Route of administration for illicit prescription opioids: a comparison of rural and urban drug users
Tóm tắt
Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA) involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use.
A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101) and a major metropolitan area (n = 111) in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported nonmedical use and ROA (swallowing, snorting, injecting) for the following prescription drugs: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, OxyContin® and other oxycodone.
Among urban participants, swallowing was the most common ROA, contrasting sharply with substance-specific variation in ROA among rural participants. Among rural participants, snorting was the most frequent ROA for hydrocodone, methadone, OxyContin®, and oxycodone, while injection was most common for hydromorphone and morphine. In age-, gender-, and race-adjusted analyses, rural participants had significantly higher odds of snorting hydrocodone, OxyContin®, and oxycodone than urban participants. Urban participants had significantly higher odds of swallowing hydrocodone and oxycodone than did rural participants. Notably, among rural participants, 67% of hydromorphone users and 63% of morphine users had injected the drugs.
Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use.
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Tài liệu tham khảo
Miller N, Greenfeld A: Patient characteristics and risks factors for development of dependence on hydrocodone and oxycodone. Am J Ther. 2004, 11: 26-32. 10.1097/00045391-200401000-00008.
Woolf C, Hashmi M: Use and abuse of opioid analgesics: potential methods to prevent and deter non-medical consumption of prescription opioids. Curr Opin Investig Drugs. 2004, 6: 61-66.
Substance Abuse and Mental Health Services Administration: Nonmedical use of prescription pain relievers. The NSDUH Report. 2004, Rockville, MD; Office of Applied Studies
Substance Abuse and Mental Health Services Administration: Results from the 2006 National Survey on Drug Use and Health. 2007, Rockville, MD: Office of Applied Studies
Drug Enforcement Administration. OxyContin®: Pharmaceutical Division: : Drug Intelligence Brief. Arlington, VA. 2002
Hutchinson A: OxyContin Testimony. House Committee on Appropriations, Commerce, Justice, State, and Judiciary. 2001
National Institute of Drug Abuse: Research Report Series: Prescription Drugs Abuse and Addiction (NIH Pub No 05-4881). 2005, Bethesda, MD: National Institute of Drug abuse
McCabe SE, Cranford JA, Boyd CJ, Teter CJ: Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav. 2007, 32 (3): 562-575. 10.1016/j.addbeh.2006.05.022.
Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C: Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008, 136 (3): 380-387. 10.1016/j.pain.2007.08.013.
Cicero TJ, Surratt H, Inciardi JA, Munoz A: Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf. 2007, 16: 827-840. 10.1002/pds.1452.
Rosenblum A, Parrino M, Schnoll SH, Fong C, Maxwell C, Cleland CM, Magura S, Haddox JD: Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend. 2007, 90: 64-71. 10.1016/j.drugalcdep.2007.02.012.
Havens JR, Oser CB, Leukefeld CG, Webster JM, Martin SS, O'Connell DJ, Surratt HL, Inciardi JA: Differences in Prevalence of Prescription Opiate Misuse Among Rural and Urban Probationers. Am J Drug Alcohol Abuse. 2007, 33: 309-317. 10.1080/00952990601175078.
Wunsch MJ, Nakamoto K, Behonick G, Massello W: Opioid deaths in rural Virginia: A description of the high prevalence of accidental fatalities involving prescribed medications. Am J Addict. 2009, 18: 5-14. 10.1080/10550490802544938.
Strang J, Bearn J, Farrell M, Finch E, Gossop M, Griffiths P, Marsden J, Wolff K: Route of drug use and its implications for drug effect, risk of dependence and health consequences. Drug Alcohol Rev. 1998, 17: 197-211. 10.1080/09595239800187001.
Xian X, Jun L, Jianling B, Rongbin Y: Epidemiology of hepatitis C virus infection among injection drug users in China: Systematic review and meta-analysis. Public Health. 2008, 122: 990-1003. 10.1016/j.puhe.2008.01.014.
