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The aim was to examine prevalence of past 30-day prescription stimulant nonmedical use (NMU) by adults assessed for substance use problems and to better understand patterns of route of administration (ROA) and drug problem severity. Data were collected from a computer administered assessment of substance use problems completed by adults (age ≥ 18) using the Addiction Severity Index-Multimedia Version (ASI-MV

Objective: To examine abuse prevalence for OxyContin and comparator opioids over a 6-year period prior to and following market entry of reformulated OxyContin and assess consistency in abuse across treatment settings and geographic regions. Design: An observational study examining longitudinal changes using cross-sectional data from treatment centers for substance use disorder. Setting: A total of 874 facilities in 39 states in the United States within the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO ® ) surveillance system. Participants: Adults (72,060) assessed for drug problems using the Addiction Severity Index-Multimedia Version (ASI-MV ®) from January 2009 through December 2015 who abused prescription opioids. Main outcome measure(s): Percent change in past 30-day abuse. Results: OxyContin had significantly lower abuse 5 years after reformulation compared to levels for original OxyContin. Consistency of magnitude in OxyContin abuse reductions across geographic regions, ranging from 41 to 52 percent with differences in abuse reductions in treatment setting categories occurred. Changes in geographic region and treatment settings across study years did not bias the estimate of lower OxyContin abuse through confounding. Conclusion: In the postmarket setting, limitations and methodologic challenges in abuse measurement exist and it is difficult to isolate singular impacts of any one intervention given the complexity of prescription opioid abuse. Expectations for a reasonable threshold of abuse for any one ADF product or ADF opioids as a class are still uncertain and undefined. A significant decline in abuse prevalence of reformulated OxyContin was observed 5 years after its reformulation among this treatment sample of individuals assessed for substance use disorder that was lower historically for the original formulation of this product.

Objective Formulating prescription opioids to limit abuse remains a priority. OROS extended-release (ER) hydromorphone HCl (EXALGO) may have lower abuse potential than many other opioid products. Three postmarketing studies of the relative abuse liability of OROS hydromorphone ER were conducted. Methods Estimates of abuse, unadjusted, and adjusted for prescription volume, were generated for OROS hydromorphone ER and comparators from Q2 2010 through Q2 2014 for a high-risk, substance abuse treatment population and the general population using poison control center data. Comparators were selected for compound, market penetration, and route of administration (ROA) profile. ROA comparisons were made among the substance abuse treatment population. Internet discussion was examined to determine abusers' interest in and desire for the OROS formulation. Results Examination of abuse prevalence among adults within substance abuse treatment, intentional poison exposures, and Internet discussion levels generally support the hypothesis that OROS hydromorphone ER may have lower abuse potential than many other opioid products. OROS hydromorphone ER also seems to be abused less often by alternate ROAs (eg, snorting and injection). Lower levels of online discussion were observed along with relatively low endorsement for abuse. Discussion Abuse of OROS hydromorphone ER was observed in high-risk substance abuse and general population samples but at a very low relative prevalence compared to comparators. Evidence suggests it may be less often abused by alternate ROAs than some comparators. Online data did not find evidence of high levels of desire for OROS hydromorphone ER by recreational abusers. Continued monitoring of this product's abuse liability is warranted.

We examined the feasibility of Aging Well by Design, a Lifestyle RedesignCommunity-dwelling older adults participated in the 12-wk program, which emphasized an occupational approach to healthy aging. Outcomes evaluated were recruitment, attendance, resource use, participant satisfaction, and subjective benefit to participants.The 13 participants, ages 66-88 yr, attended an average of 10 of 12 sessions. The intervention was completed as planned, physical resources were suitable, and financial resources were adequate. Participants expressed satisfaction with the program's facilitator, group discussions, and materials. Perceived benefits were social relationships, awareness of community resources, and change in attitude toward aging.Implementation of a 3-mo Lifestyle Redesign-inspired program within a health care system was feasible.

