Multiple Determinants of Specific Modes of Prescription Opioid Diversion.

Numerous national surveys and surveillance programs have shown a substantial rise in the abuse of prescription opioids over the past 15 years. Accessibility of these drugs to non-patients is the result of their unlawful channeling from legal sources to the illicit marketplace (diversion). Empirical data on diversion remain absent from the literature.

Patterns of prescription opioid abuse and comorbidity in an aging treatment population.

Very little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems.

Prescription Drug Abuse & Diversion: Role of the Pain Clinic.

The goal of this research is to better understand the role that South Florida pain management clinics may be playing in the abuse and diversion of prescription drugs. This study explores 1) the characteristics and practices of pain clinics that may be facilitating the drug-seeking endeavors of prescription drug abusers and 2) the drug-seeking behaviors of prescription drug abusers who use pain clinics as a primary source for drugs. Thirty in-depth interviews were conducted with prescription drug abusers in South Florida.

An effective HIV risk-reduction protocol for drug-using female sex workers.

Female sex workers are especially vulnerable to HIV infection, particularly those who use drugs and engage in street-based sex exchange. This study examines the risk behaviors and HIV serostatus of 806 drug-using female sex workers in Miami and assesses the relative impact of two HIV and hepatitis prevention interventions on changes in risk behavior. Drug-using sex workers were recruited using targeted sampling strategies and were randomly assigned to the NIDA Standard Intervention or an innovative Sex Worker Focused (SWF) Intervention.

Prescription drugs purchased through the internet: who are the end users?

Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources. The scientific literature on this topic is limited to anecdotal reports or studies plagued by small sample sizes. Within this context, the focus of this paper is an examination of five national data sets from the U.

The "black box" of prescription drug diversion.

A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine whether there are consistent patterns of diversion among various populations of prescription drug abusers. Data are drawn from the RADARS System, the National Survey of Drug Use and Health, the Delaware School Survey, and a series of quantitative and qualitative studies conducted in Miami, Florida. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted.

Examination of an interventionist-led HIV intervention among criminal justice-involved female prisoners.

The purpose of this study was to examine the implementation, adherence and protocol fidelity for the Reducing Risky Relationships for HIV (RRR-HIV) study. The RRR-HIV study is a phase III trial of a randomized intervention to reduce human immunodeficiency virus (HIV) risk behaviors among incarcerated women in four US states: Connecticut, Delaware, Kentucky and Rhode Island. The intervention consists of five interventionist-led prison-based group sessions and a sixth individual community-based session.

Integrating nine prescription opioid analgesics and/or four signal detection systems to summarize statewide prescription drug abuse in the United States in 2007.

Purpose: Integrate statewide rankings of abuse across different drugs and/or signal detection systems to summarize prescription drug abuse in each state in 2007.

Methods: Four signal detection systems (Opioid Treatment Programs, Key Informants, Drug Diversion, and Poison Centers) that covered heterogeneous populations collected data on the abuse of nine opioids: hydrocodone, immediate-release oxycodone, tramadol, extended-release [ER] oxycodone, fentanyl, morphine, methadone, hydromorphone, and buprenorphine). We introduce here linearized maps which integrate nine drugs within each system; four systems for each drug; or all drugs and systems.

FDA approvals of generic drugs: impact on the diversion of opioid analgesics with a potential for abuse.

Generic drugs account for half of all prescription drug purchases in the United States. Although they are bioequivalent to their branded counterparts, they are typically sold at substantial discounts from the branded price. Given this, the purpose of this analysis is to examine the impact of the introduction of generic forms of selected opioids on their diversion to the illicit marketplace.

Prescription opioid abuse and diversion in an urban community: the results of an ultrarapid assessment.

Objective: Prescription-drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription-drug abusers and dealers on the specific mechanisms of diversion is extremely limited.

Design: A pilot ultrarapid assessment was carried out in Wilmington, Delaware, during December 2006 to better understand the scope and dynamics of prescription-drug abuse and diversion. This involved focus groups with prescription-drug abusers and key informant interviews with police, regulatory officials, prescription-drug dealers, and pill brokers.

Partner relationships and HIV risk behaviors among women offenders.

The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders.

Integrating an HIV/HCV brief intervention in prisoner reentry: results of a multisite prospective study.

