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      Differences in the Pattern of Non-Recreational Sharing of Prescription Analgesics among Patients in Rural and Urban Areas

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          Abstract

          Introduction: This study aimed to analyze differences in sharing of prescription analgesics between rural and urban populations. Methods: We surveyed 1000 participants in outpatient family medicine settings in Croatia. We used a 35-item questionnaire to analyze patients’ characteristics, pain intensity, prescription analgesic sharing behavior, and perception of risks regarding sharing prescription medications. Results: Prescription analgesic sharing was significantly more frequent in the rural (64%) than in the urban population 55% ( p = 0.01). Participants from rural areas more commonly asked for verbal or written information than those from urban areas when taking others’ prescription analgesics ( p < 0.001) or giving such analgesics ( p < 0.001). Participants from rural areas more commonly informed their physician about such behavior compared to those from urban areas ( p < 0.01), and they were significantly more often asked about such behavior by their physician (p < 0.01). Perceptions about risks associated with sharing prescription medication were similar between rural and urban populations. Conclusions: There are systematic differences in the frequency of prescription analgesics and associated behaviors between patients in family medicine who live in rural and urban areas. Patients from rural areas were more prone to share prescription analgesics. Future studies should examine reasons for differences in sharing prescription analgesics between rural and urban areas.

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          Patterns of abuse among unintentional pharmaceutical overdose fatalities.

          Aron Hall (2008)
          Use and abuse of prescription narcotic analgesics have increased dramatically in the United States since 1990. The effect of this pharmacoepidemic has been most pronounced in rural states, including West Virginia, which experienced the nation's largest increase in drug overdose mortality rates during 1999-2004. To evaluate the risk characteristics of persons dying of unintentional pharmaceutical overdose in West Virginia, the types of drugs involved, and the role of drug abuse in the deaths. Population-based, observational study using data from medical examiner, prescription drug monitoring program, and opiate treatment program records. The study population was all state residents who died of unintentional pharmaceutical overdoses in West Virginia in 2006. Rates and rate ratios for selected demographic variables. Prevalence of specific drugs among decedents and proportion that had been prescribed to decedents. Associations between demographics and substance abuse indicators and evidence of pharmaceutical diversion, defined as a death involving a prescription drug without a documented prescription and having received prescriptions for controlled substances from 5 or more clinicians during the year prior to death (ie, doctor shopping). Of 295 decedents, 198 (67.1%) were men and 271 (91.9%) were aged 18 through 54 years. Pharmaceutical diversion was associated with 186 (63.1%) deaths, while 63 (21.4%) were accompanied by evidence of doctor shopping. Prevalence of diversion was greatest among decedents aged 18 through 24 years and decreased across each successive age group. Having prescriptions for a controlled substance from 5 or more clinicians in the year prior to death was more common among women (30 [30.9%]) and decedents aged 35 through 44 years (23 [30.7%]) compared with men (33 [16.7%]) and other age groups (40 [18.2%]). Substance abuse indicators were identified in 279 decedents (94.6%), with nonmedical routes of exposure and illicit contributory drugs particularly prevalent among drug diverters. Multiple contributory substances were implicated in 234 deaths (79.3%). Opioid analgesics were taken by 275 decedents (93.2%), of whom only 122 (44.4%) had ever been prescribed these drugs. The majority of overdose deaths in West Virginia in 2006 were associated with nonmedical use and diversion of pharmaceuticals, primarily opioid analgesics.
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            Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature.

            Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals. We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.
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              Prevalence of pain in the Spanish population: telephone survey in 5000 homes.

