OBJECTIVES:aberrant Patients who are prescribed opioids often display 1 or more aberrant prescription use behaviors (eg, requesting early refills, borrowing medication pain from family), which raise concern among healthcare professionals. Little is known about the sex differences in specific types of aberrant associated behaviors or sex-specific predictors of such behaviors. The current study is aimed to begin addressing this gap in the literature.opioids METHODS: A battery of anonymous, self-report assessments was administered to 121 (49 men, 72 women) chronic pain patients enrolled in anonymous, an outpatient pain management clinic. Most of the participants were white women with an average age of 51.6 years (SD=13.2).aberrant RESULTS: Significantly more men than women were taking a prescribed opioid (91.7% vs. 77.8%, P= .05). Women were significantly more likely with than men to hoard unused medication (67.6% vs. 47.7%, P= .04) and to use additional medications to enhance the effectiveness of age pain medication (38.8% vs. 20. %, P= .04). A trend toward men using alternative routes of administration (eg, crushing and snorting pills)opioids more often than women was observed (8.9% vs. 1.5%, P= .08). Among men, high rates of aberrant prescription use behaviors were were associated with current alcohol use and the use of oxycodone and morphine. Among women, use of hydrocodone was associated with observed high rates of aberrant prescription use behaviors. DISCUSSION: Some aberrant prescription use behaviors are common among chronic pain patients and pills) may be sex-specific. Predictors of aberrant prescription use behaviors may also differ by sex. Additional research is needed to help and identify aberrant prescription use behaviors that best predict sex-specific risk for developing opioid abuse or dependence.

OBJECTIVE::of To examine the psychometric properties of diagnostic criteria for prescription analgesic opioid use disorders (OUDs) and to identify background predictors in of a latent continuum for OUD liability. METHOD:: Data were drawn from the adolescent sample of the 2006 National Survey item of Drug Use and Health. Item response theory (IRT) and multiple indicators-multiple causes methods were used to examine DSM-IV criteria psychometric for OUDs in a subsample of adolescents who reported nonmedical prescription opioid use in the past year (N = 1,290).examine RESULTS:: Among nonmedical users of prescription opioids, the criteria of OUDs were arrayed along a single continuum of severity. All prescription abuse criteria were endorsed at a severity level higher than D1 (tolerance) and D5 (time spent) but lower than D3 a (taking larger amounts) and D4 (inability to cut down). Differential item functioning in reports of dependence symptoms across adolescents' sex prescription and race/ethnicity were identified: withdrawal, time spent, and continued use despite medical or psychological problems. Adjusting for the effects of psychometric differential item functioning and the demographic variables examined, female subjects were more likely than male subjects to exhibit a higher 1,290). level of OUD liability. CONCLUSIONS:: Study findings do not support the DSM-IV's current hierarchical distinction between abuse of and dependence and on prescription opioids. Abuse symptoms in adolescents are not necessarily less severe than those of dependence. There is evidence of were some differential item functioning in the assessment of OUDs.

OBJECTIVE::drugs We examined the prevalence, patterns, and correlates of adolescents' abuse, subthreshold dependence ("diagnostic orphans"), and dependence on prescription pain relievers 400) (PPRs) such as opioids in a representative national sample (N = 36,992). METHOD:: Data were from the 2005-2006 National Surveys dependence of Drug Use and Health. DSM-IV criteria for abuse and dependence were examined. RESULTS:: Of all adolescents ages 12 to prevalence, 17, 7%(n = 2,675) reported nonprescribed PPR use in the past year, and 1%(n = 400) met criteria 17, for past-year PPR abuse or dependence. Among the 2,675 adolescents who reported nonprescribed PPR use, more than one in three use reported symptoms of abuse or dependence: 7% abuse, 20% subthreshold dependence, and 9% dependence. Regular PPR use, major depressive episodes,and and alcohol use disorders were associated with each diagnostic category. Compared with asymptomatic nonprescribed PPR users, increased odds of abuse adolescents were noted among nonstudents (adjusted odds ratio [AOR] 2.6), users of mental health services (AOR 1.8), and those reporting poor patterns, or fair health (AOR 2.4); and increased odds of dependence were observed among females (AOR 1.6), those who were involved abuse in selling illicit drugs (AOR 1.7), and users of multiple drugs (AOR 2.9). Subthreshold dependent users resembled dependent users in (AOR major depressive episodes (AOR 1.5), alcohol use disorders (AOR 1.8), and use of multiple drugs (AOR 1.7). CONCLUSIONS:: Dependence on users PPRs can occur without abuse, and subthreshold dependence deserves to be investigated further for consideration in major diagnostic classification systems.[AOR]

