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. This paper examines abusers’ sources of diverted drugs from two large studies: 1) a national sample of opioid treatment clients (N=1983), and 2) a South Florida study targeting diverse populations of opioid abusers (N=782). The most common sources of diverted medications were dealers, sharing/trading, legitimate medical practice (e.g., unknowing medical providers), illegitimate medical practice (e.g., pill mills), and theft, in that order. Sources varied by users’ age, gender, ethnicity, risk-aversiveness, primary opioid of abuse, injection drug use, physical health, drug dependence, and either access to health insurance or relative financial wealth. Implications for prescription drug control policy are discussed.

This paper reports on changes in substance use and substance dependence symptoms - without intervention - among young adult multidrug users in the club scene, ages 18–29, (N=444) who participated in a natural history study. Computer-assisted personal interviews at baseline and 6-, 12-, and 18-month follow-ups included well-tested measures of substance use and dependence. Changes in substance dependence symptoms and drug use frequencies were calculated using the Cohen’s d statistic. Mean age was 22; 40% were female; 58% Hispanic, 17% White, and 21% Black. At 18-month follow-up assessment, participants reported significantly fewer days of cocaine (d= −.85 at 18 months), ecstasy (d= −.93), benzodiazepine (d= −.82), and prescription opioid (d= −.81) use, as well as reduced substance dependence symptoms (d= −.42). These results, together with data from focus groups with completers, suggest that comprehensive health and social risk assessments may have quite strong intervention effects among young adult multidrug users.

The high cost of life-saving antiretroviral (ARV) therapy for HIV represents an expense that impedes accessibility and affordability by patients. This price structure also appears to motivate the diversion of ARVs and the targeting of HIV-positive patients by pill brokers in the illicit market. Our field research with indigent, HIV-positive substance abusers links ARV diversion to high levels of competing needs, including psychiatric disorders, HIV stigma, and homelessness. Interventions to reduce diversion must address the needs of highly vulnerable patients.

Objectives Neighborhood factors have been associated with increased HIV risk behaviors and elevated AIDS-related mortality, yet prior research has not examined the impact of neighborhood disorder on behavioral disease management among HIV-positive individuals. We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures leading to reduced antiretroviral (ARV) medication adherence. Methods Using targeted sampling, the study enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida. Participants completed a one-time standardized interview, which took approximately one hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related non-adherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. Results The total indirect effect in the model was statistically significant (p=.001), and the proportion of the total effect mediated was 53 percent. The model indicated substantial influence of neighborhood disorder on non-adherence to ARVs, operating through recent homelessness and diverter network size. Conclusions Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARVs, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.