Open Access Open Access  Restricted Access Subscription or Fee Access

Self-reports of prescription opioid abuse and diversion among recreational opioid users in a Canadian and a United States city

Beatrice Setnik, PhD, Carl L. Roland, PharmD, MS, Veeraindar Goli, MD, Glenn C. Pixton, MS, Naama Levy-Cooperman, PhD, Ira Smith, MD, Lynn Webster, MD

Abstract


Objective: To explore behaviors related to prescription opioid abuse and diversion in individuals who self-reported past recreational (nonmedical) opioid use.

Design: A questionnaire was developed and included in two abuse potential clinical studies conducted in Canada (Toronto, ON, August 2010 to January, 2011) and the United States (Salt Lake City, UT, February-May 2011).

Participants: Recreational opioid users.

Main outcome measure(s): Self-reported behaviors related to prescription opioid abuse and diversion.

Results: The questionnaire was completed by 174 participants in the Canadian study and 80 participants in the US study. Most participants reported that they used prescription opioids for nonmedical purposes a few times a month. Most had taken their first prescription opioid between the ages of 12 and 24 years and the two most common reasons were to treat pain or to feel high/stoned. When asked about specific opioids taken for nonmedical purposes in the past year, oxycodone, acetaminophen with codeine, and morphine were commonly used by both cohorts, whereas hydrocodone use was substantially greater in the US cohort versus the Canadian cohort. Participants reported various tampering methods and routes of administration, with swallowed whole, crushed and snorted, and chewed/crushed and swallowed as the most prevalent. Most participants indicated taking other drugs with prescription opioids to get high, most commonly marijuana and alcohol. The most common sources for obtaining prescription opioids were family/friends.

Conclusions: Two cohorts of recreational opioid users from Canada and the United States reported similar experiences with various prescription opioids and indicated a predominance of diversion from family/friends.


Keywords


abuse, diversion, opioids, prescription opioids, questionnaire, recreational use

Full Text:

PDF

References


Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

National Opioid Use Guideline Group: Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. 2010. Available at http://nationalpaincentre.mcmaster.ca/opioid/. Accessed January 7, 2014.

Katz NP, Adams EH, Chilcoat H, et al.: Challenges in the development of prescription opioid abuse-deterrent formulations. Clin J Pain. 2007; 23(8): 648-660.

Stanos S: Continuing evolution of opioid use in primary care practice: Implications of emerging technologies. Curr Med Res Opin. 2012; 28(9): 1505-1516.

Health Canada: Drug and Alcohol Use Statistics, Canadian Alcohol and Drug Use Monitoring Survey (CADUMS). Available at http://www.hc-sc.gc.ca/hc-ps/drugs-drogues/cadums-esccadeng.php. Accessed August 4, 2015.

Centre for Addiction and Mental Health: CAMH Monitor. Available at http://www.camh.ca/en/research/news_and_publications/Pages/camh_monitor.aspx. Accessed August 4, 2015.

Centers for Disease Control and Prevention: Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011; 60(43): 1487-1492.

Substance Abuse and Mental Health Services Administration; US Department of Health and Human Services: Results from the 2012 National Survey on Drug Use and Health: Summary of national findings. 2013. Available at http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#ch1.1. Accessed August 4, 2015.

Health Canada: Canadian Alcohol and Drug Use Monitoring Survey. Summary of results for 2011. 2012. Available at http://www.hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2011/summarysommaire-eng.php. Accessed August 4, 2015.

Ialomiteanu AR, Adlaf EM, Mann RE, et al.: CAMH Monitor eReport: Addiction and mental health indicators among Ontario adults, 1977-2009. 2011. Available at http://www.camh.ca/en/research/Documents/www.camh.net/Research/Areas_of_research/Population_Life_Course_Studies/CAMH_Monitor/CM2009_eReport_Final.pdf. Accessed August 4, 2015.

Shield KD, Ialomiteanu A, Fischer B, et al.: Non-medical use of prescription opioids among Ontario adults: Data from the 2008/2009 CAMH Monitor. Can J Public Health. 2011; 102(5): 330-335.

Brands B, Paglia-Boak A, Sproule BA, et al.: Nonmedical use of opioid analgesics among Ontario students. Can Fam

Physician. 2010; 56(3): 256-262.

Johnston LD, O’Malley PM, Bachman JG, et al.: Monitoring the future: National results on adolescent drug use: 2012 overview, key findings on adolescent drug use. 2013. Available at http://www.monitoringthefuture.org/pubs/monographs/mtfoverview2012.pdf. Accessed August 4, 2015.

Boyd CJ, Teter CJ, West BT, et al.: Non-medical use of prescription analgesics: A three-year national longitudinal study. J Addict Dis. 2009; 28(3): 232-242.

Setnik B, Sommerville K, Goli V, et al.: Assessment of pharmacodynamics effects following oral administration of crushed morphine sulfate and naltrexone hydrochloride extended-release capsules compared with crushed morphine sulfate controlled-release tablets and placebo in nondependent recreational opioid users. Pain Med. 2013; 14(8): 1173-1186.

Setnik B, Goli V, Levy-Cooperman N, et al.: Assessing the subjective and physiological effects of intranasally administered crushed extended-release morphine formulations with and without a sequestered naltrexone core in recreational opioid users. Pain Res Manag. 2013; 18(4): e55-e62.

McColl S, Sellers EM: Research design strategies to evaluate the impact of formulations on abuse liability. Drug Alcohol Depend. 2006; 83(suppl 1): S52-S62.

US Food and Drug Administration: Guidance for industry: Abuse-deterrent opioids—Evaluation and labeling. 2015. Available at http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm334743.pdf. Accessed August 4, 2015.

Brown J, Setnik B, Lee K, et al.: Assessment, stratification, and monitoring of the risk for prescription opioid misuse and abuse in the primary care setting. J Opioid Manag. 2011; 7(6): 467-483.

McCabe SE, West BT, Morales M, et al.: Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction. 2007; 102(12): 1920-1930.

McCabe SE, Boyd CJ, Cranford JA, et al.: Motives for nonmedical use of prescription opioids among high school seniors in the United States: Self-treatment and beyond. Arch Pediatr Adolesc Med. 2009; 163(8): 739-744.

McCabe SE, Cranford JA, Boyd CJ, et al.: Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav. 2007; 32(3): 562-575.

Zacny JP, Lichtor SA: Nonmedical use of prescription opioids: Motive and ubiquity issues. J Pain. 2008; 9(6): 473-486.

American Lung Association: Trends in tobacco use. 2011. Available at http://www.lung.org/finding-cures/our-research/trend-reports/Tobacco-Trend-Report.pdf. Accessed August 4, 2015.

Health Canada: Canadian Tobacco Use Monitoring Survey (CTUMS) 2012. 2013. Available at http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/ctums-esutc_2012-eng.php. Accessed August 4, 2015.

McCabe SE, Teter CJ, Boyd CJ, et al.: Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey. Addict Behav. 2005; 30(4): 789-805.

Lord S, Downs G, Furtaw P, et al.: Nonmedical use of prescription opioids and stimulants among student pharmacists. J Am Pharm Assoc (2003). 2009; 49(4): 519-528.

International Narcotics Control Board: Narcotic drugs report 2012. Estimated world requirements for 2013. Statistics for 2011. 2012. Available at http://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2012/Narcotic_Drugs_Report_2012.pdf. Accessed August 4, 2015.

Nosyk B, Marshall BDL, Fischer B, et al.: Increases in the availability of prescribed opioids in a Canadian setting. Drug Alcohol Depend. 2012; 126(1-2): 7-12.

Young AM, Havens JR, Leukefeld CG: Route of administration for illicit prescription opioids: A comparison of rural and urban drug users. Harm Reduct J. 2010; 7: 24.

Johnston LD, O’Malley PM, Bachman JG, et al.: American teens more cautious about using synthetic drugs. 2013 data from in-school surveys of 8th-, 10th-, and 12th-grade students. Table 5: Source of prescription drugs among those who used in last year in grade 12, 2007-2013. 2013. Available at http://www.monitoringthefuture.org/data/13data/13drtbl5.pdf. Accessed August 4, 2015.

Office of National Drug Control Policy: Epidemic: Responding to America's prescription drug abuse crisis. 2011. Available at http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf. Accessed August 4, 2015.

Volkow ND, McLellan TA: Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. JAMA. 2011; 305(13): 1346-1347.

Katz N, Dart RC, Bailey E, et al.: Tampering with prescription opioids: Nature and extent of the problem, health consequences, and solutions. Am J Drug Alcohol Abuse. 2011; 37(4): 205-217.

Fischer B, Rehm J, Patra J, et al.: Changes in illicit opioid use across Canada. CMAJ. 2006; 175(11): 1385-1387.

Young AM, Havens JR, Leukefeld CG: A comparison of rural and urban nonmedical prescription opioid users’ lifetime and recent drug use. Am J Drug Alcohol Abuse. 2012; 38(3): 220-227.




DOI: https://doi.org/10.5055/jom.2015.0299

Refbacks

  • There are currently no refbacks.