Prescription drug misuse (PDM), defined as use without a prescription or solely for the feeling or experience caused by the drug, has become a popular topic among substance use researchers. While the vast majority of studies on the topic tackle epidemiological questions surrounding PDM, there is a notable lack of studies that look specifically at risk factors rooted in sociological/criminological theories. The current research seeks to bridge this gap in the literature by examining theoretically based explanations for PDM among college students utilizing three criminological theories commonly applied to other forms of substance use: Social Learning Theory, Social Bonding/Control theory, and General Strain Theory. In addition, this study also seeks to examine differences in user types characterized by motives for misuse as they relate to predictors stemming from these theories of interest. Utilizing an independently collected sample of 841 college undergraduates from a large southern university, the findings show that nearly one in four students misused prescription drugs in the past semester. Motivations for PDM were primarily instrumental in nature, with very few respondents misusing solely for recreational purposes. Furthermore, social learning based risk factors could best account for PDM within the sample with partial and indirect supports also found for strain based risk factors as well. Implications of these findings as well as theoretical and practical applications are presented.

The production and approval process for the various labels used in clinical trials wastes significant time and resources through the need to outsource label production or rely on large reams of pre-cut label stock for each revision throughout the process. An in-house, on-demand label printing and cutting system is a potential remedy to this waste. Previous work by Cheadle et al. resulted in a functional electomechanical prototype of the label cutting aspect of this research, capable of rudimentary linear cuts. In this continued research, emphasis was placed on improved label cutting capabilities and creating PC control software for label design. Cutting operations were enhanced through the development of an algorithm for circular cuts, proportional motor control, and a prototype graphical user interface (GUI) for simple user control. The changes to cutting methods have improved linear cutting precision to an average of 0.00402-in (s = 0.00602-in, n=26) at minimum. The new method for circular cuts has an average precision of 0.04384-in (s = 0.01471-in, n=26). The target precision for cuts is 0.040-in, suggesting that linear cuts are satisfactory, but circular cuts must still be refined. The prototype user interface developed for this research is capable of driving the label cutting system through RS232 communication and exposes all functionality of the system to date. Overall, this research has enhanced the capabilities of the label cutting system significantly, but further work is required to realize a complete label production solution.

No description available.

No description available.

No description available.

No description available.

No description available.

This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted.