Oxycodone hydrochloride controlled-release, also known as extended-release oxycodone (ER oxycodone), was reformulated with physicochemical barriers to crushing and dissolving intended to reduce abuse through nonoral routes of administration (ROAs) that require tampering (eg, injecting and snorting). Manufacturer shipments of original ER oxycodone (OC) stopped on August 5, 2010, and reformulated ER oxycodone (ORF) shipments started August 9, 2010. A sentinel surveillance sample of 140,496 individuals assessed for substance abuse treatment at 357 U.S. centers between June 1, 2009, and March 31, 2012, was examined for prevalence and prescription-adjusted prevalence rates of past-30-day abuse via any route, as well as abuse through oral, nonoral, and specific ROAs for ER oxycodone and comparators (ER morphine and ER oxymorphone) before and after ORF introduction. Significant reductions occurred for 8 outcome measures of ORF versus OC historically. Abuse of ORF was 41% lower (95% CI: −44 to −37) than historical abuse for OC, with oral abuse 17% lower (95% CI: −23 to −10) and nonoral abuse 66% lower (95% CI: −69 to −63). Significant reductions were not observed for comparators. Observations were consistent with the goals of a tamper resistant formulation for an opioid. Further research is needed to determine the persistence and generalizability of these findings. Perspective This article presents preliminary findings indicating that 8 outcome measures of abuse of a reformulated ER oxycodone were lower than that for original ER oxycodone historically, particularly through nonoral ROAs that require tampering (ie, injection, snorting, smoking), in a sentinel sample of individuals assessed for substance use problems for treatment planning.

Objective: To determine what, if any, public health and societal impacts are associated specifically with injection of prescription opioids. Design: Cross-sectional observational study. Setting: Five hundred forty treatment facilities in 35 states across the United States performing Addiction Severity Index-Multimedia Version (ASI-MV) assessments. Participants: Adult patients (29,459) who reported past 30-day abuse of any prescription opioid on the ASI-MV assessment between January 2007 and January 2011. Main outcome measures: The public health indicators selected for this study were liver disease, HIV/AIDS status, recent visit to an emergency room, treatment for pain, treatment for overdosing, homelessness, residence with alcohol/substance abuser, and unemployment. Results: Prescription opioid injection was significantly associated with health problems, psychosocial problems, and utilization of medical services. Conclusions: This study demonstrates an approach to measure the potential impact of injecting prescription opioids on public health indicators. Findings indicate a positive association between injection of prescription opioids and public health indicators suggesting a need for prescription opioid formulations that may inhibit injection of these medications. Keywords: prescription drug injection, public health, correlates DOI:10.5055/jom.2013.0142

