OxyContin® use and misuse in three populations: Substance abuse patients, pain patients, and criminal justice participants

Martha J. Wunsch, MD; Karen L. Cropsey, PsyD; Eleanor D. Campbell, MS; Janet S. Knisely, PhD

doi:10.5055/jom.2008.0011

Authors

Martha J. Wunsch, MD
Karen L. Cropsey, PsyD
Eleanor D. Campbell, MS
Janet S. Knisely, PhD

DOI:

https://doi.org/10.5055/jom.2008.0011

Keywords:

prescription medication misuse and abuse, OxyContin (TM), pain patients, criminal justice, substance abuse

Abstract

Objective: This study was designed to describe and compare individuals in rural Appalachia prescribed, abusing or diverting OxyContin® a region with high rates of prescription medication abuse and misuse.
Setting and Participants: Fifty subjects treated for OxyContin®abuse, 34 subjects prescribed OxyContin®for pain and 50 subjects incarcerated due to OxyContin®-related charges from rural Appalachia.
Interventions: The Addiction Severity Index, DSM-IV Checklist, and an investigator developed questionnaire were administered to all three groups.
Results: All three groups included individuals prescribed OxyContin® for pain and demographic variables and psychiatric/medical histories failed to discriminate between the pain and substance abuse (SA) subjects. SA and criminal justice subjects were significantly more likely to have a current DSM-IV diagnosis of psychoactive abuse/dependence and more likely to be younger and unmarried.
Conclusion: This study found that these groups are not distinct and in depth evaluations, including a detailed SA history, are needed to identify the pain patient at risk for abuse and/or diversion of prescribed opioids.

Author Biographies

Martha J. Wunsch, MD

Addiction Medicine, Edward Via Virginia College of Osteopathic Medicine, Blacksburg, Virginia.

Karen L. Cropsey, PsyD

Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, West Birmingham, Alabama.

Eleanor D. Campbell, MS

Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia. Janet S. Knisely, PhD, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia.

Janet S. Knisely, PhD

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia.

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.

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: 215-232.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Overview of Findings from the 2003 National Survey on Drug Use and Health (NSDUH Series H-24, DHHS Publication No. SMA 04-3963). Rockville, MD, 2004.

Substance Abuse and Mental Health Services Administration, 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, ME, 2005.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Results from the 2005 National Survey on Drug Use and Health: National Findings (NSDUH Series H-30, DHHS Publication No. SMA 06-4194). Rockville, MD, 2006.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Treatment Episode Data Set (TEDS). Highlights–2005. National Admissions to Substance Abuse Treatment Services (DASIS Series: S-36, DHHS Publication No. SMA 07-4229). Rockville, MD, 2006.

Wesson DR, Ling W, Smith DE: Prescription of opioids for treatment of pain in patients with addictive disease. J Pain Symptom Manage. 1993; 8: 289-296.

Reid MC, Engles-Horton LL, Weber MB, et al.: Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med. 2002; 17: 173-179.

Compton P, Darakjian J, Miotto K: Screening for addiction in patients with chronic pain and “problematic” substance use: Evaluation of a pilot assessment tool. J Pain Symptom Manage. 1998; 16: 355-363.

Cowan DT, Allan L, Griffiths P: A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients. Int J Nurs Stud. 2002; 39: 59-69.

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.

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

Cowan DT, Wilson-Barnett J, Griffiths P, et al.: A survey of chronic noncancer pain patients prescribed opioid analgesics. Pain Med. 2003; 4: 340-351.

Kouyanou K, Pither CE, Wessely S: Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res. 1997; 43: 497-504.

Chabal C, Erjavec MK, Jacobson L, et al.: Prescription opiate abuse in chronic pain patients: Clinical criteria, incidence, and predictors. Clin J Pain. 1997; 13: 150-155.

Ives TJ, Chelminski PR, Hammett-Stabler CA, et al.: Predictors of opioid misuse in patients with chronic pain: A prospective cohort study. BMC Health Services Res. 2006; 6: 46.

