Medical use, non-medical use and use disorders of benzodiazepines and prescription opioids in adults: Differences by insurance status.

OBJECTIVES: To report and analyze prevalence's of Benzodiazepines (BZDs) and Prescription Opioids (POs) use by insurance status and to investigate associations between insurance status and BZDs, POs and concurrent medical/non-medical use and use disorders. METHODS: This study included 81,133 adults ages 18 and older from 2015 and 2016 National Survey on Drug Use and Health. Participants' self-reported past- year medical use, non-medical use and use disorders of BZDs and POs were assessed, along with their insurance status (Private/Military, Medicare, Medicaid, and Uninsured) and demographic characteristics. RESULTS: In 2015-2016, 12.6% of adults reported using BZDs and 36.9% reported using POs in the past year. Among adults, 8.3% reported past-year use of both BZDs and POs; also, 1.9% and 3.8% reported non-medical use of BZDs and POs, respectively, and 0.9% reported non-medical use of both BZDs and POs. Medicaid-covered respondents had higher risk of BZDs (aRRR = 1.59, 95%CI = [1.45, 1.74]), POs (aRRR = 1.66, 95%CI = [1.54, 1.79]) and concurrent past-year medical use (aRRR = 2.11, 95%CI = [1.87, 2.38]), higher risk of BZDs non-medical use (aRRR = 1.40, 95%CI = [1.17, 1.68]) and BZD Use Disorders (aRRR = 2.60, 95%CI = [1.82, 3.72]), POs non-medical use (aRRR = 1.67, 95%CI = [1.45, 1.92]), PO use Disorders (aRRR = 4.12, 95%CI = [3.33, 5.11]) and concurrent non-medical use (aRRR = 1.52, 95%CI = [1.20, 1.92]) and Use Disorders (aRRR = 3.68, 95%CI = [1.93, 6.78]), compared to those with private insurance. CONCLUSIONS: Future health policies should focus on reducing individual and co-prescription of BZDs and POs and providing different strategies of pain management.

Uso indevido de drogas entre médicos: problema ainda negligenciado / Substance misuse among physicians: a still neglected problem

Objetivo: Avaliar as impressões e as opiniões de médicos de áreas clínicas acerca do uso de drogas entre médicos e, mais especificamente, em ambiente cirúrgico. Métodos: Foram sorteados 100 médicos não-residentes de áreas clínicas, selecionados ao acaso entreos profissionais com vínculo em um hospital público de São Paulo. Destes, 83 concluíram o estudo, respondendo perguntas sobre o uso de drogas entre médicos. Resultados: Declararamconhecer algum colega com problemas relacionados ao uso de substâncias 67,5% dos médicos. Esse índice foi de 41,0% quando a pergunta era acerca de drogas disponíveis em ambiente cirúrgico, visto que 68,6% julgam ser fácil o desvio de psicotrópicos desselocal. Além disso, 60,2% acreditam que os médicos são mais suscetíveis ao uso abusivo de psicotrópicos quando comparados à população geral. No entanto, 88,0% do total consideramdifícil a procura por ajuda especializada. A porcentagem é de 56,6% dos que nãoconhecem serviço de atendimento direcionado exclusivamente para esses profissionais, algo que, na opinião de 83,1%, facilitaria a busca por tratamento. Dos participantes, 96,4%declararam não apresentar problemas relacionados ao uso de substâncias, ainda que 16,9% admita já ter feito uso de psicotrópicos sem prescrição. Conclusão: A freqüência de uso depsicotrópicos sem prescrição foi elevada. No entanto, parcela considerável não considera isso problema. A maioria dos profissionais não conhece serviços de atendimento específico para médicos.

Objective: To evaluate the opinions and attitudes about substance use among clinical physicians. Method: A hundred physicians of clinical areas were selected in a public hospital of São Paulo. All of them were asked to answer a questionnaire with some questionsabout drug use. 83% completed the research protocol properly. Results: 60.2% of the interviewed clinicians think that physicians are more likely to develop substance use disorders than general population. 67.5% of them stated they knew a colleague presenting a substance use disorder and in that in 41.0% of the cases the abused substance was a psychotropic available on the surgery facilities. However, 96.4% of the participants denied theycould have a substance use problem, although 16.9% declared they had already used non prescribed psychotropics. Benzodiazepines were the most frequently used substances. Inaddition, 88.0% of them consider it was difficult to search for medical help. They added that a service exclusive for physicians would make this search easier. Nevertheless, 56.6% are not aware of the existence of such a service. Conclusion: Non-prescribed psychotropic use was high. However, most part of the clinicians does not consider this a problem. Most of the professionals do not know programs on substance use disorders specific for physicians, what would be a very positive initiative according to great part of them.