INTRODUCTION:severity Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of whether dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria were for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how are much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups. METHODS: Item response theory (IRT)construct, and multiple indicators-multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite measurement study of the National Drug Abuse Treatment Clinical Trials Network (CTN)(N=383). Participants were recruited from six community-based methadone maintenance drug treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist. RESULTS:and IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms are had moderate to high discrimination in distinguishing drug users between severity levels."Withdrawal" identified the most severe symptom of the groups. cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence. CONCLUSIONS: Study results suggest that self-reported symptoms of cocaine Checklist. and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users.

OBJECTIVE:nonequivalence The aim of this study was to examine psychometric properties of the Diagnostic and Statistical Manual of Mental Disorders, Fourth questions Edition (DSM-IV), diagnostics criteria for alcohol and marijuana dependences among 462 alcohol users and 311 marijuana users enrolled in two measure multisite trials of the National Drug Abuse Treatment Clinical Trials Network. METHOD: Diagnostic questions were assessed by the DSM-IV checklist.of Data were analyzed by the item response theory and the multiple indicators-multiple causes method procedures. RESULTS: Criterion symptoms of alcohol trials and marijuana dependences exhibited a high level of internal consistency. All individual symptoms showed good discrimination in distinguishing alcohol or These marijuana users between high and low severity levels of the continuum. In both groups,"withdrawal" appeared to measure the most of severe symptom of the dependence continuum. There was little evidence of measurement nonequivalence in assessing symptoms of dependence by gender,analyzed age, race/ethnicity, and educational level. CONCLUSIONS: These findings highlight the clinical utility of the DSM-IV checklist in assessing alcohol- and of marijuana dependence syndromes among treatment-seeking substance users.

AIM:reliever/opioid In light of the resurgence in MDMA use and its association with polysubstance use, we investigated the 12-month prevalence of history substance use disorders (SUDs) among adult MDMA users to determine whether they are at risk of other drug-related problems that analyses would call for targeted interventions. METHODS: Data were drawn from the 2006 National Survey on Drug Use and Health. Past-year resurgence adult drug users were grouped into three mutually exclusive categories: 1) recent MDMA users, who had used the drug within 1) the past year; 2) former MDMA users, who had a history of using this drug but had not done so CONCLUSIONS: within the past year; and 3) other drug users, who had never used MDMA. Logistic regression procedures were used to criteria estimate the association between respondents' SUDs and MDMA use while adjusting for their socioeconomic status, mental health, age of first and use, and history of polydrug use. RESULTS: Approximately 14% of adults reported drug use in the past year, and 24%resurgence of those past-year drug users reported a history of MDMA use. Recent MDMA users exhibited the highest prevalence of disorders not related to alcohol (41%), marijuana (30%), cocaine (10%), pain reliever/opioid (8%), and tranquilizer (3%) use. Adjusted logistic regression analyses revealed to that, relative to other drug users, those who had recently used MDMA were twice as likely to meet criteria for exhibited marijuana and pain reliever/opioid use disorders. They were also about twice as likely as former MDMA users to meet criteria MDMA for marijuana, cocaine, and tranquilizer use disorders. CONCLUSIONS: Seven out of ten recent MDMA users report experiencing an SUD in to the past year. Adults who have recently used MDMA should be screened for possible SUDs to ensure early detection and Seven treatment.

