Tuesday, May 25, 2010

Another Man Done Gone - Factors in Male Prescription Abuse

Prescription Drug Abuse Research

A statement from the United States Department of Health and Human Services by Director Nora D. Volkow, M.D. before the Subcommittee on Criminal Justice, Drug Policy, and Human Resources on July 26, 2006: 

"The recent increase in the extent of prescription drug abuse in this country is likely the result of a confluence of factors, such as: significant increases in the number of prescriptions;1 significant increases in drug availability;2
aggressive marketing by the pharmaceutical industry; 3 the proliferation of illegal Internet pharmacies that dispense these medications without proper prescriptions and surveillance;4 and a greater social acceptability for medicating a growing number of conditions. The fact that doctors are prescribing these drugs legitimately and with increasing frequency to treat a variety of ailments leads to the misguided and dangerous conclusion that their non-medical use should be equally safe. This misperception of safety may contribute, for example, to the casual attitude of many college students towards abusing stimulants to improve cognitive function and academic performance." 

1 See, e.g., Zacny et. al., College on Problems of Drug Dependence taskforce on Prescription Opioid Non-Medical Use and Abuse: Position Statements, Drug and Alcohol Dependence 69 (2003) 25-232; and Compton and Volkow, Major Increases in Opioid Analgesic Abuse in the U.S.: Concerns and Strategies, Drug and Alcohol Dependence 81 (2006) 103-107. These citations include information from IMS Health's National Prescription Audit.
2 See, e.g., McCabe et al, Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs, Journal of American College Health 54 (2006) 269-278.
3 See, e.g., United States General Accounting Office, Prescription Drugs - Oxycontin Abuse and Diversion and Efforts to Address the Problem, GAO-04-110, 12/2003
4 See, e.g., Forman et al, The Availability of Web Sites Offering to Sell Opioid Medications Without Prescriptions, American Journal of Psychiatry 163 (2006) 1233-1238.

Men Who Misuse Opioids

Recent research reports that women who misuse pain drugs tend to display signs of emotional issues and affective distress, compared with men. Men, on the other hand, tend to show signs of worrisome behaviors, such as association with other people who abuse drugs and alcohol and engage in criminal behavior. (R. Jamison, The Journal of Pain, April 2010) The research recommends that men who are being treated with opioids need closer monitoring of known or suspected behavioral problems, frequent urine screens, pill counts, and compliance monitoring to help reduce risks for drug misuse.

At Boston University School of Medicine, researchers have identified clinical characteristics associated with prescription drug use disorder (PDUD) in primary care patients with chronic pain. The study found that by identifying characteristics of prescription drug abuse, primary care clinicians can identify those at risk and provide appropriate treatment. This study was funded by the National Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism. (Jane M. Liebschutz, Richard Saitz, Roger D. Weiss, Tali Averbuch, Sonia Schwartz, Ellen C. Meltzer, Elazabeth Claggett-Borne, Howard Cabral, Jeffrey H. Samet, "Clinical Factors Associated with Prescription Drug Use Disorder in Urban Primary Care Patients with Chronic Pain," The Journal of Pain, 2010)

In a study to examine the clinical characteristics of individuals with lifetime PDUD, among a population of primary care patients with chronic pain, the researched compared those afflicted with PDUD to individuals with other substance use disorders (SUD) as well as those without any history of SUD. Participants recruited for the study experienced chronic pain for more than three months, and they reported use of prescription or non-prescription pain medications. (reported as "Researchers Define Traits Associated With Prescription Drug Disorders In a Primary Care Setting," ScienceDaily, May 14 2010)

Of nearly 600 participants studied, researchers found that 18 percent had lifetime PDUD of which in this subgroup 90 percent had an additional substance addiction. More than 24 percent had an SUD other than PDUD, and 57 percent had no lifetime history of any substance problem. Of note however, only 60 were female, and 60 percent were of African decent and likely to be unemployed and poor.

The study identified a number of factors associated with PDUD and SUD:

1. Jail Time,
2. Severely Disabling Pain,
3. Cigarette Smoking,
4. Family History of Drug Abuse,
5. White (Not For SUD),
6. Male,
7. Post-traumatic Stress Disorder.

The study identified factors not associated with Substance Use Disorders:

1. Insurance,
2. Employment,
3. Income,
4. Education,
5. Age.

"This data strongly suggests that physicians treating patients with pain should assess for SUD prior to prescribing opioid analgesics," lead author Jane M. Liebschutz, MD, MPH, FACP, an associate professor of medicine and social and behavioral sciences at BUSM and a physician in the section of General Internal Medicine at Boston Medical Center. "This research may help direct care, including treatment for pain substance use disorders, as primary care physicians may not be as aware of the overlap between pain and addictions.

In particular, physicians may not think of assessing for time spent in jail, which was the largest predictor of having PDUD," said Liebschutz.

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