Purpose Prescriptions for hydrocodone immediate-release (IR) combination products have recently decreased, yet they represent the majority of opioid prescriptions dispensed and are commonly abused analgesics among both adults and adolescents. Little data exist to understand the contribution of IR products to the problem of prescription opioid abuse. This study aimed to better understand abuse patterns for hydrocodone IR combination products among adult and adolescent substance abusers. Methods This cross-sectional study examines abuse prevalence (including abuse adjusted for prescription volume and morphine milligram equivalents) and abuse characteristics for hydrocodone IR combination products and other prescription opioids among separate samples of adults and adolescents assessed for substance abuse problems or entering treatment from January 2012 through June 2015. Results Results indicate higher abuse for hydrocodone IR combination products than other opioid categories per 100 assessments but lower per prescriptions dispensed. Hydrocodone IR combination products had similar abuse prevalence to all extended-release and long-acting opioids when considering abuse measured per morphine milligram equivalents dispensed. An upward trend in hydrocodone IR combination product abuse was observed among adult substance abusers comparing the period prior to and after Drug Enforcement Administration rescheduling of these products in October 2014. Most individuals reported oral abuse of hydrocodone IR combination products, but snorting, reported by 23% of hydrocodone IR combination product abusers, also appears to be a route of abuse that may have public health relevance. Conclusions Given their high prescription volume, hydrocodone IR combination products, even at a relatively low prevalence of abuse, may contribute substantially to the overall problem of prescription opioid abuse. Additional public health interventions, including development of abuse-deterrent formulations for these types of opioid products may aid in reducing their abuse. KEY POINTS While the number of prescriptions for hydrocodone IR combination products has recently decreased, these products still represent the majority of opioid prescriptions dispensed in the United States and are commonly abused by both adults and adolescents. Lifetime abuse of immediate-release opioids is at least as prevalent as abuse of extended-release opioid products, but little data exist to understand their contribution to the problem. Postmarket surveillance data were used to examine patterns in abuse prevalence and ROA for hydrocodone IR combination products among 2 high-risk populations of adults and adolescents assessed for substance abuse treatment. Abuse prevalence was higher for hydrocodone IR combination products than other opioid categories but was lower than other opioid categories per prescriptions dispensed. Hydrocodone IR combination products had similar abuse prevalence to all ER/LA opioids when considering abuse measured per MME dispensed. Most individuals reported oral abuse of hydrocodone IR combination products, but snorting, reported by 23% of hydrocodone IR combination product abusers, also appears to be a route of abuse that may have public health relevance. These findings suggest that given their high prescription volume, hydrocodone IR combination products, even at a relatively low prevalence of abuse, may contribute substantially to the overall problem of prescription opioid abuse.

Objective The reformulation of oxycodone hydrochloride controlled-release (CR) tablets in August 2010 created a natural experiment at a national scale, providing an opportunity to evaluate patterns of abuse of prescription opioids and other drugs before and after introduction of this abuse-deterrent formulation (ADF). Design Observational, cross-sectional study Setting Sentinel sample of adults assessed for substance abuse treatment within the NAVIPPRO® surveillance system Subjects Two hundred thirty-two thousand and eight hundred seventy-four adults at 437 facilities during January 1, 2008 through December 31, 2011. Methods Time-series analysis using logistic regression to estimate quarterly prevalence of past 30-day abuse (adjusted for covariates and prescription volume) and changes in abuse pre-and post-ADF introduction. Results Increases in abuse prevalence occurred for all prescription opioids as a class and for extended-release (ER) opioids. Significantly greater abuse of ER oxymorphone and buprenorphine occurred in the post-ADF period (relative risk [RR] = 2.91, 95% confidence interval [CI] = 2.59–3.27 and RR = 1.85, 95% CI = 1.74–1.96). Increases in abuse for these two compounds were significant among groups who reported abuse via preferential routes of administration (oral only, snorting only, injection only) post-ADF introduction. Conclusions Replacement of a widely prescribed opioid formulation known for its abuse potential alone may have had little impact on overall rates of prescription opioids as a class. However, changes in abuse levels of certain opioids coinciding with ADF introduction suggest possible switching of abuse among this study sample to specific long-acting opioid analgesics. Additional follow-up studies will be important to monitor changing abuse patterns and their public health impact as new opioid formulations are developed and introduced to market.

Objective: To examine nonmedical use (NMU) of prescription ADHD stimulants among adults evaluated for substance abuse treatment. Method: 147,816 assessments from the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) system (10/01/2009 through 03/31/2012) examined NMU prevalence, routes of administration (ROA), and diversion sources. Results: Past 30-day NMU for prescription stimulants (1.29%) was significantly lower than that of prescription opioids (19.79%) or sedatives (10.62%). For stimulant products, NMU for Adderall was 0.62, followed by Adderall XR (0.42), Ritalin (0.16), Vyvanse (0.12), and Concerta (0.08); product differences likely have limited clinical relevance given the low estimates (

