-based databases that contain information about controlled substance prescriptions dispensed by pharmacies. Many states now mandate PDMP use by prescribers, despite unclear effectiveness. We hypothesize that it is possible to improve the interpretability, and hence effectiveness, of PDMPs by enhancing them. METHODS: This was a real-time simulation of an enhanced PDMP. Fifty practicing physicians (25 primary care, 25 emergency medicine) were randomized to see three cases with a standard profile or an enhanced profile that included graphical representation of prescriptions and identified risky prescribing patterns. After a two-month washout period, participants were placed in the opposite group. RESULTS: Physicians presented with the enhanced profile were more likely to correctly identify patients with multiple providers (97.0% vs. 85.8%, p = 0.002), overlapping opioid and benzodiazepine prescriptions (94.7% vs. 87.5%, p = 0.03), overlapping opioid prescriptions (89.5% vs. 70.8%, p < 0.01), high daily dosages of opioids (99.2% vs. 25.0%, p = 0.02), and traveling to distant pharmacies (79.7% vs. 2.5%, p < 0.01). There was no difference in interpretation time for the three cases (standard profile 657.3 s vs. enhanced profile 686.3 s, p = 0.31). CONCLUSIONS: A simulated PDMP with graphical displays and interpretation of findings was, for this cohort of emergency physicians and primary care physicians, associated with an increased ability to determine high-risk features on PDMP profiles.

Patterns of gabapentin and pregabalin use and misuse: Results of a population-based cohort study in France.

AIMS: The aim of this study was to assess the use and factors associated with the misuse of gabapentin and pregabalin in the general French population, through a cohort study in the EGB (General Sample of Beneficiaries), a national representative sample of the French general population. METHODS: New users of gabapentin and pregabalin were identified from June 2006 to December 2014, and new users of duloxetine served as control group. Misuse was defined as a use of higher daily doses than recommended. Cox proportional hazard regression models were performed to identify associated factors of misuse. RESULTS: Misuse was more frequent in the 8692 new users of pregabalin (12.8%) than in the 1963 gabapentin (6.6%) or the 3214 duloxetine new users (9.7%) (P < 0.001). Factors associated with misuse were pregabalin (hazard ratio [HR] 1.48; 95% confidence interval [CI] [1.29-1.69]), age (HR[18-45] versus > 70 years 1.98 [1.70-2.31] and HR[58-70] versus > 70 years 1.25 [1.06-1.47]), multiple prescribers (HR2 or 3 versus 1 prescriber 1.29 [1.15-1.45]; HR4 or more versus 1 prescriber 1.54 [1.30-1.83]), cancer (1.28 [1.11-1.47]), multiple sclerosis (1.53 [1.07-2.18]), neuropathy (1.85 [1.19-2.89]), depression (1.26 [1.07-1.49]) and methadone (2.61 [1.16-5.84]). After this first episode of drug misuse, 11.6% of gabapentin and 10.7% of pregabalin misusers developed a primary addiction. CONCLUSION: In a cohort of new users, misuse is more likely to occur in new users of pregabalin, with different associated factors of misuse compared to gabapentin and duloxetine. Health professionals and prescribers must be aware of this misuse potential, which could lead to abuse and dependence.

Nonmedical Prescription Opioid Use by Parents and Adolescents in the US.

BACKGROUND: To date, intergenerational patterns of nonmedical prescription opioid (NMPO) use have not been examined. We investigate the association between parental and adolescent NMPO use in the United States. METHODS: Data are from 35 000 parent-child dyads with an adolescent aged 12 to 17 years from the 2004-2012 nationally representative National Surveys on Drug Use and Health. Using multivariable logistic regression models, we estimated the association between self-reported parental and adolescent lifetime NMPO use, controlling for parental and adolescent use of other drugs, attitudes about drug use, parental and adolescent psychosocial risk factors, and sociodemographic characteristics. RESULTS: Controlling for other factors, parental NMPO use was associated with adolescent NMPO use (adjusted odds ratio [aOR] 1.30; 95% confidence interval [CI] 1.09-1.56). Mothers' use had a stronger association with adolescent use than fathers' use (aOR 1.62 [95% CI 1.28-2.056] versus aOR 0.98 [95% CI 0.74-1.24]). Associations between parental and adolescent NMPO use did not differ by adolescent sex or race and/or ethnicity. Parental lifetime smoking, low monitoring, and parent-adolescent conflict were uniquely associated with adolescent NMPO use (aOR 1.19-1.24) as were adolescent smoking, marijuana use, depression, delinquency, and perceived schoolmates' drug use (aOR 1.25-1.71). Perceived risk of drug use and religiosity were associated with lower rates of adolescent NMPO use (aOR 0.77-0.93). Use among older adolescents was higher than among younger adolescents (aOR 1.27; 95% CI 1.21-1.34). CONCLUSIONS: Parent-based interventions targeted at adolescent NMPO use should address parental NMPO use and smoking and promote positive parenting.

