How does availability of prescription opioids affect pain reliever abuse at the county level? an ecological study 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 abuse. Indiana's past-year prevalence rate for nonmedical pain reliever use was highest among young adults ages 18 to 25 (14.4%; 95% CI: 11.9-17.3) and surpassed the nation's rate (10.4%; 95% CI: 10.0-10.8). Research indicates that substance use may be linked to drug availability and social-environmental characteristics of the community. Methods: An ecological study to assess the impact of opioid availability and demographic characteristics on pain reliever abuse in Indiana was conducted; the county-level served as unit of analysis. We examined census information on gender, race, and age; INSPECT data (Indiana's prescription drug monitoring program) on the number of opioid prescriptions dispensed; and the Treatment Episode Data Set for prescription opioid abuse reported at treatment admission. Results: According to multiple linear regression analysis, our model (F_4,87= 14.94, p<0.0001) was significant in predicting over 40% of the variance in pain reliever abuse. Conclusion: Use of prescription opioids is a legitimate treatment for many conditions. However, availability of these drugs and certain demographics may contribute to the increasing number of abuse. Raising awareness among healthcare professionals and policies encouraging routine use of INSPECT prior to prescribing scheduled substances may reduce the prevalence of abuse, dependence, and diversion. These findings are based on multiple linear regression analysis. Within the next few weeks, we will conduct additional spatial analyses to get a better understanding of the risk at the county-level.