Chitwood DD, Comerford M, Sanchez JS: Prevalence and Risk Factors for HIV Among Sniffers, Short-Term Injectors, and Long-Term Injectors of Heroin. J Psychoactive Drugs. 2003, 35: 445-453.
Nelson KE, Galai N, Safaeian M, Strathdee SA, Celentano DD, Vlahov D: Temporal trends in the incidence of human immunodeficiency virus infection and risk behavior among injection drug users in Baltimore, Maryland, 1988-1998. Am J Epidemiol. 2002, 156: 641-653. 10.1093/aje/kwf086.
Alter MJ: Prevention of spread of hepatitis C. Hepatology. 2002, 36: S93-S98. 10.1002/hep.1840360712.
Gossop M, Griffiths P, Powis B, Strang J: Severity of dependence and route of administration of heroin, cocaine and amphetamines. Br J Addict. 1992, 87: 1527-1536. 10.1111/j.1360-0443.1992.tb02660.x.
Gossop M, Griffiths P, Powis B, Strang J: Cocaine: patterns of use, route of administration, and severity of dependence. Br J Psychiatry. 1994, 164: 660-664. 10.1192/bjp.164.5.660.
Strang J, Griffiths P, Powis B, Gossop M: Heroin chasers and heroin injectors: differences observed in a community sample in London, UK. Am J Addict. 1999, 8: 148-160. 10.1080/105504999305956.
Gossop M, Griffiths P: Frequency of non-fatal heroin overdose: Survey of heroin users recruited in non-clinical settings. Br Med J. 1996, 313: 402-402.
Neaigus A, Miller M, Friedman SR, Hagen DL, Sifaneck SJ, Ildefonso G, des Jarlais DC: Potential risk factors for the transition to injecting among non-injecting heroin users: a comparison of former injectors and never injectors. Addiction. 2001, 96: 847-860. 10.1046/j.1360-0443.2001.9668476.x.
Abelson J, Treloar C, Crawford J, Kippax S, van Beek I, Howard J: Some characteristics of early-onset injection drug users prior to and at the time of their first injection. Addiction. 2006, 101: 548-555. 10.1111/j.1360-0443.2006.01379.x.
Roy E, Haley N, Leclerc P, Cédras L, Blais L, Boivin JF: Drug injection among street youths in Montreal: predictors of initiation. J Urban Health. 2003, 80: 92-105.
Neaigus A, Gyarmathy A, Miller M, Frajzyngier VM, Friedman SR, des Jarlais DC: Transitions to Injecting Drug Use Among Noninjecting Heroin Users. J Acquir Immune Defic Syndr. 2006, 41 (4): 493-503. 10.1097/01.qai.0000186391.49205.3b.
Fischer B, Manzoni P, Rehm JR: Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort). Eur Addict Res. 2006, 12: 230-239. 10.1159/000094425.
Fuller CM, Vlahov D, Ompad DC, Shah N, Arrio A, Strathdee SA: High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study. Drug Alcohol Depend. 2002, 66: 189-10.1016/S0376-8716(01)00200-9.
Bravo MJ, Barrio G, de la Fuente L, Royuela L, Domingo L, Silva T: Reasons for selecting an initial route of heroin administration and for subsequent transitions during a severe HIV epidemic. Addiction. 2003, 98 (6): 749-760. 10.1046/j.1360-0443.2003.00393.x.
Firestone M, Fischer B: A qualitative exploration of prescription opioid injection among street-based drug users in Toronto: Behaviours, preferences and drug availability. Harm Reduct J. 2008, 5: 30-10.1186/1477-7517-5-30.
Sherman SG, Smith L, Laney G, Strathdee SA: Social influences on the transition to injection drug use among young heroin sniffers: a qualitative analysis. Int J Drug Policy. 2002, 13: 113-10.1016/S0955-3959(02)00010-5.
