Trends in the Nonmedical Use of OxyContin, United States, 2006 to 2013.

OBJECTIVES: The role of the opioid OxyContin in the opioid abuse epidemic has been well documented. In 2010, OxyContin was reformulated to make it more difficult to abuse. We assessed past-year OxyContin nonmedical use among a nationally representative population and among nonmedical users of opioid pain relievers in the United States between 2006 and 2013. MATERIALS AND METHODS: Data are from the National Survey on Drug Use and Health. Prevalence estimates of past-year OxyContin nonmedical use overall and by sociodemographic, geographic, and substance use characteristics were calculated for each year, 2006 through 2013. Multivariable logistic regression was used to identify individual characteristics associated with past-year OxyContin nonmedical use before and after reformulation. RESULTS: In 2013, the of past-year nonmedical use of OxyContin among people 12 years and older in the United States was 0.5%. This was significantly lower than the prevalence in 2010 (0.7%; P<0.05), but was similar to that in 2006 to 2009 and 2011 to 2012. Among past-year nonmedical users of pain relievers in 2013, the prevalence of OxyContin nonmedical use was 13.0%. This was significantly higher than the prevalence in 2006 (10.5%; P<0.05), and was similar to that in 2007 through 2012. Groups with increased odds of using OxyContin nonmedically in the past-year were similar before and after reformulation (2009-2010 and 2012-2013, respectively). For 2012-2013, odds for past-year OxyContin nonmedical use after reformulation were greatest for: people reporting ≥200 days of pain reliever nonmedical use, adjusted odds ratio (aOR)=3.61 (95% confidence interval [CI], 2.47-5.28); past-year heroin users, aOR=3.45 (95% CI, 2.22-5.37); and people with past-year pain reliever abuse or dependence, aOR=2.57 (95% CI, 1.88-3.51). DISCUSSION: The prevalence of past-year OxyContin nonmedical use in 2013, 3 years after reformulation, was significantly lower than the prevalence in the reformulation year, but similar to other years before and after reformulation. The prevalence of OxyContin nonmedical use among nonmedical users of pain relievers was higher than or similar to historical prevalence rates before reformulation. Groups with increased odds of OxyContin nonmedical use were similar before and after reformulation.

Mortality associated with illegal drug use among adults in the United States.

OBJECTIVES: To examine all-cause and cause-specific mortality over a 15-year follow-up period in relation to at-baseline reported lifetime use of illegal drugs from five classes (marijuana, cocaine, heroin, hallucinogens, and inhalants) among adults in the United States (US) household population. METHODS: The study involved 20,983 sample adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use supplemental questionnaire and also met the eligibility criteria for mortality follow-up. Cox proportional hazards models were estimated to examine the relationships. RESULTS: Adults who at baseline reported lifetime heroin use were at significantly higher risk of all-cause death over the follow-up period (hazard rate ratio or HR = 2.02; 95% confidence interval or CI 1.26-3.23), compared with those who did not report using drugs from any of the five classes, even after adjusting for age, sex, race, education, marital status, cigarette smoking status, and alcohol use status. Those who at baseline reported lifetime cocaine (no heroin) use had a significantly higher rate of death associated with human immunodeficiency virus diseases over the follow-up period than nonusers of drugs from any of the five classes. Several limitations of the analysis are discussed. CONCLUSIONS: Further research is needed to understand and track the elevated mortality associated with illegal drug use and the correlates of drug-poisoning deaths.

Substance use among women: associations with pregnancy, parenting, and race/ethnicity.

OBJECTIVE: To examine the association of pregnancy and parenting (0- to 2-year-old child) statuses with past 30-day use of alcohol, cigarettes and marijuana, psychotherapeutics and cocaine among American women aged 18-44, overall and by race/ethnicity. METHODS: Five years of data (2002-2006) from the National Survey on Drug Use and Health (NSDUH) were pooled. Binary logistic regression analyses stratified by race/ethnicity were performed to examine the relationships adjusting for age, marital status, education and family income. RESULTS: Overall, past 30-day alcohol, cigarette, marijuana, psychotherapeutic or cocaine use was substantially lower among pregnant women, particularly in their second or third trimesters, than among their parenting or non-pregnant counterparts. Logistic regression analysis suggested a strong negative association between pregnancy status and substance use, with no considerable variations in the magnitude of the relationship by race/ethnicity for most measures. The relationship between parenting status and substance use was in the same direction, but relatively weak, and not statistically significant for non-Hispanic (NH) blacks for any measures except for alcohol use. Regardless of pregnancy and parenting statuses, NH white women reported substance use at the highest rates, followed by Hispanics and NH blacks. CONCLUSIONS: There is indirect evidence of postpregnancy resumption in substance use. Pregnant and parenting women, regardless of race/ethnicity, could benefit from prevention efforts focusing on cessation rather than temporary abstinence from substance use.

Method of delivery and neonatal mortality among very low birth weight infants in the United States.

OBJECTIVE: To examine the association between method of delivery (primary cesarean section vs. vaginal) and neonatal mortality risk (as well as causes of death) among very low-birth weight first-born infants in the United States. More specifically, to examine this association separately for breech/malpresenting and vertex-presenting infants, while adjusting for selected maternal characteristics, and pregnancy, labor and delivery complications. METHODS: The study population was derived from the 1995-1998 birth cohort linked birth/infant death data sets. Binary and multinomial logit regression analyses were performed to assess the relationship in four very low-birth weight categories. RESULTS: Among breech/malpresenting neonates, compared to those delivered vaginally, infants delivered by a primary cesarean section had significantly lower adjusted relative risks of death for all very low-birth weight categories and the decrease in relative risk tended to be larger with each increasing birth weight category. However, for vertex-presenting neonates, results are mixed, suggesting decreased relative mortality risks associated with primary cesarean section, which were significant for 500-749 g, not significant for 750-999 g, and barely significant for 1,000-1,249 g. In contrast, for vertex-presenting neonates weighing 1,250-1,499 g, there was a significantly increased adjusted relative risk associated with primary cesarean section. Differences in cause-specific neonatal mortality by method of delivery and presentation status were also discussed. CONCLUSIONS: Primary cesarean section appears to be associated with decreased neonatal mortality risks in each very low-birth weight category for breech/malpresenting infants, but results are mixed for vertex-presenting infants. Causal inferences should be avoided because this was an observational study by design.

Racial differences in leading causes of infant death in the United States.

We used linked birth/infant death records of over 23 million singletons belonging to six birth cohorts (1989-91 and 1995-97) and examined changes in race differentials in the overall and cause-specific infant mortality risks across time in the United States. Results show that infant mortality declined for all races during the time period, with disproportionately greater declines among non-Hispanic American Indians (AIs). Among the leading causes of infant death, declines in mortality from sudden infant death syndrome (SIDS), respiratory distress syndrome (RDS) and congenital anomalies contributed the most to the overall decline in infant mortality in the 1995-97 cohorts, compared with the 1989-91 cohorts. Disproportionately greater reductions in mortality resulting from SIDS and congenital anomalies led to more rapid mortality declines among non-Hispanic AIs than for other races. There are disturbing findings that infants of almost every race experienced increases in mortality from newborn affected by maternal complications of pregnancy (maternal complications) and that none of the race groups experienced a significant decline in mortality from disorders resulting from short gestation/low birthweight.