Medical marijuana legalization and associated illicit drug use and prescription medication misuse among adolescents in the U.S.

BACKGROUND: Use of illicit drugs and misuse of prescription medications among U.S. adolescents have been major public health issues. As over half of the states have implemented medical marijuana laws (MMLs), it is unclear if MML implementation is associated with use of illicit drugs and misuse of prescription medications among adolescents. METHODS: This study used data from the 2013-2014 National Survey of Drug Use and Health and included adolescents aged 12-18 with a total of 26,826 participants after the propensity-score matching used to reduce selection bias between states that had and had not implemented MML. Seven logistic regressions were conducted to examine MML implementation and associated use of illicit drugs (including cocaine/crack, heroin, hallucinogens, and inhalants) and misuse of prescription medications (including pain relievers, tranquilizers/sedatives, and stimulants), controlling for sociodemographics and use of cigarettes, alcohol, and marijuana. RESULTS: Adolescents residing in the states that had legalized medical marijuana were more likely to use cocaine/crack and heroin in the past 12 months (OR = 1.63, 2.61, respectively; both ps < 0.05). However, MML implementation was not associated with the likelihood of using other illicit drugs or misusing prescription medications. CONCLUSIONS: The study findings suggest that for the states that have implemented MML, policy and educational interventions should as well be implemented to prevent not only marijuana use but also use of other harder drugs such as cocaine/crack and heroin among adolescents. States that have yet implemented MML should consider the possible associations between MML implementation and use of other illicit drugs when legislating MML.

Poly-product drug use disparities in adolescents of lower socioeconomic status: Emerging trends in nicotine products, marijuana products, and prescription drugs.

Greater diversification of nicotine products, marijuana products, and prescription drugs have contributed to increasing trends in adolescent poly-product use-concurrent use of 2 or more drugs-within these drug classes (e.g., nicotine use via e-cigarettes, hookah, cigars). Extant work suggests that poly-product drug use disparities may be disproportionately heightened among youth from lower socioeconomic status (SES) backgrounds, however, it is unknown whether indicators of objective SES or subjective SES differentially increase risk of poly-product use including these newly emerging drugs. This study examined associations of parental education and subjective social status (SSS: perceptions of social standing compared to society [societal SSS] or school [school SSS]) with poly-product use of nicotine products, marijuana products, and prescription drugs among adolescents (N = 2218). Lower parental education and school SSS were associated with increased odds of past or current single, dual, or multiple product use of nicotine, marijuana, and prescription drugs. Findings suggest that risk for poly-product use of emerging drugs are higher for adolescents who endorse lower perceived social standing relative to peers at school and who were from a lower parental SES background.

Trends in the Misuse of Tranquilizers, Sedatives, and Sleeping Pills by Adolescents in Spain, 2004-2014.

PURPOSE: Misuse of prescription medication has increased during the last 20 years among adolescents and young adults. We aimed to report the prevalence and factors associated with misuse of tranquilizers, sedatives, and sleeping pills (TSSp) in high-school students in Spain. We also analyzed misuse of these drugs during the decade 2004-2014. METHODS: Nationwide, epidemiological, cross-sectional study on the misuse of TSSp by the Spanish school population. We used individualized secondary data retrieved from the 2004 and 2014 Spanish State Survey on Drug Use in Secondary Education. A total of 179,114 surveys respondents aged 14-18 years. Estimates and trends of previous 30 days misuse of TSSp. RESULTS: The prevalence of TSSp misuse among school population aged 14-18-years increased significantly from 2004 (2.40%) to 2014 (2.96%). The values for consumption were always greater in adolescent girls than boys throughout the study (3.51% vs. 2.18%). The variables associated with a greater probability of TSSp misuse were consumption of alcohol, tobacco, and marijuana. Students who reported consumption of an illicit drug other than marijuana during the previous year are 4.91 times more likely to misuse TSSp (adjusted odds ratio = 4.91; 95% confidence interval, 4.15-5.81). CONCLUSIONS: We found that misuse of TSSp by adolescents in Spain has significantly increased from 2004 to 2014. Misuse of TSSp was more likely in adolescent girls than Spanish boys. Alcohol, tobacco, and marijuana consumption are factors associated with the use of TSSp.