Objective: Evaluate nonmedical use (NMU) of ADHD prescription stimulants (Ritalin®, Adderall®, Adderall®XR, Concerta®, and Vyvanse®) in a U.S. adult general population sample. Method: In all, 10,000 adults (aged 18-49) from an online, opt-in panel, proximity matched to U.S. Census demographics, were surveyed to assess NMU prevalence, routes of administration (ROA), reasons for NMU, and diversion source. Results: Lifetime NMU of any prescription drug was 35.1%, pain medications (24.6%), sedatives/tranquilizers (15.6%), sleep medications (9.9%), and prescription stimulants (8.1%). Within the prescription stimulants, rates of NMU (per 100,000 prescriptions dispensed) were 1.62 for Ritalin and 1.61 for Adderall followed by Adderall XR (0.62), Concerta (0.19), and Vyvanse (0.13). Respondents used stimulants mostly for wakefulness and performance enhancement, obtained the drugs from family/friends, and used oral ROA. Conclusion: NMU of ADHD prescription stimulants were low compared with other prescription medications. While prevalence of NMU was higher for immediate-release than extended-release ADHD medications, absolute rates for prescription stimulants were low.

Understanding the spatial distribution of opioid abuse at the local level may facilitate public health interventions.Using patient-level data from addiction treatment facilities in New Mexico from ASI-MV Connect, we applied geographic information system (GIS) in combination with a spatial scan statistic to generate risk maps of prescription opioid abuse and identify clusters of product- and compound-specific abuse. Prescribed opioid volume data was used to determine whether identified clusters are beyond geographic differences in availability.Data on 24 452 patients residing in New Mexico were collected. Among those patients, 1779 (7.3%) reported abusing any prescription opioid (past 30 days). According to opioid type, 979 patients (4.0%) reported abuse of any hydrocodone, 1007 (4.1%) for any oxycodone, 108 (0.4%) for morphine, 507 (2.1%) for Vicodin or generic equivalent, 390 (1.6%) for OxyContin, and 63 (0.2%) for MS Contin or generic equivalent. Highest rates of abuse were found in the area surrounding Albuquerque with 8.6 patients indicating abuse per 100 interviewed patients. We found clustering of abuse around Albuquerque (P = 0.001; Relative Risk = 1.35, and a radius of 146 km). At the compound level, we found that drug availability was partly responsible for clustering of prescription opioid abuse. After accounting for drug availability, we identified a second foci of Vicodin abuse in the southern rural portion of the state near Las Cruces, NM and El Paso, Texas and bordering Mexico (RR = 2.1; P = 0.001).A better understanding of local risk distribution may have implications for response strategies to future introductions of prescription opioids.

Purpose The National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO™) is a scientific, comprehensive risk management program for scheduled therapeutics. NAVIPPRO™ provides post-marketing surveillance, signal detection, signal verification and prevention and intervention programs. Here we focus on one component of NAVIPPRO™ surveillance, the Addiction Severity Index-Multimedia Version® (ASI-MV®) Connect, a continuous, real-time, national data stream that assesses pharmaceutical abuse by patients entering substance abuse treatment by collecting product-specific, geographically-detailed information. Methods We evaluate population characteristics for data collected through the ASI-MV® Connect in 2007 and 2008 and assess the representativeness, geographic coverage, and timeliness of report of the data. Analyses based on 41 923 admissions to 265 treatment centers in 29 states were conducted on product-specific opioid abuse rates, source of drug, and route of administration. Results ASI-MV® Connect data revealed that 11.5% of patients reported abuse of at least one opioid analgesic product in the 30 days prior to entering substance abuse treatment; differences were observed among sub-populations of prescription opioid abusers, among products, and also within various geographic locations. Conclusions The ASI-MV® Connect component of NAVIPPRO™ represents a potentially valuable data stream for post-marketing surveillance of prescription drugs. Analyses conducted with data obtained from the ASI-MV® Connect allow for the characterization of product-specific and geospatial differences for drug abuse and can serve as a tool to monitor responses of the abuse population to newly developed “abuse deterrent” drug formulations. Additional data, evaluation, and comparison to other systems are important next steps in establishing NAVIPPRO™ as a comprehensive, post-marketing surveillance system for prescription drugs. Copyright © 2008 John Wiley & Sons, Ltd.

