Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA.
Harm Reduct J. 2010 Oct 15;7:24. doi: 10.1186/1477-7517-7-24.
Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA) involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use.
A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101) and a major metropolitan area (n = 111) in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported nonmedical use and ROA (swallowing, snorting, injecting) for the following prescription drugs: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, OxyContin® and other oxycodone.
Among urban participants, swallowing was the most common ROA, contrasting sharply with substance-specific variation in ROA among rural participants. Among rural participants, snorting was the most frequent ROA for hydrocodone, methadone, OxyContin®, and oxycodone, while injection was most common for hydromorphone and morphine. In age-, gender-, and race-adjusted analyses, rural participants had significantly higher odds of snorting hydrocodone, OxyContin®, and oxycodone than urban participants. Urban participants had significantly higher odds of swallowing hydrocodone and oxycodone than did rural participants. Notably, among rural participants, 67% of hydromorphone users and 63% of morphine users had injected the drugs.
Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use.
近年来，非医疗处方类阿片类药物的使用已成为一个主要的公共卫生问题，尤其是在阿巴拉契亚农村地区。对于农村和城市药物使用者中非医疗处方类阿片类药物的使用途径（ROA），知之甚少。本研究旨在描述农村-城市地区非医疗处方类阿片类药物使用的 ROA 差异。
从肯塔基州一个农村阿巴拉契亚县（n = 101）和一个主要大都市区（n = 111）中招募了 212 名有意愿的处方药物使用者作为研究对象。同意参与的参与者接受了访谈者管理的问卷调查，该问卷调查了社会人口统计学、精神疾病以及自我报告的非医疗使用和 ROA（吞咽、鼻吸、注射）情况，包括以下处方药物：丁丙诺啡、芬太尼、氢可酮、氢吗啡酮、美沙酮、吗啡、奥施康定®和其他羟考酮。
在城市参与者中，吞咽是最常见的 ROA，与农村参与者的特定物质 ROA 形成鲜明对比。在农村参与者中，鼻吸是氢可酮、美沙酮、奥施康定®和羟考酮最常见的 ROA，而注射是氢吗啡酮和吗啡最常见的 ROA。在年龄、性别和种族调整分析中，农村参与者鼻吸氢可酮、奥施康定®和羟考酮的几率明显高于城市参与者。城市参与者吞咽氢可酮和羟考酮的几率明显高于农村参与者。值得注意的是，在农村参与者中，67%的氢吗啡酮使用者和 63%的吗啡使用者曾注射过这些药物。
替代 ROA 在农村药物使用者中很常见。这一发现对农村药物滥用治疗和减少伤害具有影响，在这些治疗和减少伤害中，干预措施应包括预防和减少药物使用特定途径的健康并发症的方法。
