Prescription opioid abuse among drug-involved street-based sex workers

Hilary L. Surratt, PhD; James A. Inciardi, PhD; Steven P.q Kurtz, PhD

doi:10.5055/jom.2006.0042

Authors

Hilary L. Surratt, PhD
James A. Inciardi, PhD
Steven P.q Kurtz, PhD

DOI:

https://doi.org/10.5055/jom.2006.0042

Keywords:

opioids, substance abuse, diversion, sex workers

Abstract

National population surveys and individual studies over the past decade have documented the escalating abuse of a variety of prescription medications, particularly prescription opioids. Although surveillance data provide important information for estimating the prevalence of prescription opioid abuse in the general population, studies documenting the patterns of prescription drug abuse among chronic street-drug-using populations are extremely rare. This paper examines the abuse of prescription opioids among drug-involved street-based sex workers in Miami, Florida. The data for this study were drawn from an ongoing HIV intervention trial initiated in 2001, designed to test the relative effectiveness of two alternative HIV prevention protocols for this population. Participants in the study were recruited through traditional targeted sampling strategies, and complete data are available on 588 street-based sex workers. In terms of prescription drug abuse, 12.2 percent of the sample reported using at least one opioid analgesic in the past 90 days without having a legitimate prescription. Logistic regression analyses were conducted to examine the associations between prescription opioid abuse and its predictors. In the multivariate model, factors positively associated with prescription opioid abuse included: Caucasian race (OR = 2.53; 95 percent CI 1.30 to 4.91), current powder cocaine use (OR = 2.28; 95 percent CI 1.28 to 4.08), current heroin use (OR = 2.08; 95 percent CI 1.10 to 3.92), 90-day physical abuse/victimization (OR = 2.07; 95 percent CI 1.18 to 3.61), and shorter sex-work involvement (OR = 1.98; 95 percent CI 1.13 to 3.48). In contrast, daily crack smoking was negatively associated with prescription opioid abuse (OR = 0.61; 95 percent CI 0.33 to 1.10). This study provides some of the first empirical evidence to indicate that prescription opioid abuse is emerging in a heretofore unstudied community of marginalized drug-using sex workers. In addition, data on this population’s mechanisms of access to prescription opioids clearly suggest that there is an active black market for these drugs. These findings warrant intensive study to determine the relative contribution of each mechanism of diversion to the illicit market.

Author Biographies

Hilary L. Surratt, PhD

Center for Drug and Alcohol Studies, University of Delaware, Coral Gables, Florida.

James A. Inciardi, PhD

Center for Drug and Alcohol Studies, University of Delaware, Coral Gables, Florida.

Steven P.q Kurtz, PhD

Center for Drug and Alcohol Studies, University of Delaware, Coral Gables, Florida.

References

Compton WM, Volkow ND: Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug Alcohol Depend. 2006; 81: 103-107.

Gilson AM, Ryan KM, Joranson DE, et al.: A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. J Pain Symptom Manage. 2004; 28(2): 176-188.

Miller NS, Greenfeld A: Patient characteristics and risk factors for development of dependence on hydrocodone and oxycodone. Am J Ther. 2004; 11(1): 26-32.

Zacny J, Bigelow G, Compton P, et al.: College on Problems of Drug Dependence taskforce on prescription opioid nonmedical use and abuse: Position statement. Drug Alcohol Depend. 2003; 69(3): 215-232.

Substance Abuse and Mental Health Services Administration and Office of Applied Studies: Results from the 2004 National Survey on Drug Use and Health: National Findings. NSDUH Series H-28, DHHS Publication No. SMA 05-4062. Rockville, MD: Office of Applied Studies, 2005.

Substance Abuse and Mental Health Services Administration and Office of Applied Studies: Treatment Episode Data Set (TEDS) 1992-2002. National Admissions to Substance Abuse Treatment Services DASIS Series: S-23, DHHS Publication No. (SMA) 04-3965. Rockville, MD: Office of Applied Studies, 2004.

Kurtz SP, Inciardi JA, Surratt HL, et al.: Prescription drug abuse among ecstasy users in Miami. J Addict Dis. 2005; 24(4): 1-16.