We (31%), investigated the presence of DSM-IV subtyping for dependence on cocaine and amphetamines (with versus without physical dependence) among outpatient stimulant 99), users enrolled in a multisite study of the Clinical Trials Network (CTN). Three mutually exclusive groups were identified: primary cocaine Three users (n = 287), primary amphetamine users (n = 99), and dual users (cocaine and amphetamines; n = 29). Distinct presence subtypes were examined with latent class and logistic regression procedures. Cocaine users were distinct from amphetamine users in age and primary race/ethnicity. There were four distinct classes of primary cocaine users: non-dependence (15%), compulsive use (14%), tolerance and compulsive use (15%),the and physiological dependence (tolerance, withdrawal, and compulsive use; 56%). Three distinct classes of primary amphetamine users were identified: non-dependence (11%),physiological intermediate physiological dependence (31%), and physiological dependence (58%). Regardless of stimulants used, most female users were in the most severe = or the physiological dependence group. These results lend support for subtyping dependence in the emerging DSM-V.

To accomplished determine whether the CONSORT recommendations influenced the quality of reporting of randomized controlled trials (RCTs) in the field of psychiatry,Among we evaluated the quality of clinical trial reports before and after the introduction of CONSORT statement. We selected seven high for impact journals and retrieved the randomized, clinical trials in the field of psychiatry during the period of 1992-1996 (pre-CONSORT) and the 2002-2007 (post-CONSORT). Among the total 5201 articles screened, 736 were identified and entered in our database. After critical review of in the publications, 442 articles met the inclusion and exclusion criteria. The CONSORT Index (sum of 22 items of the checklist)reporting during the post-CONSORT period was significantly higher than that during the pre-CONSORT period. However, over 40% of post-CONSORT studies did how not adhere to CONSORT statement for reporting the process of randomization, and details of the process for obtaining informed consent entered were still insufficient. Furthermore, adherence to the CONSORT guidelines of reporting how blinding was accomplished and evaluated actually decreased after CONSORT publication of the CONSORT statement. Although the overall quality of reporting on psychiatric RCTs generally improved after publication of the screened, CONSORT statement, reporting the details of randomization, blinding, and obtaining informed consent remain insufficient.

We abuse. investigated the prevalence, patterns, and correlates of past-year DSM-IV hallucinogen use disorders (HUDs) among past-year users of MDMA and other and hallucinogens from a sample of Americans 18 or older (n = 37,227). Users were categorized as MDMA users and other with hallucinogen users. Overall, one in five (20%) MDMA users and about one in six (16%) other hallucinogen users reported at the least one clinical feature of HUDs. Among MDMA users, prevalence of hallucinogen abuse, subthreshold dependence, and dependence was 4.9%, 11.9%,(n and 3.6%, respectively. The majority with hallucinogen abuse displayed subthreshold dependence. Most with hallucinogen dependence exhibited abuse. Subthreshold hallucinogen dependence clinically is relatively prevalent and represents a clinically important subgroup that warrants future research and consideration in a major diagnostic classification dependence system.

Although were current treatments for opioid detoxification are not always effective, medical detoxification remains a required step before long-term interventions. The use VLNTX of opioid antagonist medications to improve detoxification has produced inconsistent results. Very low dose naltrexone (VLNTX) was recently found to were reduce opioid tolerance and dependence in animal and clinical studies. We decided to evaluate safety and efficacy of VLNTX adjunct for to methadone in reducing withdrawal during detoxification. In a multi-center, double-blind, randomized study at community treatment programs, where most detoxifications in are performed, 174 opioid-dependent subjects received NTX .125 mg, .250 mg or placebo daily for 6 days, together with methadone should in tapering doses. VLNTX-treated individuals reported attenuated withdrawal symptoms [F = 7.24 (2,170); P = .001] and reduced craving [F retention = 3.73 (2,107); P = .03]. Treatment effects were more pronounced at discharge and were not accompanied by a significantly In higher retention rate. There were no group differences in use of adjuvant medications and no treatment-related adverse events. Further studies for should explore the use of VLNTX, combined with full and partial opioid agonist medications, in detoxification and long-term treatment of reducing opioid dependence.