Trends in non-medical prescription opioids and heroin co-use among adults, 2003-2014.

BACKGROUND: Patterns in non-medical prescription opioid (NMPO) and heroin use have recently shifted, with evidence that NMPO-only users transition to NMPO and heroin co-use. Co-use is associated with increased risk of morbidity and overdose, highlighting the need for further investigation. This study aims to quantify, describe, and explore trends in co-use. METHODS: Using data from the 2003-2014 National Surveys on Drug Use and Health, we compared co-use to NMPO- and heroin-only use across demographic, substance use and mental health characteristics with chi-squared tests. Logistic regression models assessed trends in opioid use overall, and among co-users. RESULTS: From 2003 to 2014, the prevalence of all opioid use (NMPO-only, heroin-only, and co-use) and NMPO-only use decreased 6.08% (p < 0.01) and 4.65% (p < 0.001), respectively, while prevalence of heroin-only use increased 21.32% (non-significant). Co-use increased 248.17% (p < 0.001) overall, and did so in all demographic, substance use, and mental health groups. Demographic, substance use, and mental health characteristics of co-users were more similar to the heroin-only group than to NMPO-only. The highest co-use prevalence was among those: without health insurance (8.72%), aged 26-34 (9.76%), reporting unemployment (12.08%), and with a major depressive episode, psychological distress, and who illicitly use or abuse drugs other than opioids or marijuana in the past year (9.33%, 10.75%, 11.87%, and 16.81%, respectively). DISCUSSION: The increased prevalence of co-use and differences across demographic, substance use, and mental health characteristics highlight the need for targeted prevention and response interventions for this emerging, high-risk group.

The Opioid Crisis: a Comprehensive Overview.

PURPOSE OF REVIEW: The opioid crisis most likely is the most profound public health crisis our nation has faced. In 2015 alone, 52,000 people died of drug overdoses, with over 30,000 of those people dying from opioid drugs. A recent community forum led by the Cleveland Clinic contrasted this yearly death rate with the loss of 58,000 American lives in 4 years of the Vietnam War. The present review describes the origins of this opioid epidemic and provides context for our present circumstances. RECENT FINDINGS: Alarmingly, the overwhelming majority of opioid abusers begin their addiction with prescription medications, primarily for chronic pain. Chronic postoperative pain, which occurs in 10-50% of surgical patients, is a major concern in many types of surgery. Nationwide, the medical community has made it a priority to ensure that postsurgical analgesia is sufficient to control pain without increasing non-medically appropriate opioid use. The opioid epidemic remains a significant pressing issue and will not resolve easily. Numerous factors, including the inappropriate prescription of opioids, lack of understanding of the potential adverse effects of long-term therapy, opioid misuse, abuse, and dependence, have contributed to the current crisis.

Gender differences in trends for heroin use and nonmedical prescription opioid use, 2007-2014.

BACKGROUND: Trends in the current opioid epidemic in the United States show that use of heroin is increasing while nonmedical use of prescription opioids is slowing. Understanding gender differences in these trends is essential to efforts to address the opioid epidemic. This study compared gender difference in trends in heroin and nonmedical prescription opioid use in the U.S. between 2007 and 2014. METHODS: Data from the National Survey on Drug Use and Health (NSDUH) were used to trace prevalence and to estimate risk for heroin and nonmedical prescription opioid use in the last year for women and men. RESULTS: Prevalence rates in the total sample (N = 447,188) indicate a notable increase in heroin use and a steady decline in the nonmedical use of prescription opioids between 2007 and 2014 for both women and men. Women are increasing heroin use at a faster rate than men but decreasing nonmedical prescription opioid use at a slower rate than men. Overall, risk factors for both heroin use and nonmedical prescription opioid use are similar to other illicit substances, but the magnitude of associations indicates that women may be at greater risk for the nonmedical use of prescription opioids than for the use of heroin. CONCLUSIONS: Trend analyses reveal a linear increase in heroin use and a quadratic decline in nonmedical prescription opioid use at the population level. The differential rates of change between men and women in use of both opioids highlight the need for comprehensive, gender-sensitive approaches to prevention and treatment for both heroin and nonmedical prescription opioid use. Future research should continue to explore gender differences in treatment access, including access to medication-assisted treatments and treatments integrated with health and social services, especially for women.