Van Ameijden EJ, Van Den Hoek JA, Hartgers C, Coutinho RA: Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994, 139: 1153-1163.
Strang J, Griffiths P, Gossop M: Heroin in the United Kingdom: different forms, different origins, and the relationship to different routes of administration. Drug Alcohol Rev. 1997, 16: 329-337. 10.1080/09595239700186711.
Cicero TJ, Surratt H, Inciardi JA, Munoz A: Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf. 2007, 16: 827-840. 10.1002/pds.1452.
Strang J, Des Jarlais DC, Griffiths P, Gossop M: The study of transitions in the route of drug use: The route from one route to another. Br J Addict. 1992, 87: 473-483. 10.1111/j.1360-0443.1992.tb01948.x.
De la Fuente L, Saavedra P, Barrio G, Royuela L, Vicente J: Temporal and geographic variations in the characteristics of heroin seized in Spain and their relation with the route of administration. Spanish Group for the Study of the Purity of Seized Drugs. Drug Alcohol Depend. 1996, 40: 185-194. 10.1016/0376-8716(95)01208-7.
Hakansson A, Medvedeo A, Andersson M, Berglund M: Buprenorphine Misuse among Heroin and Amphetamine Users in Malmo, Sweden: Purpose of Misuse and Route of Administration. Eur Addict Res. 2007, 13: 207-215. 10.1159/000104883.
Liappas IA, Dimopoulos NP, Mellos E, Gitsa OE, Liappas AI, Rabavilas AD: Oral transmucosal abuse of transdermal fentanyl. J Psychopharmacol. 2004, 18: 277-280. 10.1177/0269881104042634.
Passik SD, Hays L, Eisner N, Kirsh KL: Psychiatric and Pain Characteristics of Prescription Drug Abusers Entering Drug Rehabilitation. J Pain Palliat Car Pharmacother. 2006, 20: 5-13.
Back SE, Payne RA, Waldrop AE, Smith A, Reeves S, Brady KT: Prescription opioid aberrant behaviors: a pilot study of sex differences. Clin J Pain. 2009, 25: 477-484. 10.1097/AJP.0b013e31819c2c2f.
Green TC, Grimes Serrano JM, Licari A, Budman SH, Butler SF: Women who abuse prescription opioids: Findings from the Addiction Severity Index-Multimedia Version® Connect prescription opioid database. Drug Alcohol Depend. 2009, 103: 65-73. 10.1016/j.drugalcdep.2009.03.014.
United States Department of Agriculture: 2003 Rural-Urban Continuum Codes for Kentucky. 2003, United States Department of Agriculture, August 18, 2003 edition
County Economic Status, Fiscal Year 2010: Appalachian Kentucky. [http://www.arc.gov/reports/region_report.asp?FIPS=21999&REPORT_ID=33]
United States Census Bureau: United States Census 2000. 2000
Barendregt C, Van der Poel A, Van de Mheen D: Tracing Selection Effects in Three Non-Probability Samples. Eur Addict Res. 2005, 11: 124-131. 10.1159/000085547.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 (Suppl): 22-33.
McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, Pettinati H, Argeriou M: The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat. 1992, 9: 199-213. 10.1016/0740-5472(92)90062-S.
McCabe SE, Boyd CJ, Teter CJ: Subtypes of nonmedical prescription drug misuse. Drug Alcohol Depend. 2009, 102: 63-70. 10.1016/j.drugalcdep.2009.01.007.
Barrau K, Thirion X, Micallef Jl, Chuniaud-Louche C, Bellemin Ba, San Marco JL: Comparison of methadone and high dosage buprenorphine users in French care centres. Addiction. 2001, 96: 1433-1441. 10.1046/j.1360-0443.2001.961014337.x.
Obadia Y, Perrin V, Feroni I, Vlahov D, Moatti J-P: Injecting misuse of buprenorphine among French drug users. Addiction. 2001, 96: 267-272. 10.1046/j.1360-0443.2001.96226710.x.
