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Official websites use. Share sensitive information only on official, secure websites. Nonmedical prescription drug use NMPDU has become a major public health issue but little is known in Asian populations. Past-year prescription drug use was divided into medical use only MUO and nonmedical use NMU , defined as using the drug without a prescription, or more frequently, or in larger doses than prescribed. The prevalence of past-year NMU was 3. Nonmedical use of analgesics correlated with tobacco use and problematic alcohol use. The correlates of nonmedical drug use offer useful clues for prevention strategies. Nonmedical prescription drug use NMPDU typically refers to the use of prescription drugs for reasons other than prescribed, for a dosage higher than prescribed, or simply without a doctor's prescription United Nations Office on Drugs and Crime, Besides, there has been increasing research on people who received prescription medications but reported medical use only MUO. On one hand, people with MUO would imply that their anxiety or pain might be ameliorated such that their risk of developing substance use disorder decreased or not different from that of people not receiving such prescription medication i. On the other hand, people receiving prescription medication might have diversion or turn into NMU because of the ease to access these medications. Adolescents who had recent MUO of anxiolytic or sleep medications were found to have increased risk of NMU of such medications during the follow-up Boyd et al. Hence, it warrants to examine whether people with NMU were different from those with MUO, given that people using prescription medications might have some indications that were not present among people not receiving such medications. Factors consistently associated with NMU when compared to people without NMU as well as compared to people with MUO would imply a robust correlation that may have policy implications. It is conceivable that the risk of NMPDU increases when the prescriptions for psychotropics increased dramatically over years, as the case in the US Kolodny et al. In Taiwan, the implementation of National Health Insurance in Cheng, may have further ramifications for the prescription of psychotropics. Under the system, patients have relatively easy access to receive prescription drugs with a low percentage of copayment and can get the prescribed medications at the clinic or hospital. To delineate the whole picture of prescription drug use, we divided past-year prescription drug use into NMU, MUO, and non-use. Using a stratified, multistage, probability-proportional-to-size random sampling from the Taiwanese population household registry, 28, individuals were selected as potential participants. The distributions of demographic characteristics of the 17, participants, whether in the adolescent or adult samples, were equivalent to those of their counterparts in the entire population. Detailed information about the sampling and methodology of the survey was available elsewhere Chen et al. Participants were asked to complete anonymously a computer-assisted self-interview on tablet computers, containing question items on sociodemographic variables, use and problematic use of psychoactive substance, and depressive symptoms, among others. If respondents reported ever use of any prescription drugs, they would be further asked about their last time use, use of dosage and frequency. The questions about dosage and frequency were asked with three options, including lower than prescribed, the same as prescribed, and higher than prescribed. The questionnaire also had sections on use of licit substances and illicit drugs or inhalants. The questions used to assess each substance or drug had a similar structure, starting with lifetime use and then followed by questions regarding age of first use, average frequency of consumption, and recency of use. Licit substances assessed in the survey included tobacco, alcohol, and areca nut. In addition, well-validated scales were used to assess problematic use of substance. Depressive symptoms was ascertained using the item version of the Center for Epidemiological Study-Depression CES-D for depression symptoms Radloff, , with excellent reliabilities and validity demonstrated in Taiwanese adolescents Yang et al. Analyses were conducted in two parts. Out of 17, participants, a weighted prevalence of 3. Based on the cross-tabulation Supplemental Table S1 , 3. The majority of the individuals with NMU were due to their acquirement of the drugs without a doctor's prescription, i. However, respondents had difficulty identifying the name of the prescription drugs that they ever used For individuals who could identify the name of their medications, opioid analgesics e. For analgesics, NMU was associated with age adolescents and old adults aged 45—64 had decreased likelihood versus young adults aged 18—34 and educational level those not obtaining college level had decreased likelihood versus those with college level when compared to Non-NMU, whereas NMU was associated only with age old adults aged 45—64 had a decreased likelihood when compared to MUO. A similar pattern was found when NMU was compared to MUO; however, the magnitude of aOR tended to be smaller and the association with areca nut was no longer statistically significant. All of those robust correlates of NMU, except illicit drug use due to its small number, are plotted in Supplementary Fig. These findings help shed light on the scale and correlates of NMPDU in Taiwan, and provide useful clues for prevention strategies. For example, the prevalence of NMU of analgesics and hypnotics was 4. Several possible explanations could account