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Miller, 26, died of an accidental overdose of the powerful opioid fentanyl, along with cocaine and alcohol. Fentanyl has contributed to an epidemic of opioid abuse in the U. Pettit and Walter, who was also charged with being a felon in possession of ammunition, were scheduled to be arraigned on the new charges on Oct. Reavis, who was arrested last week in Arizona, does not have an arraignment date set yet. The Pittsburgh native, whose real name was Malcolm James Myers McCormick, was in a two-year relationship with Ariana Grande that ended earlier in The indictment alleged that Walter supplied the fentanyl and cocaine that Pettit sold to Miller and that Reavis, who lived in the Los Angeles area until earlier this year, acted as a middleman for the fentanyl sale. Pettit on Sept. In another set of messages included in the indictment, Reavis worried in a text sent in June about undercover police buying drugs. Copyright The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Join our Newsletter for the latest news right to your inbox. Trending Multiple dead in St.

3 charged with providing drugs that killed rapper Mac Miller

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Official websites use. Share sensitive information only on official, secure websites. With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. We sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care. A total of 27 English speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a four-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. The most common error was including use of medications without abuse potential as misuse. All cases of misunderstanding prescription drug misuse occurred among participants who screened negative for illicit drug use. Our results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical settings could potentially lead to high rates of false positive results. There is intense interest in identifying and addressing substance use in general healthcare settings. In response, researchers have moved rapidly to develop and validate brief screening tools. Recent developments highlight the importance of identifying not only use of alcohol and illicit drugs, but also misuse of prescription drugs. Prescription drug misuse, and in particular the misuse of potent prescription opioids, has skyrocketed in the past decade. Many individuals who misuse prescription drugs are not engaged in use of any illicit drugs. Yet the screening and assessment instruments that are generally considered for implementation in medical settings e. Concisely and clearly communicating the meaning of prescription drug misuse on a short screening instrument poses considerable challenges. Unlike illicit drugs, which are defined by their legal status, prescription drugs can be used appropriately or can be misused, depending on the conditions under which they are used and the intentions of the user. Yet little is known about how patients interpret this term. As a first step in developing a screening instrument that could quickly and accurately identify both illicit and prescription drug misuse, we sought to gain a better understanding of how primary care patients interpret and answer screening questions about their use of these substances. We employed cognitive interviewing, an approach developed in the s by survey methodologists and psychologists to evaluate sources of response error in questionnaires. Cognitive interviewing is supported by a large body of methodological research, and is one of the primary methods used by survey researchers to test the accuracy with which items are understood and answered by respondents. Cognitive interviewing recognizes that the question answering process can be complex, involving the cognitive steps of comprehending the question, retrieving relevant information from memory, making a decision about how to answer, and then mapping the response onto the options given in the survey question. We postulated that answering questions about illicit and prescription drug use primarily poses difficulty in the areas of comprehension and deciding on an answer. The study was conducted in over a 3-month period in early , in the adult primary care medicine clinics of a large public hospital in New York City. Individuals eligible to participate were current clinic patients, fluent in English, and 18—65 years old. A purposeful sampling approach was used to achieve approximately equal numbers of male and female participants in the predetermined age categories of 18—35 years, 36—50 years and 51—65 years. These categories were chosen to achieve a balanced representation of groups within a primary care population that would likely be targeted for substance use screening. Potential participants were approached consecutively in the clinic waiting area and screened for eligibility. There was no advertisement of the study, and all recruitment was by a single research assistant. Those expressing interest received a written information sheet, and verbal consent for participation was obtained. Participants completed a 30—40 minute interview that sought to ascertain their understanding of a brief substance use screening questionnaire. The questionnaire consisted of 4 items assessing past year use of tobacco, unhealthy alcohol consumption, illicit drug use, and misuse of prescription drugs Table 1. All subjects were given a one-page handout containing the screening questionnaire. For each item in the questionnaire, participants were first asked to answer the item using the specified response categories, and then to respond to a series of follow-up questions from the interviewer. Thinking-aloud was demonstrated by the interviewer, and then practiced by participants using a warm-up item before beginning the interview. After the participant responded to each item in the screening questionnaire, the interviewer used a series of probes and open-ended questions to gather more information on the cognitive process. Participants were asked to explain what they were thinking about as they answered the item, to repeat the item in their own words, to describe how they formulated their answer, and to assess whether the question was easy or difficult to answer. They were also asked to give examples of the type of substance that each screening question asked about e. All interviews were conducted by the primary author JM. Two adaptations were made to the questionnaire after the