Inciardi JA, Surratt HL, Martin SS, et al.: Prevalence of narcotic analgesic abuse among students: Individual or polydrug abuse? Arch Pediatr Adolesc Med. 2004; 158: 498-499.

Brands B, Blake J, Sproule B, et al.: Prescription opioid abuse in patients presenting for methadone maintenance treatment. Drug Alcohol Depend. 2004; 73: 199-207.

Iguchi MY, Handelsman L, Bickel WK, et al.: Benzo dia zepine and sedative use/abuse by methadone maintenance clients. Drug Alcohol Depend. 1993; 32(3): 257-266.

Vivian J, Saleheen H, Singer M, et al.: Under the counter: The diffusion of narcotic analgesics to the inner city street. J Ethn Subst Abuse. 2005; 4(2): 97-114.

Campbell CA: Prostitution, AIDS, and preventative health behavior. Soc Sci Med. 1991; 32(12): 1367-1378.

Goldstein PJ: Prostitution and Drugs. Lexington: Lexington Books, 1979.

Kilbourne AM, Herndon B, Anderson RM, et al.: Psychiatric symptoms, health services, and HIV risk factors among homeless women. J Health Care Poor Underserved. 2002; 13(1): 49-65.

Miller EM: Street Woman. Philadelphia, PA: Temple University Press, 1986.

Rosenberg MJ, Weiner JM: Prostitutes and AIDS: A Health Department priority? Am J Public Health. 1988; 78(4): 418-423.

Sterk CE: Cocaine and HIV seropositivity. Lancet. 1988; 1(8593): 1052-1053.

Sterk CE: Fast Lives: Women Who Use Crack Cocaine. Philadelphia, PA: Temple University Press, 1999.

Young AM, Boyd C, Hubbell A: Prostitution, drug use, and coping with psychological distress. J Drug Issues. 2000; 30(4): 789-800.

Inciardi JA, Pottieger AE, Forney MA, et al.: Prostitution, IV drug use, and sex for crack exchanges among serious delinquents: Risks for HIV infection. Criminology. 1991; 29: 221-235.

Surratt HL, Inciardi JA, Kurtz SP, et al.: Sex work and drug use in a subculture of violence. Crime Delinquency. 2004; 50(1): 43-59.

Watters JK, Biernacki P: Targeted sampling: Options for the study of hidden populations. Soc Probl. October 1989; 36(4): 416-430.

Coyle SL, Boruch RF, Turner CF: Evaluating AIDS Prevention Programs (expanded ed.). Washington, DC: National Academy Press, 1991.

Carlson RG, Wang J, Siegal HA, et al.: An ethnographic approach to targeted sampling: Problems and solutions in AIDS prevention research among injection drug and crack-cocaine users. Hum Organ. 1994; 53(3): 279-286.

Braunstein MS: Sampling a hidden population: Noninstitutionalized drug users. AIDS Educ Prev. 1993; 5(2): 131-139.

Inciardi JA, Surratt HL, McCoy HV: Establishing an HIV/AIDS intervention program for street drug users in a developing nation. J Drug Issues. 1997; 27(1): 173-193.

Latkin CA: Outreach in natural setting: The use of peer leaders for HIV prevention among drug users’ networks. Public Health Rep. 1998; 113(Suppl. 1): 151-159.

Levy JA, Fox SE: The outreach-assisted model of partner notification with IDUs. Public Health Rep. 1998; 113(Suppl. 1): 160-169.

Wiebel WW: Identifying and gaining access to hidden populations. In Lambert EY (ed.): The Collection and Interpretation of Data from Hidden Populations (NIDA Research Monograph), Vol 98. Rockville, MD: National Institute on Drug Abuse, 1990, pp. 4-11.

Wiebel WW: The Indigenous Leader Outreach Model. NIH Publication No. 93-3581. Rockville, MD: US Department of Health and Human Services, 1993.

Dowling-Guyer S, Johnson ME, Fisher DG, et al.: Reliability of drug-users’ self-reported HIV risk behavior and validity of self-reported recent drug use. Assessment. 1994; 1(4): 383-392.

