Patterns of Prescription Medication Diversion among Drug Dealers

This research examined the following questions: (1) how do drug dealers acquire their inventories of prescription medications? and (2) which types of prescription medications do dealers most commonly sell? Data are drawn from a National Institute on Drug Abuse-funded research study that examined prescription drug diversion and abuse in South Florida. In-depth semi-structured interviews (n = 50) were conducted with an ethnically diverse sample of prescription drug dealers from a variety of milieus to assess patterns of diversion. Audiotapes of the interviews were transcribed, coded, and thematically analysed using the NVivo 8 software program. Dealers relied on a wide array of diversion methods including visiting multiple pain clinics, working with pharmacy employees to steal medications from pharmacies, and purchasing medications from indigent patients. The type of medication most commonly sold by dealers was prescription opioid analgesics, and to a lesser extent benzodiazepines such as alprazolam. These findings inform public health policy makers, criminal justice officials, the pharmaceutical industry and government regulatory agencies in their efforts to reduce the availability of diverted prescription drugs in the illicit market. Specifically, these data support the need for statewide prescription drug monitoring programs and increased training for healthcare workers who have access to controlled medications

The Stories behind the Struggle: A Closer Look at First Experiences with Opioid Misuse

The opioid crisis is a national public health emergency. Over 47,000 people in the U.S. died of opioid overdoses in 2017. Improving our knowledge about how people first come to misuse opioids can help to inform prevention and treatment interventions. This research brief shows that opioid misuse most often begins before age 25, most people obtain the opioids they misuse from friends and family rather than a health care provider, and experimenting and coping with life stressors are the most common motivations for starting opioid misuse

Diversion of Benzodiazepines through Healthcare Sources

Background—Benzodiazepines (BZ) are often diverted from legal sources to illicit markets at various points in the distribution process which begins with a pharmaceutical manufacturer, followed by distribution to healthcare providers, and finally, to the intended users. Little is known about the extent of BZ diversion involving distribution points directly related to healthcare sources (e.g., a script doctor) as opposed to points further down the distribution chain (e.g., street dealers). The present study examines the scope of BZ diversion via mechanisms directly related to a healthcare source. It examines the association between BZ dependence and the direct utilization of particular healthcare-related diversion sources among a diverse sample of prescription drug abusers in South Florida. Method—Cross-sectional data were collected from five different groups of drug users: methadone-maintenance clients (n = 247), street drug users (n = 238), public-pay treatment clients (n = 246), private-pay treatment clients (n = 228), and stimulant using men who have sex with men (MSM; n = 248). Results—Findings suggest that those ages 26 to 35 years old, non-Hispanic White participants, private-pay treatment clients, those who are insured, and those with higher incomes had higher odds of utilizing healthcare diversion sources. Participants utilized a pharmacy as a diversion source more than other healthcare sources of diversion, and the highest number of BZs were obtained from doctor shopping compared to other diversion sources. Those who reported BZ dependence also had 2.5 times greater odds of using a healthcare source to obtain BZs than those who did not meet criteria for dependence. Discussion—Prevention of BZ diversion through healthcare sources should include strategies to reduce doctor shopping and diversion from pharmacies

Prescription Opioid Abuse Etiology: Pathways to Initiation

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is quite small. Little is known about why and how the onset of POA occurs, especially among high risk drug using populations. The present study aims to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed using the NVivo software program. This research was conducted within a storylines framework, which operates on the premise that the path to drug abuse represents a biography, or a process, rather than a static condition. Analysis revealed the presence of four trajectories leading to POA. The first pathway to POA, the South Florida Effect, highlighted the role that the local “pill culture” can play in influencing the formation of POA, while the second focused on females who initiate their POA through the help of an abusing male. The third, or the Cocaine Context, describes an entryway into POA via the world of cocaine. The final POA trajectory, Prescribed Addiction, reveals how users who are prescribed opioids can fall into problems with POA. This study adds to the dearth of research on POA etiology by not only illuminating the psycho-social factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. While some of these findings support previous research, others alter the manner in which POA etiology should be viewed. This study expands current notions of POA initiation by providing clear and detailed descriptions of the circumstances and events that can lead to POA. These findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more importantly when and how to intervene most efficaciously

Drug Prevention Programmes in Schools: Selecting Programme Providers

Schools are an important venue for implementing drug prevention programmes. School-based programmes have been shown to be an efficacious and cost-effective method of reducing substance use disorders among youth. There exists lack of consensus, however, regarding who makes the most effective programme providers. Drug prevention programmes are led by a wide variety of people, including classroom teachers, mental health professionals and the police. Few studies specifically examine the relative effectiveness of different facilitators and existing results are mixed. This has made it difficult to determine empirically which group makes the most effective programme providers. The purpose of this paper, therefore, is to present information that can be used by school officials, educators and policymakers to inform choices regarding who should implement drug prevention programmes in schools. The paper will include a brief introduction to universal classroom-based drug prevention in the USA and an overview of the role of facilitator. A discussion of the practical implications and relative (dis)advantages of using persons from three commonly used provider types (classroom teachers, mental health professionals and the police) is also provided. The paper concludes with a brief summary of programme provider issues in an international context. The information presented in this paper provides important insights for schools as they attempt to select the most appropriate programme providers for their specific communities

Racial/Ethnic Differences In Factors That Place Adolescents At Risk For Prescription Opioid Misuse

Although considerable research attention is paid to the misuse of controlled medications, a relatively small number of studies focus on prescription opioid misuse (POM) among racial/ethnic minority adolescents. This study aimed to determine the prevalence of POM among adolescents in the three largest racial/ethnic groups (Whites, Hispanics, Blacks) and identify demographic and psychosocial factors that increase the risk of POM. Additionally, the authors applied concepts from social bonding theory and social learning theory to determine the extent to which these concepts explain adolescent POM among each group. Using data from the 2012 National Survey of Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with an increased risk of POM. Results show that Blacks (6.08 %) have the highest prevalence rate of adolescent POM and risk factors vary by race/ethnicity. These findings are important in that they enhance the ability of prescribers to identify high-risk adolescent patients and help to make prevention interventions more culturally relevant

Perceptions of fentanyl among African Americans who misuse opioids: implications for risk reduction

Abstract Background Fentanyl is a powerful synthetic opioid that is 50 times more powerful than heroin and has become ubiquitous in the illicit drug supply in the USA. Studies show that among people who use drugs, fentanyl is sometimes viewed as a desirable substance due to its high potency and low cost, while others have an unfavorable perception because of its association with overdose. Unfortunately, studies on the perceptions of fentanyl are relatively rare and existing studies tend to rely on samples with little African American representation. The objective of this study, therefore, was to identify and describe perceptions of fentanyl among African Americans who misuse opioids, while capturing their motivations for seeking out or avoiding fentanyl. Methods In-depth interviews (n = 30) were conducted with a sample of African American adults who misuse opioids in Southwest Florida between August 2021 and February 2022. Audiotapes of interviews were transcribed, coded, and thematically analyzed. Results Analyses revealed the presence of three subtypes of fentanyl-related perceptions: (1) fentanyl as an avoided adulterant, (2) fentanyl as a tolerated adulterant, and (3) fentanyl as a drug of choice. Conclusions These findings show that African Americans’ perceptions of fentanyl are not monolithic and suggest the distribution of fentanyl test strips and naloxone may be an effective risk reduction strategy. Given that most studies on fentanyl rely on quantitative data from drug seizures and death certificates, this study uniquely contributes to the literature by capturing the voices of African Americans who use drugs

Prescription Opioid Misuse Among African-American Adults: A Rural-Urban Comparison of Prevalence and Risk

Background: Prescription opioid misuse (POM) remains a public health concern in the United States. Although the problem has been studied extensively, little research attention is paid to POM among African-Americans (AAs), and even fewer studies consider rural status in their analysis. The goal of this study, therefore, was to identify and compare prevalence and predictors of POM among rural and urban AA adults using data from a nationally representative sample. Methods: Using pooled data across five years (2012–2016) of the National Survey on Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with POM among AA adults. Results: Findings show that urban and rural AAs have comparable prevalence rates of POM, which is somewhat surprising given that POM often varies based on rural status. A number of factors (e.g., receiving government assistance, religiosity, smoking tobacco or marijuana, misuse of other prescription medications) were significantly correlated with POM for urban and rural AAs, while others (e.g., being age 50+, graduating high school, visiting an emergency department, being arrested, binge drinking) varied by rural status. Conclusion: Results indicate that AA nonmedical prescription opioid users are not a monolith and have distinct demographic, clinical, and psychosocial profiles based on geographic region. Because AAs have been virtually ignored in the POM literature, our findings are an important step towards understanding POM among this understudied group. These results invite additional investigation into AA POM and encourage researchers to consider rural status in their analysis of POM among AAs