first 16 interviews were completed. The first adaptation was to change from an interviewer- to a self-administered screening form. The first 16 subjects Study ID 1—16 were read each item by the interviewer and answered verbally. The following 11 subjects Study ID 17—27 read and completed the questionnaire on their own 8 on paper, 3 on a touchscreen computer before proceeding with the cognitive interview. However, to ensure that reading difficulty did not interfere with the cognitive interviewing assessment, all participants were read each item aloud by the interviewer before answering the additional probes and open-ended questions. A second adaptation was altering the term used to describe prescription drug misuse. These alternative items were administered and discussed in a second part of the interview, following completion of the screening questionnaire and cognitive interviewing portions that are the focus of the present analysis. Five items were tested, of which each participant received two or three. During each interview, notes were taken on paper by two members of the research team, the interviewer and an observer. These interview notes were incorporated into detailed field notes that were written by each of the two researchers at the end of every interview day. To facilitate the accurate recording of field notes, a maximum of two interviews were conducted per day. The field notes, as well as responses to the screening questionnaire, were the data used for this analysis. This analysis focuses primarily on the screening question for misuse of prescription drugs, and secondarily on the screening question for illicit drugs. Notes were analyzed by the interviewer and by a second investigator who was not present during the interviews. Codes were developed by the primary author in the course of the analysis using a grounded theory approach. Codes identified examples of how the questionnaire item was interpreted, types of correct and incorrect responses to the item, and names of drugs that would be included in that category. We then sought to determine whether responses to the illicit drug use and prescription drug misuse screening items were correct versus incorrect, based on the final coded interviews. For illicit drug use, having a correct answer required naming only illegal drugs, and an incorrect answer would include only legal drugs. An imprecise answer would include both illegal drugs and legal substances having abuse potential e. We examined the frequency of correct, incorrect, and imprecise responses to the illicit and prescription drug use items by screening response positive vs. We then looked for respondent characteristics such as age, gender, education level, other drug use that might be associated with misclassification. Characteristics of the 27 participants are summarized in Table 2. While all participants were fluent in English, for 6 English was not their primary language. Eight participants were born outside the US. ID 3: Interviewer administeredquestionnaire; participant did not comprehend the question. ID 4: Interviewer administeredquestionnaire; participant refused to answer. After answering each screening item, participants were asked to give their own description or definition of its meaning. For the prescription drug item, which was phrased as either nonmedical use or recreational use, 5 of the 27 participants described a full range of behaviors that could be considered misuse of prescription drugs. These behaviors included taking a medication only for its euphoric effects, and taking a medication having abuse potential that was either not prescribed, or was prescribed but then taken either more frequently or at higher doses than directed. Two participants did not emphasize the euphorigenic aspects of prescription drug misuse, and instead described addictive behaviors in their definitions. One of these participants focused on illegitimate medication seeking, while the other discussed the risks of addiction and overdose. No participants included taking a prescription medication for a condition other than that for which it was prescribed in their definitions of prescription drug misuse. However, there were some differences between interpretations of these items that fell into an identifiable pattern. Nonmedical use definitions generally focused on taking medications that were not prescribed by a medical provider, while recreational use definitions focused on taking medications for pleasure. Many participants described nonmedical use in terms of taking any medication without a prescription, including medications that are not considered to have abuse potential. Examples included Lipitor, and acetaminophen prescribed by a medical provider Table 4. Nonmedical use was viewed by some participants as taking medications for the purpose of treating a legitimate medical condition, but without seeking the care of a medical provider. We classified this behavior as self medicating. Of those participants who received the nonmedical use version of the screening item, 6 described it as self medicating. In other cases, it was less clear that the drug would be medically indicated, but the intention is still to treat what the patient believes is a legitimate medical problem. Two participants, both of whom had used illicit drugs in the past, noted a discrepancy between recreational use and addiction. None included over-the-counter medications in their examples of drugs that might be used recreationally. Definitions and examples of illicit drug use focused on the illegal status of these substances. Misclassification of drugs belonging to this category was uncommon Table 4. In the context of the interview, it was clear that these participants were listing these prescription medications as examples of drugs that are bought and sold illicitly. One participant had an imprecise understanding, based on including tobacco and alcohol in this category along with illicit drugs. Because the 3 participants who listed street-purchased medications pills, sedatives, opioids as illicit drugs restricted their classification to drugs that were bought and sold illicitly, they were considered to have an overall correct understanding of illicit drug use. Screening results and accuracy of screening response for participants having correct versus incorrect or imprecise understanding of illicit illegal drug use or prescription drug misuse nonmedical or recreational use. Five had an incorrect, and 3 had an