Something for pain: Responsible opioid use in emergency medicine.

The United States is currently experiencing a public health crisis of opioid addiction, which has its genesis in an industry marketing effort that successfully encouraged clinicians to prescribe opioids liberally, and asserted the safety of prescribing opioids for chronic non-cancer pain, despite a preponderance of evidence demonstrating the risks of dependence and misuse. The resulting rise in opioid use has pushed drug overdose deaths in front of motor vehicle collisions to become the leading cause of accidental death in the country. Emergency providers frequently treat patients for complications of opioid abuse, and also manage patients with acute and chronic pain, for which opioids are routinely prescribed. Emergency providers are therefore well positioned to both prevent new cases of opioid misuse and initiate appropriate treatment of existing opioid addicts. In opioid-naive patients, this is accomplished by a careful consideration of the likelihood of benefit and harm of an opioid prescription for acute pain. If opioids are prescribed, the chance of harm is reduced by matching the number of pills prescribed to the expected duration of pain and selecting an opioid preparation with low abuse liability. Patients who present to acute care with exacerbations of chronic pain or painful conditions associated with opioid misuse are best managed by treating symptoms with opioid alternatives and encouraging treatment for opioid addiction.

Consumo de antibióticos a partir de las ventas en droguerías en Santiago de Cali, Colombia / Consumption of antibiotics measured from sales in drugstores in Santiago de Cali, Colombia

Introducción: los antibióticos son medicamentos empleados tanto en pacientes hospitalizados como ambulatorios, sin embargo, son estos últimos los que mayor riesgo de un uso irracional poseen. Objetivo: determinar el consumo total y de un grupo de antibióticos por comunas en Santiago de Cali, durante los años 2010 a 2013.,Métodos: se calculó el tamaño de muestra y se recogió la información de ventas de un grupo de droguerías. Luego se empleó la metodología de la Dosis Diaria Definida por mil habitantes-día, estimando el consumo total y de cada antibiótico para cada comuna y en diferentes unidades de tiempo. De esta forma se calculó: consumo mes a mes de 2010 a 2013, consumo anual ponderado de 2010 a 2013, consumo ponderado de cada mes del año y consumo ponderado por cada comuna. Resultados: el consumo total de antibióticos fue de 4,3 Dosis Diaria Definida por mil habitantes-días, el antibiótico más consumido fue la amoxicilina, para el total el mes de mayor consumo fue marzo de 2011, el año de mayor consumo fue 2011, el mes del año de mayor consumo total de los tres años fue diciembre y la comuna de mayor consumo fue la 22. Conclusión: se identificó el consumo total y por antibióticos, los meses del año y las comunas de mayor consumo(AU)

Introduction: antibiotics are drugs used in inpatient and outpatient care: however, the latter type of patients is the one more likely to irrationally use these drugs. Objective: to determine the total consumption of a group of antibiotics by communes in Santiago de Cali from 2010 to 2013. Methods: the sample size was calculated and sales information was collected from a group of drugstores. The Defined Daily Dose per 1000 inhabitant-days was used, estimating the total consumption and the consumption of each antibiotic for each commune and in various time units. In this way, monthly consumption from 2010 to 2013, weighted annual consumption from 2010 to 2013, weighted consumption of each month of the year and weighed consumption per commune. Results: the total consumption of antibiotics was 4.3 Defined Daily Dose per 1000 inhabitant-days; the most consumed antibiotic was amoxicillin; the month with highest consumption rate was March 2011; the year of highest consumption was 2011, the month of the year with the highest consumption in the three studied years was December and the commune with the highest consumption was the no. 22. Conclusions: this study identified the total consumption and the consumption per antibiotics, the months of the year and the communes of highest consumption of antibiotics(AU)