Manchikanti L, Cash KA, Damron KS, et al.: Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables. Pain Phys. 2006; 9: 215-225.

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

McCabe SE, Boyd CJ, Teter CJ: Illicit use of opioid analgesics by high school seniors. J Substance Abuse Treat. 2005; 28: 225-230.

Sees KL, Di Marino ME, Ruediger NK, et al.: Non-medical use of OxyContin® tablets in the United States. J Pain Palliative Care Pharmacother. 2005; 19: 13-23.

Passik SD, Hays L, Eisner N, et al.: Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation. J Pain Palliative Care Pharmacother. 2006; 20: 5-13.

Hays LR: A profile of OxyContin addiction. J Addict Dis. 2004; 23: 1-9.

Havens JR, Talbert JC, Walker R, et al.: Trends in controlledrelease oxycodone (OxyContin) prescribing among Medicaid recipients in Kentucky, 1998-2002. J Rural Health. 2006; 22: 276-278.

United States General Accounting Office: Prescription Drugs: Oxycontin abuse and diversion and efforts to address the problem. Available at http://www.gao.gov/new.items/d04110.pdf. Accessed December, 2006.

Massello W: Oxycodone deaths in Southwest Virginia, An epidemic problem. Presentation and Abstract. National Association of Medical Examiners 2001 Annual Meeting. Richmond VA.

McLellan AT, Luborsky L, Cacciola J, et al.: New data from the Addiction Severity Index: Reliability and validity in three centers. J Nervous Mental Dis. 1985; 173: 412-423.

Hudziak J, Helzer JE, Wetzel MW, et al.: The use of the DSMIIIR checklist for initial diagnostic assessments. Comprehensive Psychiatry. 1993; 34: 375-383.

Potter JS, Hennessy G, Borrow JA, et al.: Substance use histories in patients seeking treatment for controlled-release oxycodone dependence. Drug Alcohol Depend. 2004; 76: 213-215.

Mumola CJ: Substance Abuse and Treatment, State and Federal Prisoners, 1997. U.S. Department of Justice, Bureau of Justice Statistics. (NCJ 172871).

Hojsted J, Sjogren P: Addiction to opioids in chronic pain patients: A literature review. Eur J Pain. 2007; 11: 490-518.

Conway KP, Compton W, Stinson FS, et al.: Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006; 67: 247-257.

Fazel S, Danesh J: Serious mental disorders in 23,000 prisoners: A systematic review of 62 surveys. Lancet. 2002; 319: 545-550.

Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment (ECA) Study. JAMA. 1990; 264: 2511-2518.

Johnson ME, Brems C, Burke S: Recognizing comorbidity among drug users in treatment. Am J Drug Alcohol Abuse. 2002; 28: 243-261.

Ross HE, Glaser FB, Germanson T: The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry. 1988; 45: 1023-1031.

Brooner RK, King VL, Kidorf M, et al.: Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry. 1997; 54: 71-80.

Rounsaville BJ, Weissman MM, Crits-Christoph K, et al.: Diagnosis and symptoms of depression in opiate addicts. Course and relationship to treatment outcome. Arch Gen Psychiatry. 1982; 39: 151-156.

Rounsaville BJ, Weissman MM, Kleber H, et al.: Heterogeneity of psychiatric diagnosis in treated opiate addicts. Arch Gen Psychiatry. 1982; 39: 161-166.

Katon W, Egan K, Miller D: Chronic pain: Lifetime psychiatric diagnoses and family history. Am J Psychiatry. 1985; 142: 1156-1160.

Ballantyne JC, LaForge KS: Opioid dependence and addiction during opioid treatment of chronic pain. Pain. 2007; 129: 235-255.

Manchikanti LJ, Giordano J, Boswell MV, et al.: Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Opioid Manage. 2007; 3: 89-100.

Knisely K, Wunsch MJ, Cropsey KL, et al.: Prescription opioid misuse index: A brief questionnaire to assess misuse. J Substance Abuse Treat (in press).