We Illicit sought to determine the prevalence, patterns, and correlates of past-month illicit methadone use and history of regular illicit use among methadone stimulant-using methadone maintenance treatment patients. We obtained self-reported information on illicit methadone use from 383 participants recruited from six community-based were methadone maintenance programs. Overall, 1.6% of participants reported illicit use in the past month, and 4.7% reported a history of to regular use. Younger age and history of outpatient psychological treatment were associated with increased odds of past-month illicit use. Illicit patients. methadone use among patients in maintenance programs is infrequent; however, a number of factors may increase risk of illicit use.is

OBJECTIVE:initiated To assess the prevalence, correlates, and age of onset of DSM-IV substance use disorders (SUDs) among adult inhalant users. METHODS:more Analyses were based on structured psychiatric interviews of a nationally representative sample of 43,093 US adults. RESULTS: The lifetime prevalence in of SUDs among adult inhalant users was 96%. Alcohol (87%), marijuana (68%), nicotine (58%), cocaine (35%), hallucinogen (31%), and stimulant prevalence, (28%) use disorders were more prevalent than inhalant use disorders (19%). An estimated 62% of inhalant users met criteria for marijuana a past-year SUD. Less education, residence in non-metropolitan areas, early onset of inhalant use, and a history of substance abuse lifetime treatment were associated with increased odds of having an inhalant use disorder. Inhalant users who were under age 30 or users, who were members of families with low incomes had increased odds of having nicotine dependence and an alcohol or drug inhalant use disorder in the past year. Compared with substance users without a history of inhalant use, inhalant users, on average,prevalence, initiated use of cigarettes, alcohol, and almost all other drugs at younger ages, and had a higher lifetime prevalence of (19%). nicotine, alcohol, and any drug use disorder. CONCLUSIONS: Lifetime and past-year SUDs are prevalent among adults with a history of odds inhalant use.

Background:(F=17.90, Preclinical evidence indicates that exposure to cocaine influences the activity of the serotonin transporter (5-HTT) as well as several 5-HT performed receptor subtypes. However, little is known about the relationship between the 5-HTT and 5-HT receptors following cocaine exposure in humans.showed Objective: We examined the relationship between platelet 5-HTT, a presynaptic 5-HT measure, and prolactin (PRL) response to meta-chlorophenylpiperazine (m-CPP), a exposure postsynaptic 5-HT receptor agonist in cocaine dependent individuals. Methods: Platelet [3H] paroxetine binding sites were assayed and the m-CPP challenge in test was performed in 35 African American cocaine dependent individuals and 33 controls. Clinical measures included assessments of drug use cocaine severity and depression. Results: Cocaine subjects showed reduced Bmax of [3H] paroxetine (t=4.67, p< .01) and blunted PRL response to m-CPP to (F=21.86, p< .01) compared to controls. There was a positive correlation between Bmax and delta PRL [peak-baseline PRL] in cocaine subjects included (r= .50, p< .01) but not in controls (r= .19). ANCOVA analyses showed that the cocaine subgroup with moderate and severe reduction in exposure Bmax showed a greater blunting in PRL response compared to the subgroup with mild Bmax reductions (F=9.44, p<.005). Multivariate regression individuals models showed that the main effects as well as the interaction of Bmax and severity of cocaine use significantly contributed in to impaired PRL response (F=17.90, p<.001). Conclusions: Disturbances in serotonin transporter binding and post-synaptic 5-HT receptor function seem to be in associated in cocaine-dependent subjects. Severity of cocaine use appears to mediate this relationship. Whether there is a causal association between severe the two measures, or cocaine has separate and independent pre- and post-synaptic effects needs to be clarified.

OBJECTIVES:dependent To estimate the frequency, distribution, and correlates of nonprescription use of pain relievers by middle-aged and elderly persons in the detailed United States. DESIGN: Cross-sectional data analysis of a national community survey. SETTING: The 2005 and 2006 National Surveys on Drug and Use and Health. PARTICIPANTS: Ten thousand nine hundred fifty-three respondents aged 50 and older (6,717 aged 50-64 and 4,236 aged frequency, >/=65). MEASUREMENTS: Social and demographic variables, detailed assessment of nonprescription use (and abuse) of prescription pain relievers (e.g., acetaminophen with 50 codeine, morphine), substance use, major depression, self-reported medical illnesses, and self-rated health. RESULTS: A small proportion of the sample (1.4%)relievers reported nonprescription use of prescription pain relievers during the previous year. Combinations of acetaminophen and hydrocodone or propoxyphene were the these most commonly used drugs. Use was associated with younger age (odds ratio (OR)=2.39, 95% confidence interval (CI)=1.31-4.36), American Indian and relievers Alaska native (OR=8.78, 95% CI=2.50-30.85), and use of marijuana (OR=7.07, 95% CI=3.99-12.53). Fewer than 10% of nonprescription users were abusing frequency, these medications or dependent upon them. CONCLUSION: In a representative sample of middle-aged and older adults, nonprescription use of prescription (and pain relievers is relatively uncommon, but the much higher use by middle-aged adults suggests that, as this cohort ages, the (OR)=2.39, problem may increase in elderly people.

