Khary K. Rigg

Patterns of prescription medication diversion among drug dealers

This research examined the following questions: (1) how do drug dealers acquire their inventories of prescription medications? and (2) which types of prescription medications do dealers most commonly sell? Data are drawn from a National Institute on Drug Abuse-funded research study that examined prescription drug diversion and abuse in South Florida. In-depth semi-structured interviews (n = 50) were conducted with an ethnically diverse sample of prescription drug dealers from a variety of milieus to assess patterns of diversion. Audiotapes of the interviews were transcribed, coded, and thematically analysed using the NVivo 8 software program. Dealers relied on a wide array of diversion methods including visiting multiple pain clinics, working with pharmacy employees to steal medications from pharmacies, and purchasing medications from indigent patients. The type of medication most commonly sold by dealers was prescription opioid analgesics, and to a lesser extent benzodiazepines such as alprazolam. These findings inform public health policy makers, criminal justice officials, the pharmaceutical industry and government regulatory agencies in their efforts to reduce the availability of diverted prescription drugs in the illicit market. Specifically, these data support the need for statewide prescription drug monitoring programs and increased training for healthcare workers who have access to controlled medications.

Understanding the Etiology of Prescription Opioid Abuse Implications for Prevention and Treatment

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

Urban vs. rural differences in prescription opioid misuse among adults in the United States: informing region specific drug policies and interventions.

BACKGROUND In the United States, prescription opioid misuse (POM) has increased dramatically over the past two decades. However, there are still questions regarding whether rural/urban differences in adult POM exist, and more important, which factors might be driving these differences. METHODS Using data from the 2011 and 2012 National Survey on Drug Use and Health, we conducted unadjusted and adjusted binary logistic regression analyses to determine the association between metropolitan status and POM. RESULTS We found that urban adults were more likely to engage in POM compared to rural adults because of their higher use of other substances, including alcohol, cannabis, and other illicit and prescription drugs, and because of their greater use of these substances as children. CONCLUSION This study fills an important gap in the literature by not only identifying urban/rural differences in POM, but by also pointing out factors that mediate those differences. Because patterns and predictors of POM can be unique to geographic region, this research is critical to informing tailored interventions and drug policy decisions. Specifically, these findings suggest that interventions should be aimed at urban illicit drug users and adults in manual labor occupations.

Comparing Characteristics of Prescription Painkiller Misusers and Heroin Users in the United States

INTRODUCTION Prescription painkiller misuse (PPM) is a major U.S. public health concern. However, as prescribing practices have tightened and prescription painkillers have become less accessible, many users have turned to heroin as a substitute. This trend suggests the face of heroin users has likely changed over the past several years. Understanding the demographic, socioeconomic, psychosocial, and substance use characteristics of different groups of opiate users is important for properly tailoring interventions. METHODS This study used data from the 2010-2013 National Survey on Drug Use and Health to examine differences in characteristics of U.S. adults in three mutually exclusive categories of past-year opiate use: heroin-only (H-O, N=179), prescription painkiller-only (PP-O, N=9,516), and heroin and prescription painkiller (H-PP, N=506). RESULTS Socioeconomic disadvantage, older age, disconnection from social institutions, criminal justice involvement, and easy access to heroin were associated with greater odds of being in the H-O group. HH-P users were more likely to be young white males with poor physical and mental health who also misuse other prescription medications and began such misuse as adolescents. PP-O users were the most economically stable, most connected to social institutions, least likely to have criminal justice involvement, and had the least access to heroin. CONCLUSIONS Results suggest the socio-demographic characteristics of heroin users versus PP misusers vary widely, and the conditions leading to heroin use versus PPM versus both may be different. Ultimately, a one-size-fits-all approach to opiate prevention and treatment is likely to fail. Interventions must account for the unique needs of different user groups.

Understanding Barriers to Mental Health Care for Recent War Veterans Through Photovoice

Despite an urgent need for mental health care among U.S. service members returning from deployments to Iraq and Afghanistan, many veterans do not receive timely or adequate treatment. We used photovoice methods to engage veterans in identifying barriers to utilizing mental health services. Veterans described how key aspects of military culture and identity, highly adaptive during deployment, can deter help-seeking behavior and hinder recovery. Veterans’ photographs highlighted how mental health symptoms and self-coping strategies operated as barriers to care. Many veterans’ photos and stories revealed how negative health care encounters contributed to avoidance and abandonment of treatment; some veterans described these experiences as re-traumatizing. Visual methods can be a powerful tool for engaging recent war veterans in research. In particular, community-based participatory research approaches, which have rarely been used with veterans, hold great promise for informing effective interventions to improve access and enhance provision of patient-centered care for veterans.

