title: Non-medical use of non-opioid psychotherapeutic medications in a community-based cohort of HIV-infected indigent adults.
abstract: BACKGROUND
  Non-opioid psychotherapeutic medications significantly increase the risk of opioid overdose-related deaths. We prospectively followed HIV-infected indigent adults sampled from the community to examine rates of and factors associated with non-medical use of benzodiazepines, muscle relaxants, and prescription stimulants.
  
  
  METHODS
  We interviewed participants quarterly for 2 years about alcohol and illicit substance use; depression; use of prescribed opioid analgesics, benzodiazepines and muscle relaxants; opioid analgesic misuse; and non-medical use (i.e., use without a prescription) of benzodiazepines, muscle relaxants, and prescription stimulants. Using mixed-effects multivariate logistic regression, we determined factors associated with non-medical use of benzodiazepines, muscle relaxants, and prescription stimulants.
  
  
  RESULTS
  Among the 296 participants at enrollment, 52.0% reported taking opioid analgesics that had been prescribed, 17.9% took benzodiazepines that had been prescribed, and 8.1% took muscle relaxants that had been prescribed. Over the 2-year study interval, 53.4% reported prescription opioid misuse, 25.3% reported non-medical use of benzodiazepines, 11.5% reported non-medical use of muscle relaxants, and 6.1% reported non-medical use of prescription stimulants. In multivariable analysis, opioid analgesic misuse in the past 90 days was associated with non-medical use of benzodiazepines, muscle relaxants, and prescription stimulants during the same time interval. Illicit substance use and depression were not associated with non-medical use of these medications.
  
  
  CONCLUSIONS
  Prescription opioid analgesic misuse is associated with non-medical use of other psychotherapeutic medications. Health care providers should monitor for non-medical use of a broad array of psychoactive medications among high-risk populations to minimize harm.
authors.affiliation: Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, San Diego, CA 92093, USA. Electronic address: mvijayaraghavan@ucsd.edu.
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
authors.affiliation: University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94117, USA. Electronic address: Daniel.Freitas@ucsf.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freitas
authors.affiliation: Massachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, 100 Cambridge, 15th Floor, Boston, MA 02114, USA. Electronic address: dbangsberg@partners.org.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Department of Physiological Nursing/UCSF, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA. Electronic address: chris.miaskowski@nursing.ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.affiliation: University of California, San Francisco, 521 Parnassus Avenue, San Francisco, CA 94117, USA; Division of General Internal Medicine, San Francisco General Hospital, 1001 Potrero Avenue, SFGH 10, San Francisco, CA 94143, USA. Electronic address: mkushel@medsfgh.ucsf.edu.
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D000701:Analgesics, Opioid; D001569:Benzodiazepines; D000697:Central Nervous System Stimulants; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central; D011203:Poverty / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011619:Psychotropic Drugs; D012495:San Francisco; D013223:Statistics as Topic
chemical_list: D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D009125:Muscle Relaxants, Central; D011619:Psychotropic Drugs; D001569:Benzodiazepines
keywords: Benzodiazepines; Muscle relaxants; Non-medical use; Prescription stimulants
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