imprecise understanding of the screening item. Among the 8 participants with an incorrect or imprecise understanding of the screening item, 6 screened negative for prescription drug misuse. The screening result was inaccurate for 2 of the 8 participants with an incorrect or imprecise understanding of the item: one participant screened positive based on their Tylenol use, and the other screened negative because they did not consider taking a drug prescribed to someone else to be nonmedical use. One participant misread the question as asking how many prescription medications she took, but had a correct understanding of the screening item when it was read by the interviewer. As a result, although she had a correct understanding of recreational use her response on the screening form was inaccurate. Conversely, a correct interpretation of the prescription drug item was given by all 7 participants who screened positive for illicit drugs. We did not observe a clear association between correctness of response to the prescription drug item and age, race, education level, or primary language. Many primary care patients in our sample misunderstood the language used to describe misuse of prescription medications. While the concept of recreational use seemed easier for most participants to grasp, this term also has potential drawbacks. It is also possible that using a term such as recreational use, which focuses on euphoric effects, may fail to capture use of prescribed medications for conditions other than that for which they were prescribed. For example, a patient who had an opioid prescribed for back pain and then took it for help with sleep may not classify their use as recreational, though this behavior would be considered misuse of a prescription drug. In the recreational self-administered version, the inaccurate responses were due to language difficulty. Most individuals who misunderstood the meaning of the prescription drug screening item in fact did not appear to be engaged in misuse. We found a relatively low rate of false positive screens 3 of 27 participants when the screening result was compared to narrative descriptions of actual drug use behavior. Another two participants were unable to give an answer. By contrast, for the illicit drug use item there was just one inaccurate screening response, and the question was answered by each of the 27 participants. All participants who reported illicit drug use had a correct interpretation of prescription drug misuse. All those who had an incorrect or imprecise interpretation of prescription drug misuse screened negative for illicit drugs. This may indicate that among populations with relatively low rates of illicit drug use, as in primary care, screening instruments to detect prescription drug misuse are likely to have a higher rate of misclassification. The primary limitation of our study is its small sample size, which hinders the generalizability of our results and precludes the ability to rigorously test for predictors of correct versus incorrect understanding of the screening items. This limited our ability to compare the accuracy of the screening response based upon wording alone. The language used in the screening questionnaire may be easier to interpret for a highly educated or less culturally diverse population. Yet given the goal of developing screening tools that can be used in a wide range of primary care settings, these attributes of the study population could also be interpreted as a strength of our approach. Any broadly recommended screening tool should be able to identify prescription drug misuse, and to elicit it even among those who are not engaged in illicit drug use. Yet there is currently no brief screening tool, suitable for use in medical settings, that has been validated specifically for detection of prescription drug misuse in a general primary care population. Nonmedical use language has the potential to lead to a substantial number of false positive or invalid responses on standardized screening instruments. These responses would trigger further assessment to rule out a substance use problem; a process that could present a significant burden to health care systems. Finally, it should be noted that many instruments considered for screening and assessment in primary care patients were validated in populations having a higher prevalence of illicit drug use, such as in drug treatment or psychiatric patients. We found that individuals who reported illicit drug use were able to correctly understand the screening questions on prescription drug misuse, but there was considerable misinterpretation of these questions among individuals who did not use illicit drugs. Our study thus highlights the potential hazards of adopting substance use screening instruments in general medical settings without rigorously evaluating their accuracy in the population in which they are intended to be used. Jennifer McNeely, Email: jennifer. Perry N. Halkitis, Email: perry. Rubina Khan, Email: rubina. Marc N. Gourevitch, Email: marc. As a library, NLM provides access to scientific literature. Subst Abus. Published in final edited form as: Subst Abus. Find articles by Jennifer McNeely. Find articles by Perry N Halkitis. Find articles by Ariana Horton. Find articles by Rubina Khan. Find articles by Marc N Gourevitch. PMC Copyright notice. The publisher's version of this article is available at Subst Abus. Item Administered to participants 1. In the past year, how often have you used tobacco? In the past year, how often have you used alcohol, X or more drinks in a day? In the past year, how often have you used any illegal drug? In the past year, how often have you used any prescription drug for non-medical reasons? In the past year, how often have you used any prescription drug recreationally? Open in a new tab. Statement of Contributions: JM conceived of the study, conducted the interviews, and led the writing and analysis PH assisted with study design, advised on the analysis, and contributed to the writing RK led data collection and participated in interpretation of results AH contributed to the analysis and presentation of results and contributed to the writing MG assisted with conception and design of the study and contributed to the writing All authors have approved of the final manuscript. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Prescription drugs nonmedical use or recreational use.

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