PRESCRIPTION DRUG USE, HEALTH SERVICES UTILIZATION, AND HEALTH PROBLEMS IN RURAL APPALACHIAN KENTUCKY

Rural states like Kentucky now lead the nation in the illicit diversion of narcotic prescription physics In order to understand this phenomenon, we examine the generally popularly abused prescription drug OxyContin?® through comparing differences in drug use, health services use, and criminality among a nontreatment cluster of rural Appalachian probationers who reported using OxyContin?® (n = 101) with nonusers of OxyContin?® (n = 194) Although OxyContin?® users were younger, a number of differences emerg OxyContin?® users exhibited higher horizontals of use for 15 illicit physics examined; used more detoxification services; attended more AA/NA meetings; reported more depression, anxiety, put in commotion concentrating, and violence; and reported more crime for 16 crimes. We discuss the implications of OxyContin?® use including the possibility that it may be a marker for other illicit rural physic use.

INTRODUCTION

OxyContin?® has received a great deal of new publicity for its pain management efficacy, for its misuse and abuse potential, and as a "fad drug" The active ingredient in OxyContin?® is oxycodone, a semisynthetic narcotic analgesic greatest in quantity often prescribed for moderate to morose pain, chronic pain syndromes, and terminal cancers (Inciardi & Goode 2003) Oxycodone has been used for above 80 years in the United States and is fix in a variety of pain prescription analgesics, including OxyContin?® (Davis et al., 2003) In 1996 OxyContin?® was introduced to the prescription remedy market as a longer lasting dosage of oxycodone vis-? -vis its controlled-release means of delivery. Since its introduction to the public, OxyContin?® has given many patients relief from pain; however, it has also proven to be not rarely diverted from medical use, and has been associated with addiction (Inciardi & Goode 2003) In addition, medicine Abuse Warning Network (DAWN) data display that oxycodone-related emergency department visits increased by means of 560% between 1995 and 2002 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2003)

As physics of abuse, the prevalence rates of oxycodone and its derivatives (eg OxyContin?®) are unclear, although novel reports in the popular pres describe a burgeoning vexed question in rural areas (Johnson, 2003; Rosenberg, 2003) Overall, prescription remedy abuse continues to be a major question at issue in the United States, particularly among young nation For example, the 2002 National review on Drug Use and Health (NSDUH) formerly the National Household take a view of on Drug Abuse (NHSDA), showed that the initiation of nonmedical prescription medicine use occurs among populations aged 12 to 25 and these abuse rates have continued to rise since the mid 1980 (SAMHSA, 2002) The greatest in quantity common types of prescription medicines abused by young adults are pain relievers, which include codeine, methadone, meperidine, percocet hydrocodone, and oxycodone (SAMHSA, 2002) remedy seizures by law enforcement agencies that are analyzed by dint of forensic laboratories provide further evidence of this riddle Drug analyses conducted by state and local forensic laboratories, which are gathered by the National Forensic Laboratory Information a whole (NFLIS), indicate that pharmaceutical proceedss represent 13 of the top 25 substances identified in the first half of 2003 (Drug Enforcement Administration [DEA], 2003) Based national estimates, oxycodone ranked sixth (1%) without of the top 25 greatest in quantity frequently identified drugs (DEA, 2003)

Although a certain number of national data have shown that OxyContin?® is increasingly abused in more urban areas (DEA, 2002; Office of National remedy Control Policy [ONCDP], 2002), OxyContin?® has earned the nickname of "hillbilly heroin" for profitable reason. The emergence of oxycodone as a misused and abused prescription pharmaceutical has been particularly acute in certain areas of the political division most notably in Maine, West Virginia, Virginia, and Appalachian Eastern Kentucky (Davis, et al, 2003; Inciardi & Goode 2003)

Data from Kentucky provide a sobering picture of OxyContin?® use in smaller, rural communities. For example, in the first six month of 2001 single substance abuse treatment provider in Eastern Kentucky reported that 120 of its 295 (41 %) treatment admissions were related to OxyContin?®; in Franklin shire Kentucky, 453 of 608 (75%) substance abuse treatment admissions were associated with OxyContin?® (DEA, 2002) Other data from Kentucky glance at that the number of patients statewide who sought treatment for oxycodone addiction increased 163% between 1998 and 2000 and that Kentucky has more [i]or[/i] less of the highest rates of OxyContin?®-related crimes in the nation (Inciardi & Goode 2003)

Little is known about the health service utilization of oxycodone abusers in general or about OxyContin?® abusers in particular, on the contrary there is evidence to put in mind of that traditional opiate users have significant medical moot points (Patkar, Sterling, Gottheil, & Weinstein, 1999) In single study examining medical symptoms reported through alcohol-, cocaine-, and opiate-dependent patients in outpatient medicine treatment, opiate users reported more medical riddles among the 17 body combination of parts to form a wholes in comparison to cocaine users (Patkar, et al., 1999) Another research indicated that heroin, cocaine, and injection physic users (including opiate users) were more likely to be admitted to the hospital for infection, a finding that was independent of the individual's HIV status (Weintraub et al., 2001) Although it is impossible to ascertain the amplitude to which OxyContin?® is diverted into illicit channels, clearly these preliminary studies signal the ne for research regarding the misuse and abuse of OxyContin?® as well as the criminal behavior and user health status associated with it.