Aims: To compare data on the prevalence of illicit drug use collected in an online national survey of non-medical use of prescription medicine and the Crime Survey for England and Wales (CSEW). Methods: The online national survey was undertaken in July 2014 using amarket research company. Data included in this study were demographics and the prevalence of illicit drug use in those aged 16–59 years residing in England or Wales (n=1594). CSEW is an annual household survey in England and Wales; the 2013/14 CSEW included 34,906 respondents aged 16–59 years. Lifetime and last year prevalence of illicit drug use was compared between the whole groups and in young adults (16–24 years). Results: Prevalence of use of illicit drugs in the online national survey and CSEW were similar for the whole groups (lifetime use: online survey 32.6%, CSEW35.6%. Last year use: online survey 8.6%, CSEW 8.8%) and young adults (lifetime use: online survey 31.4%, CSEW 36.3%. Last year use: online survey 15.0%, CSEW 18.9%). For lifetime use, cannabis was the most common drug in each data source (23.7% and 29.9%), amphetamines was the second (9.7% and 11.1%) and any cocaine was the third (8.2% and 9.5%). Conclusions: The prevalence of use of illicit drugs was similar in the online national survey and the CSEW. The comparability of these findings demonstrates the feasibility of using an online survey administered with a market research company to obtain data comparable to the well-established household CSEW with a considerably smaller sample. This methodology could be used to further explore aspects of illicit drug use and non-medical use of prescription medicines. Financial support: The RADARS® System is part of Denver Health and Hospital Authority, a division of the state of Colorado. It is supported by subscriptions from pharmaceutical manufacturers.

Aims: Colorado (CO) passed laws approving medical marijuana in 2000 and legal recreation use of marijuana in 2012. Using data from individuals 18 and older from the Addiction Severity Index Multimedia Version (ASI-MV) post-marketing surveillance system, we assessed trends in initiation and prevalence of marijuana use in CO from 2008 to 2014. Methods: Data included unique responses from 13,945 clients being assessed with the ASI-MV for treatment need in 35 CO substance abuse treatment centers from January 1, 2008 to September 30, 2014. Descriptive statistics and generalized estimating equation models explored trends over time in past year initiation and prevalence of marijuana use, controlling for age, gender, race, and 3-digit ZIP code. We also tested for associations with nonmedical prescription opioid use (NMPU). Results: 48% of respondents were under 34, 40% were female, 51%were non-Whiteminority, and the primary substance of abuse was 45.2% alcohol, 14.7% marijuana, 11.5% cocaine, 7.1% prescription opioids, and 6.8% heroin. There was no statistically significant increase in initiation of marijuana use over the study period. Initiation was 12.2% (95% CI: 3.4%, 35.6%) in Q12008 and 17.8% (95% CI: 13.4%, 23.4%) in Q32014. Initiationwas associated (all p< .0005) with younger age (adjusted odds ratio (aOR) 3.53 for

Background Self-report of nonmedical prescription opioid use (NMPU) is a cornerstone of drug abuse surveillance, policymaking, and treatment service planning, but misclassification creates bias and may confuse or undermine NMPU estimates [1]. We detected old OxyContin (OC) abuse reports long after a reformulated version (OP) was released (August 2010). This study explored sources of possible NMPU misclassification and proposed solutions. Materials and methods A mixed-methods approach identified demographic, behavioral, and cognitive factors influencing endorsement of old formulations in: a) multivariable regression analyses of NMPU data from the ASI-MV surveillance program [2] examined predictors of endorsing old (vs. new) formulations during the post-reformulation period (n = 8032); b) prevalence estimates of OC availability from an online recreational drug user forum survey (fall 2013; n = 459); and c) semistructured interviews (n = 29) and cognitive interviews (n = 7) among residential and outpatient substance abuse treatment program clients reporting past 2-year use of OC/OP. A coding guide identified patterns and themes of misidentification in transcribed interviews.