L’objectif de ce travail était d’analyser de manière conjointe différents indicateurs d’abus, de dépendance et de détournement de médicaments psychoactifs en conditions réelles d’utilisation issus de sources de données hétérogènes afin d’en présenter une vision synthétique. Les sources de données utilisées dans ce travail sont issues des outils et programmes des Centres d’Evaluation et d’Information sur la Pharmacodépendance – Addictovigilance (CEIP-A). Elles permettent de mesurer directement l’abus auprès de populations spécifiques de patients dépendants ou sous traitement de substitution par l’enquête OPPIDUM (Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse). Ces outils permettent aussi de mesurer le détournement via la mesure du nombre d’ordonnances falsifiées par l’enquête OSIAP (Ordonnances Suspectes, Indicateur d’Abus Possible) ainsi que la mesure du phénomène de « Doctor Shopping » (chevauchement d’ordonnances) et la mesure du nombre de patients présentant des comportements déviants (issu d’une analyse de classification) à partir de bases de données de remboursement de l’assurance maladie. Cette approche multi-sources a d’abord été appliquée à l’analyse de l’importance du détournement d’usage du clonazépam (Publication n°1). Ce travail a permis de mettre en évidence le détournement émergent du clonazépam et a surtout permis d’illustrer les difficultés à faire émerger cette information de manière cohérente et standardisée au travers des différentes sources de données. Ensuite, l’un des pré-requis d’un système de surveillance de l’abus et du détournement de médicaments étant de permettre d’étudier des tendances évolutives, nous avons proposé la méthode de classification visant à établir des profils de sujets déviants de manière à analyser l’évolution de détournement d’usage de méthyphénidate sur quatre années (Publication n°2). Cette méthode de classification a par la suite, été appliquée de manière conjointe à une méthode de mesure du « Doctor Shopping » pour étudier le détournement d’usage de la Buprenorphine Haut Dosage (BHD) dans la région PACA-Corse (Publication n°3). Cette étude nous a non seulement permis de mettre en évidence un problème important de détournement d’usage de la BHD mais elle nous a permis aussi de montrer la concordance entre ces deux méthodes (mesure du « Doctor Shopping » et méthode de classification) et d’évaluer leurs apports respectifs pour la surveillance de l’abus des médicaments. Ces deux méthodes ont par la suite été analysées de manière conjointe aux données issues des enquêtes OPPPIDUM et OSIAP pour permettre d’étudier et de comparer le détournement d’usage des médicaments de la famille des benzodiazépines (Publication n°4) et des opioïdes (Publication n°5). Cette approche multi-sources permet de limiter les biais inhérents à chaque méthode ou source prise isolément. L’ensemble de nos travaux met en exergue la pertinence d’un tel système pour évaluer l’abus d’un médicament mais aussi pour le comparer à d’autres substances. Néanmoins, le développement d’un tel système appliqué au domaine de la pharmacodépendance est relativement nouveau, et nécessite des améliorations tant dans l’intégration d’autres sources de données, que dans la méthodologie employée pour intégrer et synthétiser l’information ainsi obtenue. Finalement, cette thèse a montré que les CEIP-A avaient le potentiel pour mettre en œuvre un système multi-sources pouvant apporter une réelle contribution à l’étude de la pharmacodépendance en France. / The objective of this work was to analyze abuse, dependence and diversion of psychoactive medicines in real settings using jointly different indicators issued from mixed datasources in order to present a synthetic vision. The datasources used in this work are issued from the tools developed by the Centres for Evaluation and Information on Pharmacodependency (CEIP). They allow to measure directly drug abuse with specific populations of dependent patients or under opiate treatment (OPPIDUM (Observation of the Illicit Psychotropic Products or Diverted from their Medicinal Use) survey)). These tools also allow to measure the diversion via the measure of the phenomenon of “doctor shopping” (overlapping of prescriptions) and the measure of the number of patients presenting a deviant behaviour from general health insurance databases; then they measure diversion through falsified prescriptions presented at pharmacies (the OSIAP (Forged prescriptions indicating potential abuse) survey).This multisources approach has been firstly applied to analyse abuse and diversion of clonazepam (1st publication). This study has highlighted the emerging problem of diversion of clonazepam, after flunitrazepam and has also illustrated the difficulty of analysing with consistency the information gathered by these different datasources. A good system for controlling drug diversion and abuse has to allow analysing trends. We have so proposed a classification method aiming at revealing profile of subjects with deviant behaviour to use it on an evolutive manner so as to study diversion of methylphenidate on a four year period (2nd publication). This classification method has then been applied jointly with a method measuring the “doctor shopping” to analyse diversion of High Dosage Buprenorphine (HDB) (3rd publication). This study has revealed an important problem of diversion of HDB, has also demonstrated that the two methods were globally concordant and has allowed to evaluate their advantages for the controlling of the abuse and diversion of prescription drugs. These two last methods have then been analysed jointly with data from the OPPIDUM and OSIAP surveys to allow to study and compare diversion of benzodiazepine drugs (4th publication) and opioids drugs (5th publication). This multisource approach allows to limit biases linked to each method seen individually. Our work points out the relevance of such a multisources system to estimate the abuse of a prescription drug and to compare it with the other substances. Nevertheless, the development of such a system applied to the domain of the drug dependency is relatively new, and requires improvements concerning the integration of the other sources of data and the methodology used to join and synthetize the information obtained. Finally, such a system "multi-sources” has the potential to exist and to make a real contribution to the domain of the drug dependency in France.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.