Saloner Brendan, Bachhuber Marcus, Barry Colleen L
Dr. Saloner and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail:
Psychiatr Serv. 2017 Jan 1;68(1):56-62. doi: 10.1176/appi.ps.201500245. Epub 2016 Jul 15.
An estimated 6.5 million Americans engage in nonmedical use (NMU) of prescription medications. Physicians can be important targets for interventions to reduce NMU, but little is known about which individuals engaging in NMU receive medications from a physician versus other sources.
Cross-sectional data from the National Survey on Drug Use and Health, 2006-2013, were analyzed. The sample included 34,690 persons ages 12 and older who reported prior-year NMU. Individuals identified medications used that were not prescribed to them or that they took only for the experience and feelings that they caused and identified the most recent source of each NMU medication. The sample was stratified into groups by medication obtained for NMU (opioid analgesics, stimulants, tranquilizers or sedatives, and multiple medications) and the proportion receiving each medication from a physician. Logistic regression was used to examine sociodemographic, health status, and substance use correlates of reporting a physician source for NMU medications.
The percentage that received medications from a physician varied by group: opioid analgesics, 23.7%; multiple medications, 20.1%; tranquilizers-sedatives, 11.9%; and stimulants, 10.4%. Across groups, positive correlates of reporting a physician as a source of NMU medications included male gender, non-Hispanic black race, receipt of mental health treatment, and more frequent NMU. Individuals reporting use of illicit drugs were less likely to receive medications for NMU from a physician.
Among individuals who engaged in NMU, those with the greatest medical vulnerability were more likely to have a physician source. Clinical interventions to identify harmful use can play an important role in reducing NMU.
据估计，有650万美国人非医疗性使用（NMU）处方药。医生可能是减少非医疗性使用的重要干预对象，但对于哪些非医疗性使用处方药的人是从医生处而非其他来源获得药物，我们知之甚少。
分析了2006 - 2013年全国药物使用和健康调查的横断面数据。样本包括34,690名12岁及以上报告上一年有非医疗性使用情况的人。这些人确定了所使用的非处方药物，或者他们只是为了这些药物所带来的体验和感觉而服用，并确定了每种非医疗性使用药物的最新来源。样本按非医疗性使用所获得的药物（阿片类镇痛药、兴奋剂、镇静剂或安眠药以及多种药物）和从医生处获得每种药物的比例进行分层。使用逻辑回归来检验社会人口统计学、健康状况以及非医疗性使用药物报告医生来源的物质使用相关性。
从医生处获得药物的比例因组而异：阿片类镇痛药为23.7%；多种药物为20.1%；镇静剂 - 安眠药为11.9%；兴奋剂为10.4%。在所有组中，将医生作为非医疗性使用药物来源报告的正相关因素包括男性、非西班牙裔黑人种族、接受心理健康治疗以及更频繁的非医疗性使用。报告使用非法药物的人从医生处获得非医疗性使用药物的可能性较小。
在参与非医疗性使用的个体中，医疗脆弱性最大的那些人更有可能从医生处获得药物。识别有害使用的临床干预在减少非医疗性使用方面可以发挥重要作用。