Needle R, Weatherby NL, Chitwood DD, et al.: Reliability of self-reported HIV risk behaviors of drug users. Psychol Addict Behav. 1995; 9(4): 242-250.

Weatherby N, Needle RH, Cesari H, et al.: Validity of selfreported drug use among injection drug users and crack cocaine users recruited through street outreach. Eval Program Plann. 1994; 17: 347-355.

Elifson KW: The Georgia State Prostitution Inventory. Atlanta, GA: KW Elifson, 1990.

Hurwitz W: The challenge of prescription drug misuse: A review and commentary. Pain Medicine. 2005; 6(2): 152-161.

Passik SD: Responding rationally to recent reports of abuse/diversion of Oxycontin®. J Pain Symptom Manage. 2001; 21(5): 359-360.

Forgione DA, Neuenschwander P, Vermeer TE: Diversion of prescription drugs to the black market: What the States are doing to curb the tide. J Health Care Finance. 2001; 27(4): 65-78.

McCabe SE, Teter CJ, Boyd C: Medical use, illicit use, and diversion of abusable prescription drugs. J Am Coll Health. 2006; 54(5): 269-278.

Cicero TJ, Inciardi JA, Muñoz A: Trends in abuse of OxyContin® and other opioid analgesics in the United States: 2002-2004. Pain. 2005; 6(10): 662-672.

Simoni-Wastila L, Ritter G, Strickler G: Gender and other factors associated with the nonmedical use of abusable prescription drugs. Subst Use Misuse. 2004; 39(1): 1-23.

Inciardi JA, Goode JL: OxyContin and prescription drug abuse. Consumers’ Research. 2003; 86(7): 17-21.

Sharpe TT: Behind the Eight Ball: Sex for Crack Cocaine Exchange and Poor Black Women. Binghamton, NY: Haworth Press, 2005.

Inciardi JA, Lockwood D, Pottieger AE: Women and Crack-Cocaine. New York, NY: Macmillan, 1993.

Kurtz SP, Surratt HL, Kiley MC, et al.: Barriers to health and social services for street-based sex workers. J Health Care Poor Underserved. 2005; 16(2): 345-361.

Kurtz SP, Surratt HL, Inciardi JA, et al.: Sex work and “date” violence. Violence Against Women. 2004; 10(4): 357-385.

Grzybowski S: The black market in prescription drugs. Lancet. 2004; 264(Suppl. 1): s28-s29.

US Drug Enforcement Administration: DEA unveils international toll-free hotline to report illegal prescription drug sales and rogue pharmacies operating on the Internet. US Drug Enforcement Administration Web site. Available at www.usdoj.gov/dea/pubs/pressrel/pr121504.html. Accessed January 25, 2005.

Blumenschein K: Prescription drug diversion: Fraudulent tactics utilized in the community pharmacy. Am J Pharm Educ. 1997; 61: 184-188.

Office of National Drug Control Policy: U.S. drug prevention, treatment, enforcement agencies take on “doctor shoppers,” “pill mills.” US Office of National Drug Control Policy News & Public Affairs Web site. March 1, 2004, press release. Available at www.whitehousedrugpolicy.gov/news/press04/030104.html. Accessed January 25, 2005.

US Drug Enforcement Administration: DEA Briefs & Background, Drugs and Drug Abuse, State Factsheets: Florida. US Drug Enforcement Administration Web site. Available at www.usdoj.gov/dea/pubs/states/floridap.html. Accessed January 7, 2004.

Office of National Drug Control Policy: Snapshot: Miami, Florida. Pulse Check: Trends in Drug Abuse. 2004; 164-173.

Bogart JG, Stevens SJ, Hill RJ, et al.: Criminally involved drug-using mothers: The need for system change. Prison J. 2005; 85(1): 65-82.

Logan TK, Leukefeld CG: Sexual and drug use behaviors among female crack users: A multi-site sample. Drug Alcohol Depend. 2000; 58(3): 237-245.

Nyamathi AM, Stein JA, Bayley LJ: Predictors of mental distress and poor physical health among homeless women. Psychol Health. 2000; 15(4): 483-500.

Wechsberg WM, Lam WK, Zule WA, et al.: Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. Am J Public Health. 2004; 94(7): 1165-1173.