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Access to nonmedical use of opioids begins with acquaintances

Tuesday March 4, 2014
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Most people who use opioid pain relievers without a prescription initially get them from friends or relatives for free, according to a study, with the sources of the medications eventually expanding to include prescriptions from physicians and purchases from friends, relatives, drug dealers or strangers.

Little research has examined whether the source of opioid medication differs by the frequency of nonmedical use, according to background information in the study, which was published March 3 on the website of JAMA Internal Medicine.

Christopher M. Jones, PharmD, MPH, who was with the CDC’s National Center for Injury Prevention and Control in Atlanta at the time of the study and now is with the Food and Drug Administration, and colleagues used data from the National Survey on Drug Use and Health to examine the sources of opioid pain relievers for nonmedical use and compare them with the frequency of use by individuals. In the survey, people were asked about the frequency of nonmedical use of opioids, the type of opioid pain reliever used and the source of the opioid most recently used.

Of the estimated annual 12 million nonmedical users, most were men. Most nonmedical users obtained the medication for free from friends and relatives. However, the source of the pain relievers varied based on frequency of use. As days of use increased, opioid medications were obtained from other sources, including prescriptions from physicians and purchases from friends, relatives, drug dealers or strangers. Opioid pain relievers used non-medically most frequently were prescribed by a physician for users who reported 200 to 365 days of use.

“These results underscore the need for interventions targeting prescribing behaviors, in addition to those targeting medication sharing, selling and diversion,” the authors wrote. “The essential steps healthcare providers can take to curb this serious health problem include more judicious prescribing, use of prescription drug-monitoring programs and screening patients for abuse risk before prescribing opioids.”

Study access (via subscription or purchase): http://archinte.jamanetwork.com/article.aspx?articleid=1840031

Spotlight on Tennessee

In a study focused on Tennessee, researchers found high-risk use of prescription opioid pain relievers is common, and is associated with an increased risk of death from overdose.

Each year about 2 million Tennesseans — about a third of the state population — fill an opioid prescription, reported Jane A. Gwira Baumblatt, MD, of the federal Agency for Healthcare Research and Quality in Rockville, Md., and colleagues on the website of JAMA Internal Medicine.

In Tennessee, drug overdose deaths increased from 422 in 2001 to 1,062 in 2011, and opioid-related deaths increased from 118 to 564 during the same period. The Tennessee Controlled Substances Monitoring Program monitors the prescribing of controlled substances.

Baumblatt and colleagues analyzed opioid prescription data from the TNCSMP from 2007 through 2011 to identify risk factors associated with opioid-related overdose deaths. They defined high-risk use as patients who used four or more prescribers or pharmacies per year to get medications and a high-risk dosage as a daily average of more than 100 morphine milligram equivalents.

Opioid prescription rates increased from 108.3 to 142.5 per 100 individuals per year from 2007 through 2011. Hydrocodone and oxycodone were the most commonly prescribed opioids. Physicians wrote most of the prescriptions, followed by advanced practice nurses, dentists, physician assistants and osteopathic physicians.

Among all the patients prescribed opioids in 2011, 7.6% used more than four prescribers, 2.5% used more than four pharmacies and 2.8% had an average daily dosage greater than 100 MMEs.

An increased risk of opioid-related overdose death was associated with using four or more prescribers, four or more pharmacies and more than 100 MMEs. Patients with one or more of these risk factors accounted for 55% of all overdose deaths.

“These findings highlight the need for interventions using a multifaceted approach that targets patients, prescribers and pharmacies to reduce mortality associated with opioid use,” the authors wrote. “However, these interventions will need development and evaluation to determine their effectiveness.”

Study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1840033


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