Vidal-Trecan Gl, Varescon I, Nabet N, Boissonnas A: Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France. Drug Alcohol Depend. 2003, 69: 175-10.1016/S0376-8716(02)00312-5.
Strang J: Abuse of buprenorphine (Temgesic) by snorting. BMJ (Clin Res Ed). 1991, 302: 969-969. 10.1136/bmj.302.6782.969-b.
National Drug Intelligence Center: Intelligence Bulletin: Buprenorphine: Potential for Abuse. 2004
Arvanitis ML, Satonik RC: Transdermal fentanyl abuse and misuse. Am J Emerg Med. 2002, 20: 58-59. 10.1053/ajem.2002.29562.
Martin TL, Woodall KL, McLellan BA: Fentanyl-Related Deaths in Ontario, Canada: Toxicological Findings and Circumstances of Death in 112 Cases (2002-2004). J Anal Toxicol. 2006, 30: 603-610.
Woodall KL, Martin TL, McLellan BA: Oral Abuse of Fentanyl Patches (Duragesic®): Seven Case Reports. J Forensic Sci. 2008, 53: 222-225. 10.1111/j.1556-4029.2007.00597.x.
Streisand JB, Varvel JR, Stanski DR, Le Maire L, Ashburn MA, Hague BI, Tarver SD, Stanley TH: Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology. 1991, 75: 223-229. 10.1097/00000542-199108000-00009.
Lilleng PK, Mehlum LI, Bachs L, Morild I: Deaths After Intravenous Misuse of Transdermal Fentanyl. J Forensic Sci. 2004, 49: 1364-1366. 10.1520/JFS04143.
Tharp AM, Winecker RE, Winston DC: Fatal intravenous fentanyl abuse: four cases involving extraction of fentanyl from transdermal patches. Am J Forensic Med Pathol. 2004, 25: 178-181. 10.1097/01.paf.0000127398.67081.11.
Kuhlman JJ, McCaulley R, Valouch TJ, Behonick GS: Fentanyl Use, Misuse, and Abuse: A Summary of 23 Postmortem Cases. J Anal Toxicol. 2003, 27: 499-504.
Reeves MD, Ginifer CJ: Fatal intravenous misuse of transdermal fentanyl. Med J Aust. 2002, 177: 552-553.
Carr BG, Caplan JM, Pryor JP, Branas CC: A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006, 10: 198-206. 10.1080/10903120500541324.
MacDonald M, Crofts N, Kaldor J: Transmission of hepatitis C virus: rates, routes, and cofactors. Epidemiol Rev. 1996, 18: 137-148.
van den Hoek JA, van Haastrecht HJ, Goudsmit J, de Wolf F, Coutinho RA: Prevalence, incidence, and risk factors of hepatitis C virus infection among drug users in Amsterdam. J Infect Dis. 1990, 162: 823-826.
Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP: Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008, 372: 1733-1745. 10.1016/S0140-6736(08)61311-2.
Aaron S, McMahon JM, Milano D, Torres L, Clatts M, Tortu S, Mildvan D, Simm M: Intranasal Transmission of Hepatitis C Virus: Virological and Clinical Evidence. Clin Infect Dis. 2008, 47: 931-934. 10.1086/591699.
McMahon JM, Simm M, Milano D, Clatts M: Detection of hepatitis C virus in the nasal secretions of an intranasal drug-user. Ann Clin Microbiol Antimicrob. 2004, 3: 6-6. 10.1186/1476-0711-3-6.
Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, Crosby AE, Paulozzi LJ: Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008, 300 (22): 2613-20. 10.1001/jama.2008.802.
National Institute of Drug Abuse: InfoFacts: Prescription and Over-the-counter medications. 2009, Bethesda, MD: National Institute of Drug Abuse, Accessed October 8, 2010, [http://www.nida.nih.gov/PDF/Infofacts/PainMed09.pdf]