Paper
Discordant reporting of nonmedical opioid use
Published Jan 2, 2017 · X. Ruan, S. Chiravuri, A. Kaye
The American Journal of Drug and Alcohol Abuse
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Abstract
We read with interest the article by Palamar and colleagues (1), published in The American Journal of Drug and Alcohol Abuse. The authors aimed to study the prevalence and correlates of discordant self-reporting of nonmedical use of opioids in a national sample. They utilized a nationally representative sample of 31,149 American high school seniors in the Monitoring the Future study (2009–2013), and discordant responses between self-reported 12-month nonmedical opioid use and self-reported 12-month nonmedical Vicodin and OxyContin use (reporting Vicodin/OxyContin use, but not reporting “opioid” use) were assessed. The authors found that 37.1% of those reporting nonmedical Vicodin use and 28.2% of those reporting nonmedical OxyContin use did not report overall nonmedical opioid use. Prevalence of nonmedical opioid use (8.3%) would increase when factoring in Vicodin, OxyContin, or both, by 2.8%, 1.3%, and 3.3%, respectively. Palamar et al. have concluded that the relevance of nonmedical opioid use may be underreported, particularly among specific subpopulations (1). Palamar et al. stated “According to the National Survey on Drug Use and Health (NSDUH), Vicodin appears to be the most prevalent opioid used in a nonmedical manner in the US, used by an estimated 14.2% of adults aged 18–25 in 2013 (Ref. 8).” Interestingly and surprisingly, we could not find, even once, the word “Vicodin” in the cited reference. Nor could we find words like “Norco,” “Lortab,” or “hydrocodone” in the cited reference. We wonder where the statement “Vicodin appears to be the most prevalent opioid used in a nonmedical manner in the US, used by an estimated 14.2% of adults aged 18–25 in 2013” originated from? McCabe et al. (2) found that, in high school seniors in the US, an estimated 80% of nonmedical users had an earlier history of medical use and had obtained opioids from a prescription written by their medical providers. They also found that odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. Palamar et al. used multivariable logistic regression to determine the characteristics of students who were most likely to provide a discordant response (1). Characteristics such as age, sex, race, and religiosity, etc., were weighted in the study. However, we wonder whether earlier history of medical use of opioids should have been weighted as well in their study? Young et al. (3) conducted a survey in 2579 7th–12th grade students to study nonmedical use of prescription medications by identifying distinguishing characteristics of two subtypes of adolescent nonmedical users of prescription opioids. The authors found that sensationseeking nonmedical users were best characterized by rule breaking and aggressive behaviors and possible substance dependence. Medical users and nonmedical self-treating users were best characterized by somatic complaints, anxiety/depressive symptoms, and history of sexual victimization (3). Young et al. found that approximately 14% (n = 373) of the sample reported medical use of prescription opioids in the past 12 months, while 5% (n = 148) of the sample reported nonmedical use of prescription opioids in the past 12 months. The most common reason for nonmedical use was “to relieve pain” (n = 91, 62.8%), followed by “to get high” (n = 23, 15.9%) and “to experiment” (n = 16, 11.0%) (3). To this end, we wonder what percentage of the students reported in the study of Pamalar et al. were actually using prescription opioids, including Oxycontin and Vicodin for underlying pain? Last, Palamar et al. cited their earlier work showing that frequent nonmedical opioid use is associated with increased risk for heroin initiation (4). However, Compton and colleagues (5) recently published a review article in the NEJM, pointing out that only a small fraction of nonmedical prescription opioid users initiate heroin use. Compton et al. conclude that the available data suggest that the nonmedical use of prescription opioid is neither necessary nor sufficient for the initiation of heroin
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