The abuse of and dependence on opioids are major public health problems, and have been the focus of intense media coverage and scholarly inquiry. This research explores the problem in Iowa through the lens of infectious disease modeling. We wanted to identify the current state of the crisis, factors affecting the progression of the addiction process, and evaluate interventions as data becomes available. We introduced a novel sequential Approximate Bayesian Computation technique to address shortcomings of existing methods in this complex problem space, after surveying the literature for available Bayesian computation techniques. A spatial compartmental model was used which allowed forward and backward progression through susceptible, exposed, addicted, and removed disease states. Data for this model were compiled over the years 2006-2016 for Iowa counties, from a variety of sources. Prescription overdose deaths and treatment data were obtained from the Iowa Department of Public Health, possession and distribution arrest data were acquired from the Iowa Department of Public Safety, a measure of total available pain reliever prescriptions was derived from private health insurance claims data, and population totals were obtained from the US Census Bureau. Inference was conducted in a Bayesian framework. A measure called the empirically adjusted reproductive number which estimates the expected number of new users generated from a single user was used to examine the growth of the crisis. Results expose the trend in recruitment of new users, and peak recruitment times. While we identify an overall decrease in the rate of spread during the study period, the scope of the problem remains severe, and interesting outlying trends require further investigation. In addition, an examination of the reproductive numbers estimated for contact within and between counties indicates that medical exposure, rather than spread through social networks, may be the key driver of this crisis.

This paper analyzes the impact of the 2012 legalization of recreational marijuana in Washington State on opioid abuse. Using synthetic control methodology, this paper finds that the legislation prevented 638 overdose deaths and lead to over 3,600 individuals seeking treatment for opioid abuse disorders. Due to the large health, social, and economic impacts of the opioid epidemic, further research should be conducted into ways to reduce the number of opioid prescriptions, the number of opioid overdoses, and opioid abuse generally.

The United States is in the midst of an opioid epidemic, which is leading to approximately 130 deaths each day. While research on family-based approaches for substance misuse prevention, such as alcohol and tobacco prevention, has been conducted, few if any studies have focused on prescription opioid misuse prevention. Previous literature suggests that a comprehensive family-based approach can be effective in preventing substance misuse at the family-level. Considering the multiple age groups the sandwich generation cares for, the sandwich generation may have greater access to reaching multiple age groups to prevent prescription opioid misuse. Therefore, the purpose of this study is to use formative research findings to inform family-based approaches focused on preventing opioid misuse. A dual method approach that includes qualitative focus groups and quantitative surveys is used to explore adults’ perceptions of prescription opioid misuse, factors perceived as influencing opioid misuse prevention, and perceived predictors of prescription opioid misuse prevention. Participants were adults, 30 to 59 years of age, which is the average age range of the sandwich generation. Extension agents recruited focus group participants (n = 55) and Qualtrics recruited survey participants (n = 335) for this study. Focus group transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE-PROCEED model. Focus group findings indicate that participants view the opioid crisis as a family problem, in which they have a role in preventing, and identified predisposing, reinforcing, and enabling factors that influence whether family members take a role in preventing prescription opioid misuse. Univariate frequencies and multiple linear regression analyses results of the survey data indicate that Theory of Planned Behavior determinants are predictive of the intention to talk about opioids with friends and family. In addition, comfort predicts intention to talk about opioids with friends and family, suggesting that Theory of Planned Behavior determinants and comfort predict intention. Extension agents, family life educators, and other community-health professionals can collaborate and use these findings to develop family-based approaches, such as family communication training and brief strategic family therapy, combined with community-based approaches such as motivational interviewing and media campaigns.

Rates of prescription drug misuse in Texas are alarmingly high. One in five Texas high school students have taken prescription drugs without a doctor’s prescription. In 2015, Texas had the second highest total healthcare costs from opioid abuse in the nation ($1.96 billion), and Texas is home to four of the top 25 cities in the U.S. for opioid abuse. Meanwhile, only one in three prescribers is using the statewide Prescription Drug Monitoring Program (PDMP), leading to a massive loss of data. There is substantial need for increased infrastructure and prevention measures in Texas, especially related to the emergence of prescription drug misuse. This panel will describe the current landscape of prescription drug misuse and its consequences, discuss strategies to turn down misuse, and explain the proactive approach Texas is taking to enhance misuse prevention and data infrastructure across the state.

Abstract available through Drug and Alcohol Dependence.

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Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.