Brief interventions to reduce harmful or problem behaviors have become increasingly popular in a variety of health fields, including HIV and hepatitis risk reduction. A central issue in intervention research involves the evaluation of what constitutes an effective "dose" of an intervention. This research examines the relative effectiveness of three alternative brief interventions of varying intensity designed to change the risk behaviors of inmates who are reentering society: a DVD-based, peer delivered intervention; the NIDA Standard HIV Intervention; and a standard practice condition (HIV educational video).

Tri-city study of Ecstasy use problems: a latent class analysis.

This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St.

Co-morbid pain and psychopathology in males and females admitted to treatment for opioid analgesic abuse.

The purpose of this study was to identify co-morbidity in a national sample (N=1408) of males and females entering treatment for opioid abuse. Our sample was primarily white, lived in small urban, suburban or rural locations (80%), and was well-educated. Chronic pain was a symptomatic feature in over 60% of all subjects.

The Diversion of Prescription Opioid Analgesics.

Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process -- from the original manufacturing site, to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. Although a number of recent scientific papers have discussed the problems associated with diversion, empirical data on the scope and magnitude of diversion are limited in the literature. This paper presents findings from a national diversion survey being conducted as part of risk management initiatives supported by Denver Health and Hospital Authority, designed to monitor the abuse and diversion of a variety of prescription opioid analgesics.

A psycho-economic model of ecstasy consumption and related consequences: a multi-site study with community samples.

Becker and Murphy's (1988) theory of rational behavior suggests that economic factors play an influential role in the decision leading to drug consumption and possibly dependence. Psychological models, on the other hand, emphasize internal regulatory cues that motivate drug use and play a contributory role in dependence. Until now, the confluence of both economic and psychological models has not been tested empirically.

Using thought mapping and structured stories to decrease HIV risk behaviors among cocaine injectors and crack smokers in the South of Brazil.

Objectives: To compare changes in AIDS knowledge and risk behaviors among Brazilian cocaine users in an intervention trial.

Method: 119 participants were randomly assigned to either a standard or a standard plus "thought mapping" intervention, and re-interviewed 2 and 8 weeks after intake using standardized data collection instruments. Intervention effects were examined using generalized estimated equation model.

Predictors of substance abuse treatment entry for crime-involved, cocaine-dependent women.

A health services utilization model was used to examine predictors of treatment entry among a large sample (N=659) of crime-involved, cocaine-dependent women. Previous research in this area has focused on women already in treatment and resultantly excluded a critical population of drug-dependent women who are actively using but not in treatment. Thus, interviews were completed with women who were participating in substance abuse treatment programs and with women who were not currently in treatment to examine what factors may have inhibited or facilitated their entering treatment.

Working toward recovery: the interplay of past treatment and economic status in long-term outcomes for drug-involved offenders.

Research on the relationship between employment and substance use tends to focus on employment lowering use. It is also potentially the case, however, that lowered substance use among addicts may lead to better employment and thus to greater long-term abstinence. In this article, we utilize complementary elements of three mainstream criminological approaches to suggest how therapeutic community-based treatment of drug user(s) during the transition from prison to community may lower clients' levels of substance use and thus increase their likelihood of better economic outcomes.

Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States.

Purpose: The goal of these studies was to determine the relationship between prescribed use of opioid analgesics and their non-medically related use (abuse) at a regional level across the country.

Methods: To gather information about prescription drug abuse, we asked 233 drug abuse treatment specialists to provide us Quarterly reports on the number of cases of prescription opioid analgesic abusers who used opioid analgesics to get high in the past 30 days.

Results And Conclusions: We found that there was a very strong correlation between therapeutic exposure to opioid analgesics, as measured by prescriptions filled, and their abuse.

Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States.

Background: A great deal of previous work on the pharmacoeconomics of alcohol, tobacco and illicit drug abuse indicates that as cost decreases, abuse increases and vice versa. The application of these cost principles to the abuse of prescribed medications is largely unknown. In this paper we assessed whether the introduction of generic products in the U.

Differences in prevalence of prescription opiate misuse among rural and urban probationers.

We compared the prevalence of prescription opiate misuse among 2 cohorts of felony probationers (N = 1525). Multiple logistic regression was utilized to determine the independent correlates of prescription opiate misuse among rural (n = 782) and urban (n = 743) probationers participating in an HIV-intervention study. After adjustment for differences in demographic and drug use characteristics, rural participants were almost five times more likely than their urban counterparts to have misused prescription opiates.