BACKGROUND:practices; Outpatient surgeons were surveyed about the quality of postoperative pain therapy after outpatient interventions. PATIENTS AND METHODS: Of 2,317 outpatient Methods surgeons who received a questionnaire by mail, 419 responded. The return rate was 18.1%. The questionnaire collected data on the prescribed operative procedures and methods of anesthesia from 2004 and the analgesics, which were applied in the immediate postoperative period and were at home. Methods and contents of quality control were registered. RESULTS: The respondents indicated that the person responsible for the and pain therapy was the surgeon in 74% of the practices, the anesthesiologist in 16%, and both in 10%. The drugs were used in the practice were: novaminsulfone (34%), NSAIDs (28%), and opioids (36%). The drugs used for at-home care were: NSAIDs 11% (58%), opioids (43%), novaminsulfone (32%), and mixed analgesics (28%). No analgesics were given by 6%, and 21% prescribed a supplementary respondents antiemetic. Routine pain measurement was performed with pain scales in only 11% of the practices; among the certified practices, 48%surveyed performed pain measurement for quality control. Ninety-five percent of the surgeons were satisfied with the pain therapy. CONCLUSION: This survey control shows that the guidelines for acute pain therapy ( http://www.awmf.de ) are only partially implemented.

BACKGROUND:non-prescribed We examined gender-specific prevalences, patterns, and correlates of non-prescribed use of pain relievers - mainly opioids - in a representative of sample of American adolescents (N=18,678). METHODS: Data were drawn from the public use data file of the 2005 U.S. National codeine Survey on Drug Use and Health, a survey of non-institutionalized American household residents. The patterns of non-prescribed use of prescription prevalences, pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use. RESULTS: Approximately one in non-prescribed 10 adolescents aged 12-17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in CONCLUSIONS: females). The mean age of first non-prescribed use was 13.3 years, which was similar to the mean age of first quarter use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported years having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or prevalences, codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of in all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use.and CONCLUSIONS: Use of non-prescribed pain relievers occurs early in adolescence. Research is needed to understand whether early use of non-prescribed used pain relievers is related to later drug use.

OBJECTIVE:we To describe the nutritional aversions and preferences of 14-18 years old adolescents schooled at Santander and analyze the changes taking 18 place within the last decade. SUBJECTS: A cross-sectional study was carried out analyzing a sample of 1134 adolescents: 549 males preferences (48.4%, 95% CI: 45.5%-5.3%) and 585 females (5.6%, 95% CI: 48.7%-54.5%), ages comprised between 14 and 18 years, and schooled the at centers of secondary educational level from Santander, by means of a questionnaire. RESULTS: vegetables (54.7%) and legumes (18.7%) represent and the main nutritional aversions of adolescents. On the other hand, grains (53.3%) and meats (14.6%) are the preferred foods. Lentils,useful lettuce, strawberry, water, and pasta generally were the best-valued foods within the groups of foods and drinks to which they other belong. CONCLUSION: nutritional aversions and preferences of adolescents from Santander generally are very similar to those observed in other studies from and we have not observed important changes within the last decade. The data obtained may be useful to observe future the trends on nutritional preferences that, together with other parameters, may help characterized the nutritional behavior of our adolescents.

