Prescription Opioid Misuse: Initiation, Sources of Supply, and the Role of Medical Providers

Over the past 25 years, opioid analgesic misuse has increased dramatically in the U.S., with concomitant deleterious effects on health. Results from the 2014 National Survey on Drug Use and Health (NSDUH) reported that an estimated 4.3 million people aged 12 or older were current non-medical users of opioid analgesics, representing 1.6 percent of the population (SAMHSA, 2015), and unintentional drug poisoning deaths now surpass motor vehicle accidents as the leading cause of injury death (CDC 2014). Opioid analgesics are produced in the U.S. within a system of tight control and any entity or person manufacturing, distributing, prescribing, or dispensing opioid analgesics can only do so under license from the DEA. However, medication diversion—the transfer of a pharmaceutical product from a medical to non-medical channel of distribution or use—is endemic and has been estimated to be a $25 billion a year industry (U.S. General Accounting Office, 2003). Although there has been some analysis of the mechanisms of pharmaceutical diversion, much of the literature stems from epidemiologically grounded population-level analysis and few studies to date have examined the socio-cultural factors that may facilitate the movement of opioid analgesics from sanctioned to unsanctioned use. In this dissertation, I investigate the medical and non-medical use of opioid analgesics among a sample of New York City residents to explore experiences of initiation and the ways in which misuse is situated within a medical context. In particular, I focus on how participants acquire the opioids they use and the sources of pills that are diverted into the illicit market. Finally, I explore the impact of two supply-side interventions that have shaped the opioid market, and end with a discussion of the political and economic landscape that has facilitated opioid analgesic misuse in the U.S