              Pain has become the most common accompanying symptom in patients seeking medical advice, and it is one of the main issues in public health. In Spain, there are no reliable data about the impact of pain in general population. The aim of the study was to estimate the prevalence of acute and chronic pain in the Spanish general population. An epidemiological observational population-based cross-sectional study was carried out by means of a telephone survey. Multistep stratified quota-adjusted sampling was performed with people aged 18-95 years. A computer-assisted questionnaire was administered, covering physical pain symptoms, site, frequency, perceived cause, therapeutic measures and interference with daily life activities. There were 11,980 useful contacts, with 5000 effective interviews (42% of useful sample). Of the interviewees, 29.6% (95% confidence interval, 28.3-30.8%) reported having had pain the day before (women, 37.6%; men, 20.9%) and 43.2% the week before. Most common pain sites were lower extremities (22.7%) and back (cervical and lumbar levels) (21.5%), followed by head (20.5%). Frequency of pain increased with age, reaching 42.6% for people older than 65 years. Among people complaining of pain during the last day or week, duration of symptoms was higher than 3 months in 54% (chronic pain), representing 23.4% of the Spanish general population; most common causes of chronic pain were arthritis, rheumatism and migraine. Regarding treatment, 61.7% of people complaining of pain said they were taking drugs. Source of drug treatment advice was a physician or a nurse in 66.4% of cases and self-prescription in 29%. It is concluded that pain, particularly chronic pain, has a high prevalence in the Spanish general population and a significant impact on occupational and social relationships. Copyright 2002 European Federation of Chapters of the International Association for the Study of Pain.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Healthcare (Basel)
                Healthcare (Basel)
                healthcare
                Healthcare
                MDPI
                2227-9032
                06 May 2021
                May 2021
                : 9
                : 5
                : 541
                Affiliations
                [1 ]Department for Assessment of Safety and Efficacy, Croatian Agency for Medicinal Products and Medical Devices, 10000 Zagreb, Croatia
                [2 ]Department of Family Medicine, School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; mcurkov@ 123456yahoo.com
                [3 ]Department of Family Medicine, Health Centre Kutina, 44320 Kutina, Croatia; tashamed@ 123456gmail.com
                [4 ]Department of Family Medicine, School of Medicine, University of Split, 21000 Split, Croatia; marion.tomicic@ 123456mefst.hr
                [5 ]Department of Family Medicine, Health Centre Osijek, 31204 Bijelo Brdo, Croatia; vojvodic58@ 123456gmail.com
                [6 ]Department of Family Medicine, Health Centre Sisak, 44272 Lekenik, Croatia; dinka.jurisic@ 123456hotmail.com
                [7 ]Department of Family Medicine, Health Centre Imotski, 21262 Kamenmost, Croatia; marijanapuljiz@ 123456gmail.com
                [8 ]Department of Family Medicine, Health Centre Cakovec, 40000 Cakovec, Croatia; mnovinscak@ 123456gmail.com
                [9 ]Department of Family Medicine, Istrian Health Centre, 52341 Zminj, Croatia; karmelabonassin@ 123456gmail.com (K.B.); sonja.fabris.ivsic@ 123456idz.hr (S.F.I.)
                [10 ]Department of Family Medicine, Health Centre Cakovec, 40329 Kotoriba, Croatia; snjezanaph@ 123456gmail.com
                [11 ]Department of Family Medicine, Split-Dalmatia Health Center, 21000 Split, Croatia
                [12 ]Department of Family Medicine, School of Medicine, University of Rijeka, 51221 Kostrena, Croatia; ines.diminic.lisica@ 123456medri.uniri.hr
                [13 ]Department of Physics, School of Medicine, University of Split, 21000 Split, Croatia; dnejasmic@ 123456gmail.com
                [14 ]Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia; ivanamiosic1@ 123456gmail.com (I.M.); ivana.i.novak@ 123456gmail.com (I.N.); livia.puljak@ 123456unicath.hr (L.P.)
                Author notes
                [* ]Correspondence: filipa.markotic@ 123456gmail.com or filipa.markotic@ 123456halmed.hr ; Tel.: +385-91-325-8885
                [†]

                Davorka Vrdoljak died in March 2019.

                Author information
                https://orcid.org/0000-0002-4381-9601
                https://orcid.org/0000-0003-0101-0254
                https://orcid.org/0000-0003-4479-8782
                https://orcid.org/0000-0002-6801-1596
                https://orcid.org/0000-0003-2148-3227
                Article
                healthcare-09-00541
                10.3390/healthcare9050541
                8148597
                34066610
                1a5e9be1-8d09-416b-bdb6-7aee986a89f3
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 02 March 2021
                : 21 April 2021
                Categories
                Article

                prescription analgesic,sharing,lending,borrowing,rural,urban
                prescription analgesic, sharing, lending, borrowing, rural, urban

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