title: The iatrogenic epidemic of prescription drug abuse: county-level determinants of opioid availability and abuse.
abstract: BACKGROUND
  Opioid use and abuse in the United States continues to expand at an alarming rate. In this study, we examine the county-level determinants of the availability and abuse of prescription opioids to better understand the socio-ecological context, and in particular the role of the healthcare delivery system, on the prescription drug abuse epidemic.
  
  
  METHODS
  We use community-level information, data from Indiana's prescription drug monitoring program in 2011, and geospatial regression methods to identify county-level correlates of the availability and abuse of prescription opioids among Indiana's 92 counties.
  
  
  RESULTS
  The findings suggest that access to healthcare generally, and to dentists and pharmacists in particular, increases the availability of prescription opioids in communities, which, in turn, is associated with higher rates of opioid abuse.
  
  
  CONCLUSIONS
  The results suggest that the structure of the local healthcare system is a major determinant of community-level access to opioids adding to a growing body of evidence that the problem of prescription opioid abuse is, at least in part, an "iatrogenic epidemic."
authors.affiliation: Georgia State University, USA. Electronic address: ewright28@gsu.edu.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wright
authors.affiliation: Center for Health Policy, Indiana University Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis (IUPUI), USA.
authors.forename: Harold E
authors.initials: HE
authors.lastname: Kooreman
authors.affiliation: Center for Health Policy, Indiana University Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis (IUPUI), USA.
authors.forename: Marion S
authors.initials: MS
authors.lastname: Greene
authors.affiliation: Department of Psychiatry, Indiana University School of Medicine, USA.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Chambers
authors.affiliation: Department of Geography, Indiana University-Purdue University Indianapolis (IUPUI), USA.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Geography, Indiana University-Purdue University Indianapolis (IUPUI), USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wilson
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007196:Indiana / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D055553:Prescription Drugs / Q000600:supply & distribution*
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Iatrogenic epidemic; Prescription opioid abuse; Prescription opioid dispensation