for this, including differences in health insurance systems, physicians' prescription patterns, and socio-cultural attitudes toward prescription drugs. For instance, the amount of prescription opioids sold to pharmacies, hospitals, and doctors' offices quadrupled from to in the US Drug Enforcement Administration, ; Paulozzi and Centers for Disease Control Prevention, , indicating a tendency of over-prescription in the US Chang et al. In contrast, all the prescription drugs are closely monitored under the National Health Insurance in Taiwan to promote rational medical practice implemented in every contracted medical facility Wu et al. Thus, overlapping prescriptions or polypharmacy without reasonable medical indications would not be reimbursed Wang et al. However, it should be noted that the majority of individuals with NMPDU in this study had the experience of acquiring the medications without a doctor's prescription, e. Among the sociodemographics examined in this study, there were two robust findings, i. And the finding of no apparent sex difference in NMPDU is also supported by many previous studies, including a survey in Japan Tominaga et al. Intriguingly, the NMU of both types of drugs were found to have different substance use profiles. Our finding was supported by a US study showing NMU of analgesics to be associated with a greater DAST score and a higher prevalence of substance use disorder in the follow-up Boyd et al. A possible explanation for the lack of association of NMU of analgesics with illicit drug use in this study might be due to the prescription patterns of opioid analgesics in Taiwan. The prescription rates of opioids in Taiwan Pan et al. In addition, as most previous studies reporting the relationship between NMU of prescription opioids and illicit drug use were focused on oxycodone Kuehn, , it was not covered in this study as oxycodone did not enter Taiwanese market until The variety of analegesics included in this study might also help explain their lack of association with illicit drug use. On the other hand, the association of NMU of prescription analgesics with use and problematic use of alcohol is similar to the findings of US studies Garnier et al. Individuals with alcohol use disorders might have unsatisfactory pain control, which might increase their risk of NMU of analgesics. In addition, there might be common etiology underlying both NMU of analgesics and alcohol use problems, such as high impulsivity or certain psychiatric comorbidity e. Previous studies showed that depression was linked to both alcohol use Kuria et al. However, our results further revealed that the association became non-significant when compared to the group of MUO. It is possible that those with NMUPD might use these medications to self-medicate their psychological discomfort Khantzian, Thus, the screening of depression or anxiety symptoms among individuals with NMPDU might be crucial in clinical settings. Second, the closely monitoring system of prescription medications through National Health Insurance can help keep the prevalence of NMPDU at a low level. Third, as a large proportion of individuals with NMPDU still reported getting medications without a doctor's prescriptions, future policy should aim at closing the potential loophole that these prescription drugs are sold illegally to clients. We suggest to adopt a system similar to Prescription Drug Monitoring Programs to further monitor how pharmacies give medications to these patients. Pharmacological education is suggested to individuals with NMUPD for adherence to medical instructions, helping them to understand the risks of NMUPD and to address motivations for prescription drug misuse. Lastly, as drug diversion was not measured in this national survey, future direction could be focused on 1 evaluating the scale of drug diversion i. Several limitations of this study should be noted. First, given the cross-sectional nature of this survey, no causal-relationship could be established. Second, we defined NMU as self-reported use more than the prescription allowed or without a doctor's prescription, which is less stringent than an interview-based diagnosis of use disorders. Third, the prescription central nervous system medications inquired in this study did not include stimulants for attention-deficit hyperactivity disorder, rendering the past-year prevalence of NMPDU in the population underestimated. These findings provide useful information for the development of a more tailored prevention strategies of NMPDU. The content is solely the responsibility of the authors and does not necessarily represent the official views of the TFDA. Participants were informed the nature of the study and were guaranteed confidentiality prior to the survey. Afterwards, written informed consent was obtained from all participants. Study concept and design: Wei J. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Prev Med Rep. Find articles by Lian-Yu Chen. Find articles by Yi-Lung Chen. Find articles by Wen-Ing Tsay. Find articles by Shang-Chi Wu. Find articles by Yen-Tyng Chen. Find articles by Po-Chang Hsiao. Find articles by Ya-Hui Yu. Find articles by Te-Tien Ting. Find articles by Chuan-Yu Chen. Find articles by Yu-Kang Tu. Find articles by Jiun-Hau Huang. 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Construction and Analysis of Protein-Protein Interaction Network of Heroin Use Disorder
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Construction and Analysis of Protein-Protein Interaction Network of Heroin Use Disorder
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Construction and Analysis of Protein-Protein Interaction Network of Heroin Use Disorder
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