Making an even three consecutive posts on opiate abuse makes a week of it; this ought to be the last, unless further profound insights are hot-off-the-presses.
This study – actually a minor Research Letter in JAMA Internal Medicine – evaluates self-reported behavioral patterns in nonmedical drug use in the United States. This accompanies another study looking at the risk factors for unintentional opiate-related deaths, which, helpfully, adds a little context.
This survey extrapolates out to approximately 12 million nonmedical opiate users aged greater than 12 years in the United States. A slight majority of users were male, and most had annual incomes less than USD$50,000. Most interesting, however, is Table 2, which describes how the source of opiates varies with increasing frequency of use. Individuals who reported nonmedical use of opiates fewer than 30 days out of the year received their opiates predominantly for free from a friend or relative. As frequency of use increased, opiates were less frequently received from a friend for free – and more likely to be received from a physician or purchased from friends, family, or drug dealers. As the accompanying study notes, increasing prescription and increasing mean daily use of opiates were associated with increased risk of death – so it would appear the population at highest risk of death also has the greatest extent of physician contact for opiates.
But, just as important as it may be to evaluate an individual risk for opiate misuse when prescribing, it is also important to note the majority of nonmedical use was obtained via diversion activities. Every opiate prescribed enters an ecosystem of illicit exchange – presumably under-recognized by physicians, else I would expect far fewer prescriptions. Judicious – and sparing – use of opiates is far more likely to benefit society than harm.
“Sources of Prescription Opioid Pain Relievers by Frequency of Past-Year Nonmedical Use: United States, 2008-2011”
http://archinte.jamanetwork.com/article.aspx?articleid=1840031