The misuse of benzodiazepines among adolescents: Psychosocial risk factors in a national sample

BACKGROUND The misuse of benzodiazepines (BZs) among adolescents is an important issue within the fields of mental health, medicine, and public health. Though there is an increasing amount of research on prescription medication misuse, a relatively small number of studies focus on adolescent BZ misuse. The goal of this study, therefore, is to identify demographic and psychosocial factors that place adolescents at risk for misusing BZs. Additionally, the authors applied concepts from social bonding theory, social learning theory, and strain theory to determine the extent to which these concepts explain BZ misuse. METHODS Using data from the 2011 National Survey of Drug Use & Health, multivariate logistic regression models were estimated to determine which factors were associated with an increased risk of BZ misuse. RESULTS These findings help to describe the psychosocial profile of adolescent BZ misusers which should increase the ability of clinicians to identify patients who may be at greater risk for misuse. CONCLUSION This study is particularly important within the context of psychiatry, where a clearer understanding of adolescent BZ misuse is critical for informing prevention efforts and developing best practices for prescribing BZs.

Diversion of benzodiazepines through healthcare sources.

Abstract Benzodiazepines (BZ) are often diverted from legal sources to illicit markets at various points in the distribution process beginning with a pharmaceutical manufacturer, followed by healthcare providers, and finally, to the intended users. Little is known about the extent of BZ diversion involving distribution points directly related to healthcare sources versus points further down the distribution chain. The present study examines the scope of BZ diversion, and the association between BZ dependence and the direct utilization of particular healthcare-related diversion sources among a diverse sample of prescription drug abusers in South Florida. Cross-sectional data were collected from five different groups of drug users: methadone-maintenance clients (n = 247), street drug users (n = 238), public-pay treatment clients (n = 245), private-pay treatment clients (n = 228), and stimulant-using men who have sex with men (MSM; n = 249). Findings suggest that those who are ages 26 to 35 years old, non-Hispanic White participants, private-pay treatment clients, those who are insured, and those with higher incomes had higher odds of utilizing healthcare diversion sources. Those who reported BZ dependence had 2.5 times greater odds of using a healthcare source to obtain BZs than those who did not meet criteria for dependence.

Storylines as a Neglected Tool for Mental Health Service Providers and Researchers

Mental health service providers and researchers usually explain psychological/behavioral problems in terms of risk and protective factors. Although such an approach may seem empirical, and thus accurate, the manner in which patients interpret these factors is often overlooked. The result is that practitioners and researchers draw conclusions and make possible causal attributions that do not take into account the perspective of those who are studied or in care. Storylines, however, are a promising strategy to understanding mental health problems that is sensitive to the experiences and situations of people, and can bring into view more relevant details of patients’ lives. This paper provides a theoretically grounded justification for the use of storylines in both mental health practice and research. Storylines are defined, while suggestions are provided for how this framework might be put into practice. A discussion is offered on how storylines might improve the design and implementation of health interventions by requiring these services to become more attuned to the lived experience of patients and the meanings they attach to common risk factors.

Explaining Prescription Opioid Misuse Among Veterans: A Theory-Based Analysis Using Structural Equation Modeling

Although prescription opioid misuse (POM) has serious implications for the mental and physical health of military veterans, relatively few studies utilize veteran samples. Additionally, POM studies that are grounded in theoretical models of drug use are very rare. As a result, the theoretical links that may explain POM among veterans are not well-understood. The goal of this study, therefore, is to examine the extent to which the availability-proneness model may be able to account for POM among veterans. Data from the 2010 National Survey on Drug Use and Health (n = 2,008) were analyzed using structural equation modeling to assess the models overall validity. The findings are discussed in terms of their theoretical impact and implications for future prevention and treatment interventions.

Motivations for Using MDMA (Ecstasy/Molly) among African Americans: Implications for Prevention and Harm-Reduction Programs

ABSTRACT Despite the growing popularity of MDMA (ecstasy/molly) among African Americans, their motives for using the drug are still largely unknown. The purpose of this study was to identify and describe the most salient motivations for using MDMA among this understudied population. In-depth interviews (n = 15) were conducted with a sample of African American young adults in Southwest Florida between August 2014 and November 2015. The primary motivations for using MDMA included: (1) altering the effects of marijuana and alcohol; (2) lasting longer sexually; (3) enhancing sexual pleasure; and (4) facilitating “freaky” sexual experiences. This is the first study to directly examine MDMA motivations specifically among African American drug users, and findings shed light on why some African Americans use MDMA. A better understanding of why African Americans use this drug should help to inform prevention and harm-reduction efforts. Study findings show the need for health messages that include the potential consequences of mixing MDMA with other drugs, and engaging in high-risk sexual behaviors after taking MDMA. These data contrast with motivations (e.g., introspection, self-enlightenment, getting into the music) commonly reported among groups of largely White MDMA users, suggesting that interventions tailored specifically for African American users are needed.