title: Increased Incidence of Spinal Abscess and Substance Abuse after Implementation of State Mandated Prescription Drug Legislation.
abstract: OBJECTIVE
  To investigate the incidence of spinal abscess and substance abuse in a tertiary care hospital after state legislation titled "House Bill 1" (HB1) mandated stricter regulation of prescription drugs of abuse in Kentucky in 2012.
  
  
  METHODS
  A retrospective case series study design was used to review the incidence of spinal abscess and drug abuse diagnoses admissions from 2010 to 2014. Variances in the incidence of spinal abscess and substance abuse were plotted across this time frame.
  
  
  RESULTS
  The incidence of intraspinal abscess increased 1.56-fold in 2011 (n = 26) and 2012 (n = 25) relative to 2010 (n = 16). However, in 2013, the year following implementation of HB1 legislation, the incidence of intraspinal abscess increased 2.38-fold (n = 38) and then 4.19-fold (n = 67) in 2014. The incidence of intraspinal abscess in subjects with drug abuse diagnosis remained constant between 2010 (n = 3) and 2012 (n = 3). However, it increased twofold (n = 7) in 2013 and then ninefold (n = 27) in 2014. A correlation coefficient (rSAD ) of 0.775 revealed a strong association between the increase incidence of intraspinal abscess and diagnosis of drug abuse.
  
  
  CONCLUSIONS
  The results of this retrospective study demonstrate an increased incidence of intraspinal abscess associated with drug abuse after passage of HB1 legislation regulating prescriptions of controlled medications in Kentucky. This increased incidence may be related to individuals relying on nonprescription drugs of abuse due to more highly regulated access to controlled prescription medications. However, additional factors unrelated to HB1 legislation must be taken into account.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA.|Department of Physical Medicine and Rehabilitation, Cardinal Hill Rehabilitation Hospital, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Vittal R
authors.initials: VR
authors.lastname: Nagar
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA.|Department of Physical Medicine and Rehabilitation, Cardinal Hill Rehabilitation Hospital, University of Kentucky, Lexington, Kentucky, USA.|Department of Physical Medicine and Rehabilitation, Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Joe E
authors.initials: JE
authors.lastname: Springer
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky, USA.|Department of Physical Medicine and Rehabilitation, Cardinal Hill Rehabilitation Hospital, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Salles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020802:Epidural Abscess / Q000453:epidemiology*; D033161:Government Regulation; D006291:Health Policy / Q000639:trends*; D006801:Humans; D015994:Incidence; D007629:Kentucky / Q000453:epidemiology; D007880:Legislation, Drug / Q000639:trends*; D008875:Middle Aged; D004366:Nonprescription Drugs; D063487:Prescription Drug Misuse / Q000331:legislation & jurisprudence*; D055553:Prescription Drugs; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs
keywords: Addiction; Narcotics; Pain Management; Rehabilitation Medicine; Spinal Cord; Substance Abuse