Gender-specific patterns for prescription opiate use in u.s. emergency departments

Background: Non-medical use of prescription opiates is a major public health problem and a frequent cause of emergency department (ED) visits. Differences between men and women in a variety of aspects of alcohol and drug use suggest a gender-specific approach to screening and interventions may be most effective. Objective: To describe differences between men and women in ED presentations for prescription opiate misuse. Methods: We used data from the 2010 SAMHSA Drug Abuse Warning Network, a national surveillance system of U.S. hospitals. Adjusting for complex study design, we calculated descriptive statistics on visits involving prescription opiates. Associations between gender and specific combinations of drug misuse were examined using multivariable logistic regression, adjusting for age, race, and alcohol use. Results: Of 250,136 visits, 22% involved prescription opiates, 17% illicit drugs, 5% antidepressants, 4% stimulants, 14% anxiolytics. Overall prescription opiate use did not differ between men (23%, 95% CI 20-27) and women (21%, 95% CI 19-24); however, in multivariable analysis, male gender was associated with increased odds of using prescription opiates alone (aOR 1.13, 95% CI 1.02-1.25) or in combination with illicit drugs (aOR1.85, 95% CI 1.33-2.58) and decreased odds of using prescription opiates with antidepressants (aOR 0.53, 95% CI 0.40-0.71). Conclusions: In a national sample of drug-related ED visits, prescription opioid misuse was associated with antidepressant use in women and illicit drug use in men, supporting the notion of gender-based differences in motivations for and patterns of use. Future SBIRT to address prescription opiate misuse may benefit from a gender-specific approach.