Findings from a new study may help focus prevention efforts and intervention strategies for prescription opioid abuse reduction. The study detected multiple and distinct profiles of prescription opioid users, suggesting a range of typologies rather than a simple dichotomy of those who do or do not report non-medical use of prescription opioids.
Collected using Inflexxion’s proprietary NAVIPPRO (National Addictions Vigilance Intervention and Prevention Program) system, data were obtained from November 2005 through December 2009 from 26,314 unique respondents, aged 18-70, self-reporting past month use of a prescription opioid.
This study was supported by a National Research Service Award grant from the National Institute on Drug Abuse (NIDA) and by a 2009 Developmental grant from Lifespan/Tufts/Brown Center for AIDS Research.
For most patterns, non-medical prescription opioid use did not occur in isolation of abuse of other substances. The prominence of comorbid psychiatric and medical problems suggest the need for better integration of and access to mental health, primary care and substance abuse treatment. A comprehensive public health approach that incorporates supply and demand reduction, adequately extends and supports harm reduction and treatment, and recognizes the need for effective intervention at the individual and structural levels is recommended.
More information on this study can be found in article, “Typologies of Prescription Opioid Use in a Large Sample of Adults Assessed for Substance Abuse Treatment” published November 2, 2011 in PLoS ONE, an international, peer-reviewed, open-access, online publication.
“As a population, non-medical prescription opioid users are not well-defined. We wanted to better understand who is using prescription opioids and whether we could detect subgroups of non-medical use,” says lead researcher Traci C. Green, MSc , PhD, Assistant Professor of Medicine and Epidemiology at The Warren Alpert School of Medicine of Brown University and Rhode Island Hospital.
“Previous studies have focused on various demographic groups of non-medical prescription opioid users. These populations may differ drastically in important ways, including route(s) of administration of the prescription opioid, concurrent drug and alcohol use, treatment experience, and history of substance abuse dependence, among others," Green added.
In addition, she stated that: "Such variability makes it difficult for public health statistics to make general statements about non-medical prescription opioid users. But this is an even bigger challenge for clinicians and policy makers, who are faced with the challenge of focusing prevention, screening, intervention, and treatment strategies to address non-medical prescription opioid use in a way that prioritizes individuals at high risk of harm and poor health outcomes, without a clear sense of the nature of the disparate populations that may be involved.”
Researchers detected four clinically interpretable and relevant subgroups including: use as prescribed (18.9%), prescribed misusers (26.9%), medically healthy abusers (35.8%), and illicit users (18.4%). Three of the four classes (81% of respondents) exhibited high potential risk for fatal opioid overdose and 18.4% exhibited risk factors for blood-borne infections. According to the National Center for Health Statistics, drug-related deaths like overdose now outrank car accidents as the leading cause of accidental adult death.
“This is the first study ever to differentiate the underlying subgroups of prescription opioid abusers. Finding these subgroups can help us better formulate prevention and treatment strategies that can improve public health and intervention approaches,” says co-author Simon Budman, PhD, founder and CEO of Inflexxion and co-founder of NAVIPPRO. “Our findings may help clinicians and policymakers better focus overdose and blood-borne infection prevention efforts and intervention strategies for prescription opioid abuse reduction.”
“Due to the high degree of specificity of data that NAVIPPRO gathers and the large numbers of cases in our sample, we were able to explore patterns of prescription opioid use that incorporated route of administration, source of drug, and product-level indicators of non-medical use for short and long-acting opioid medications,” says co-author Stephen F. Butler, PhD, Senior Vice President and Chief Science Officer at Inflexxion.
“The four unique groups of prescription opioid users we identified differed in key ways relevant to public health and clinical intervention, including: age, race/ethnicity, concurrent drug use, onset and duration of their drug use, routes of administration, and comorbid psychiatric and medical problems.”
“Our results add to a growing body of research indicating that prescription opioid products are being misused and abused in ways that call for more nuanced and public health-oriented post-marketing surveillance and risk management responses than have been proposed heretofore,” says Dr. Green.
“The main thrusts of the current Prescription Opioid Abuse National Strategy and the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS) components rely heavily upon provider and patient education and expansion of prescription monitoring programs. Based on our findings, such efforts will have limited effect on the largest subpopulations of non-medical prescription opioid users who are at greatest risk of adverse health events. These subpopulations are sizeable, exist primarily outside of the regular care of medical professionals, and would likely require other, very different intervention techniques, such as targeted overdose prevention counseling and response and health or social service venue-based preventive interventions.”
The writing of “Typologies of Prescription Opioid Use in a Large Sample of Adults Assessed for Substance Abuse Treatment” was funded in part by an unrestricted grant from Pfizer Pharmaceuticals, Inc.