Does Drug Availability and Social Disadvantage Drive Nonmedical Prescription Drug Use in Indiana

Background: Nonmedical prescription drug use has become an emerging public health problem in the United States. Particularly, pain relievers (opioids) have a high potential for misuse and abuse. Indiana's past-year prevalence rate for nonmedical opioid use (6.04%; 95% CI: 4.96-7.33) surpassed the nation's rate (4.89%). In 2008, over 6.1 million opioid prescriptions were dispensed to Indiana residents, representing a per capita rate of 0.96 (county-level rates ranged from 0.45 to 1.75); nonmedical use of prescription opioids was reported in 3,762 treatment episodes, representing a rate of 0.59 per 1,000 residents (county-level rates ranged from 0.06 to 1.99). Research indicates that substance use may be linked to drug availability and social-environmental characteristics of the community. Methods: To assess the relationship between social disadvantage, availability of prescription opioids, and abuse thereof, the Indiana SEOW examined population characteristics from the American Community Survey; dispensation of controlled substances from the INSPECT program; and reported prescription pain reliever use from the Treatment Episode Data Set. Results: According to multiple regression analysis both opioid dispensation and a community's poverty level significantly predicted opioid abuse at the county level (adjusted R2=0.49, F2,89=43.92, p<0.001;). Conclusion: Use of prescription opioids is legitimate and necessary for treating many conditions. However, easy accessibility of these drugs and certain community characteristics may contribute to the increasing number of abuse cases. Policies encouraging use of the INSPECT database by healthcare providers prior to prescribing scheduled drugs may help identify patients potentially at risk for prescription drug abuse, dependence, or diversion.