The Global Diversion of Pharmaceutical Drugs Non‐medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures

Fischer, Benedikt; Bibby, M.; Bouchard, Martin

doi:10.1111/j.1360-0443.2010.03092.x

Cited by 77 publications

(63 citation statements)

References 63 publications

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“…6,68 Further, surveys have shown that most people with NMPOU obtain their POAs by diversion or nonmedical sourcing from family or friends. 69 In this wider context, people with need or desire for NMPOU are unlikely to face too many barriers to find or gain access to POAs for such purposes.…”

Section: Discussionmentioning

confidence: 99%

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

et al. 2011

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Objective: In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. Method:A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.Results: Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. Conclusions:The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.Can J Psychiatry. 2011;56(8):495-502. Clinical Implications• Mental health and (or) pain comorbidities are highly coprevalent in people engaging in NMPOU.• When observing NMPOU in patients, undiagnosed or untreated mental health and (or) pain must be examined as a possible cause.• People in need of medical POA care for pain should be screened for mental health problems. Limitations• A systematic review and meta-analysis is needed to further validate and add statistical precision findings.• NMPOU was inconsistently defined and operationalized across different studies.• Most studies were cross-sectional, thus directionality of the association cannot be determined.

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Section: Discussionmentioning

confidence: 99%

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

et al. 2011

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“…It is well known that diversion of psychoactive prescription drugs involves original as well as falsified products and that diverted drugs have diverse origins, including personal prescriptions, drug theft, illegal Internet shopping as well as smuggling (Fischer et al, 2010;Fittler et al, 2013;Fountain et al, 2000;Inciardi et al, 2007;Lapyere-Mestre et al, 2014;Peirce et al, 2012;UN, 2014).…”

Section: Introductionmentioning

confidence: 99%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a confirmed intake of a psychoactive prescription drug, and to identify associated factors. Methods:Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was defined as a confirmed use of a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with nonprescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with nonprescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

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“…One important limitation of drug prescription and dispensing databases is that only personally prescribed drugs are covered, while the sources of abused drugs are diverse (84,117 (103,124). In the USA, by far the class of prescription drugs most commonly implicated in misuse and abuse are the opioid analgesics (such as oxycodone) (106,124).…”

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

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The Global Diversion of Pharmaceutical Drugs Non‐medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures

Cited by 77 publications

References 63 publications

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

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The Global Diversion of Pharmaceutical Drugs Non‐medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures

Cited by 77 publications

References 63 publications

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

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The Global Diversion of Pharmaceutical Drugs Non‐medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures