Source of prescription drugs used nonmedically in rural and urban populations

Abstract

Background: Unintentional overdose deaths due to nonmedical use of prescription drugs disproportionately impact rural over urban settings in the United States. Sources of these prescriptions may play a factor. Objective: This study examines the relationships between rurality and source of prescription drugs used nonmedically. Methods: Using data from the National Survey on Drug Use and Health 2008–2010 (n = 10 693), we examined bivariate and multivariate associations of socio-demographic and clinical correlates and source (physician or non-physician) of prescription drugs (opioid, sedative, tranquilizer, or stimulant) used nonmedically among urban and rural residents. We also examined the type of prescription drugs used nonmedically among urban and rural residents by source. Results: Among respondents reporting past year nonmedical use of prescription medications, 18.9% of urban residents and 17.5% of rural residents had a physician source for drugs used nonmedically. Likelihood of physician source for urban and rural residents was increased in Hispanic, insured individuals and those with any prescription drug dependence. Rural residents who had a non-physician source were more likely than urban residents with a non-physician source to use hydrocodone (49% vs. 43.3%, p = 0.05), morphine (17.7% vs. 14.0%, p = 0.04), tramadol products (18.1% vs. 11.2%, p = 0.003), and methadone (17.2% vs. 10.9%, p = 0.001). Conclusion: Urban and rural individuals with nonmedical use of prescription drugs are equally likely to obtain these prescriptions from a physician source. Some factors associated with obtaining prescription drugs from a physician source differed between these populations, which may have implications for public health approaches to addressing problems such as overdose.

• Drug diversion
• nonmedical use
• prescription drugs
• rural health
• substance-related disorder

Acknowledgements

Dr Wang is currently a post-doctoral fellow supported by the Veterans Affairs Connecticut Healthcare System and a research associate at Yale School of Medicine. For this study, she was supported by Robert Wood Johnson Foundation Clinical Scholars Program. Dr Becker is supported by a Veterans Affairs Health Services Research & Development CDA-2 (08-276). The funders had no role in the design or conduct of the study. Views expressed are those of the authors and do not represent those of the funding source. Dr Fiellin serves on an external advisory board to monitor for diversion and abuse of buprenorphine for Pinney Associates.