Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015

McCabe, Sean Esteban; West, Brady T.; Veliz, Philip; McCabe, Vita V.; Stoddard, Sarah A.; Boyd, Carol J.

doi:10.1542/peds.2016-2387

Cited by 195 publications

(137 citation statements)

References 38 publications

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“…Ecstasy users in particular may be more drawn to these substances for their psychedelic effects. In contrast, the proportion of ecstasy users reporting nonmedical opioid use decreased over time, and may be related to the recent decrease in self-reported nonmedical opioid use in the adolescent general population (Allen et al, 2017; McCabe et al, 2017). Decreases in perceived great risk associated with marijuana and LSD, and increases in perceived ease to obtain LSD, could be contributing to increased use of these substances among ecstasy users.…”

Section: Discussionmentioning

confidence: 98%

Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

Palamar

Mauro

Han

et al. 2017

Drug and Alcohol Dependence

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Background Ecstasy/MDMA has been one of the most prevalent party drugs for decades, and powder ecstasy recently increased in popularity. We examined trends in use to determine who to best target for prevention and harm reduction. Methods Secondary analysis of the 2007–2014 National Survey on Drug Use and Health, a repeated cross-sectional, nationally representative probability sample, was conducted. Linear trends in past-year ecstasy use and trends in demographic and other past-year substance use characteristics among ecstasy users were examined among participants ages 12–34 (N=332,560). Results Past-year prevalence of ecstasy use was stable across years at 2% (P=0.693). Over time, the proportion of ecstasy users with a college degree increased from 11.5% in 2007/08 to 24.5% in 2013/14 (P<0.001). The proportion of users who were age 12–17 decreased, as did proportions of users who are non-Hispanic black, and reported income <$20,000/year (Ps<0.001). Prevalence of past-year use of marijuana, LSD, ketamine, and DMT/AMT/Foxy increased among ecstasy users (Ps<0.05); DMT/AMT/Foxy use increased more than four-fold from 2.1% in 2007/08 to 8.7% in 2013/14. Perception of great risk associated with LSD use decreased among users and ease of obtaining LSD increased (Ps<0.05). Past-year use of 5 or more other substances also increased over time (P<0.05). Conclusions Ecstasy use in the US appears to be increasing among those with college degrees and use of other substances among ecstasy users is growing—particularly use of otherwise rare substances such as tryptamines. Results inform prevention and harm reduction strategies in this increasingly shifting group of ecstasy users.

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Section: Discussionmentioning

confidence: 98%

Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

Palamar

Mauro

Han

et al. 2017

Drug and Alcohol Dependence

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“…Opioid prescribing increased 350% between 1999 and 2015, from 180 to 640 morphine milligram equivalents per capita (1), with parallel increases in nonmedical use (2, 3), neonatal abstinence syndrome (4), and deaths due to both prescription opioid and heroin overdose (5, 6). The age-adjusted rate of prescription opioid–related deaths rose from 1.0 to 4.4 deaths per 100 000 population between 1999 and 2016, whereas heroin-related deaths increased nearly 5-fold since 2010, rising from 1.0 to 4.9 deaths per 100 000 population between 2010 and 2016 (7).…”

mentioning

confidence: 99%

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses

Fink

Schleimer

Sarvet

et al. 2018

Annals of Internal Medicine

194

146

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Background Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States. Purpose To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs. Data Sources Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists. Study Selection Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses. Data Extraction 2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention. Data Synthesis Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation. Limitation Few studies, high ROB, and heterogeneous analytic methods and outcome measurement. Conclusion Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of “best practices” and complementary initiatives to address these consequences. Primary Funding Source National Institute on Drug Abuse and Bureau of Justice Assistance.

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“…Rural dentists also reported in the network enrollment questionnaire that pediatric patients constituted a larger proportion of their practices, perhaps a consequence of the lower concentration of pediatric specialists in rural areas . Adolescence has been identified as a critical developmental period with respect to onset of PDA behavior and even prescribed use of opioids may predispose adolescents to misuse and abuse in adulthood . Of note, adolescents are an oft‐identified “at‐risk” population.…”

Section: Resultsmentioning

confidence: 99%

Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN

McCauley

Nelson

Gilbert

et al. 2019

The Journal of Rural Health

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Purpose This study compared rural to nonrural dentists with respect to opioid prescribing practices, perceptions about prescription drug abuse among patients, and training relevant to pain management and addictions. Methods A web‐based, cross‐sectional questionnaire was administered to practicing dentist members of the National Dental Practice‐Based Research Network (PBRN; N = 822) and linked with network enrollment questionnaire data regarding practitioner demographics and practice characteristics. Pain management prescribing practices and perceptions regarding relevance and scope of addiction and drug diversion among patients were assessed. Rural practice was defined as a practice whose ZIP Code has more than 50% of its population in either a nonmetropolitan county and/or a rural Census tract. Findings Rural dentists were significantly more likely than their nonrural counterparts to recommend nonsteroidal anti‐inflammatory agents/acetaminophen in combination with prescribing an opioid [F (1,820) = 4.59, P = .03]. Compared to nonrural dentists, rural dentists were more likely to report that opioid abuse/diversion was a problem in their practices [χ2 [1, n = 807] = 6.85, P < .001], were more likely to have suspected a patient of abuse or diversion [χ2 [1, n = 807] = 10.12, P = .001], and were more likely to have refrained from prescribing due to suspicions of abuse or diversion [χ2 [1, n = 807] = 12.49, P < .001]. Conclusion Rural dentists may be disproportionately impacted by patients’ opioid abuse and represent a viable target for educational outreach that encourages screening, identification, and referral of patients in need of drug abuse treatment.

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Trends in Medical and Nonmedical Use of Prescription Opioids Among US Adolescents: 1976–2015

Cited by 195 publications

References 38 publications

Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses

Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN

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