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Prescription opioid use in the rural Appalachia: A community-based study

Jennifer R. Havens, PhD, MPH, Robert Walker, MSW, LCSW, Carl G. Leukefeld, DSW


Objective: The purpose of this study is to describe the sample characteristics and methods for a study of rural medical and nonmedical prescription opioid users with a history of OxyContin® use.
Design and Setting: Snowball sampling was used to recruit 221 rural Appalachian residents. Participants included those under medical supervision for pain (n = 101) as well as those self-reporting nonmedical use of prescription opioids (n = 120). Participants were given an interviewer-administered questionnaire.
Outcome measures: Data relating to demographics, illicit and nonmedical prescription drug use, medical, legal, family, and psychiatric status, as well as pain history were collected. The primary outcomes of interest were differences in past 30 day prescription drug use between pain patients and nonmedical opioid users.
Results: A significantly greater proportion of those treated for pain reported using oxycodone and hydrocodone prescribed by a physician in the prior 30 days (p < 0.001); however, more than third of pain participants also reported nonmedical use of OxyContin®, methadone, hydrocodone, benzodiazepines, and marijuana in the prior 30 days.
Conclusions: A large proportion of rural opioid users who reported being treated for pain also reported nonmedical use of prescription drugs. Similarly, among the nonmedical users, half of those reported experiencing pain that interfered with their daily life. These results suggest that many rural prescription drug users are being either incorrectly or perhaps inadequately treated for chronic nonmalignant pain. Therefore, developing educational materials and training for rural physicians about pain treatment (including drug seeking behavior) is proposed.


rural, Appalachia, pain, opioid

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