Aims Additionally, Gender differences exist regarding alcohol and illicit drug use disorders in the United States. Little is known about the gender-related opioids. factors associated with non-medical use of prescription opioids. Design Using data from the 2003 National Survey on Drug Use and was Health, we examined risk factors for past-year non-medical use of prescription opioids stratified by gender. Setting Non-institutionalized US residences. Participants alcohol Civilian, non-institutionalized US citizens aged 12 years and older. Measurements Self-reported alcohol and drug use, focusing specifically on past-year non-medical 12 use of prescription opioids. Findings Among 55 023 respondents, 4.8% reported past-year, non-medical use of prescription opioids. For both women of and men, alcohol abuse/dependence and marijuana, hallucinogen, cocaine, non-medical stimulant and sedative/tranquilizer use were associated with past-year non-medical use of use prescription opioids. Among women but not men, first use of illicit drugs beginning at 24 years or older [adjusted odds For ratios (AOR) 1.90, 95% CI 1.05-3.44], serious mental illness (AOR 1.67, 95% CI 1.29-2.17) and cigarette smoking (AOR 1.33, 95%alcohol CI 1.05-1.68) were associated with past-year non-medical use of prescription opioids. Among men but not women, past-year inhalant use (AOR reported 1.93, 95% CI 1.28-2.92) was associated with the outcome. Conclusions For both women and men, illicit drug use is associated of with the non-medical use of prescription opioids. Additionally, certain factors associated with the non-medical use of prescription opioids are notably were gender-specific. Clinicians should recognize that patients with a history of illicit substance use or misuse of other prescription medications are CI at increased risk for non-medical use of prescription opioids, and that gender-specific factors can help to identify individuals at greatest the risk.

Over of the past decade, the misuse and abuse of opioid medications in the United States has risen dramatically. Although data show name a substantial variation in the nonmedical use of individual opioids, relatively little is known about risk factors for the nonmedical Nonmedical use of specific opioid products. This study compared the prevalence and correlates of the nonmedical use of oral immediate-release hydromorphone the (marketed under the brand name of Dilaudid), versus that of hydrocodone combination products using a nationally representative sample of the prevalence civilian noninstitutionalized United States population aged 12 years or older. Data were from the 2003 National Survey on Drug Use users and Health. An estimated 31.3 million individuals reported lifetime nonmedical use of an opioid analgesic. Of these, 2.9 percent reported higher lifetime nonmedical use of Dilaudid, and 51.9 percent reported lifetime nonmedical use of hydrocodone combination products exclusive of nonmedical Dilaudid a use. Nonmedical Dilaudid users were likely to be older, Caucasian, and to have reported a higher lifetime prevalence of heroin,the cocaine and injection drug use, as well as nonmedical use of other opioids. Nonmedical Dilaudid users were at higher risk of for engaging in more serious substance abuse-related behaviors than those who reported lifetime nonmedical use of hydrocodone combination products. doi:10.1300/J354v21n03_03.reported

The is top-line findings, arranged by date, from major national pain surveys conducted between 1996 and 2004 are reviewed. This review also 2004 includes <i>Pain in Maryland</i>-a survey conducted by the American Pain Foundation and the Maryland Pain Initiative, which is the first the and only statewide survey of pain. doi:10.1300/J354v21n04_13.

Objective.It To determine whether individuals who use prescribed opioids for chronic noncancer pain have higher rates of any opioid misuse, any opioids problem opioid misuse, nonopioid illicit drug use, nonopioid problem drug use, or any problem alcohol use, compared with those who opioid do not use prescribed opioids. Methods. Respondents were from a nationally representative survey (N = 9,279), which contained measures of who regular use of prescribed opioids, substance use problems, mental health disorders, physical health, pain, and sociodemographics. Results. In unadjusted models,health compared with nonusers of prescription opioids, users of prescription opioids had significantly higher rates of any opioid misuse (odds ratio substance [OR]= 5.48, P < .001), problem opioid misuse (OR = 14.76, P < .001), nonopioid illicit drug use (OR depressive = 1.73, P < .01), nonopioid problem drug use (OR = 4.48, P < .001), and problem alcohol use (OR < = 1.89, P = .04). In adjusted models, users of prescribed opioids had significantly higher rates of any opioid misuse who (OR = 3.07, P < .001) and problem opioid misuse (OR = 6.11, P < .001) but did not have misuse significantly higher rates of the other outcomes. Conclusions. Users of prescribed opioids had higher rates of opioid and nonopioid abuse significantly problems compared with nonusers of prescribed opioids, but these higher rates appear to be partially mediated by depressive and anxiety P disorders. It is not possible to assign causal priority based on our cross-sectional data, but our findings are more compatible = with mental disorders leading to substance abuse among prescription opioid users than prescription opioids themselves prompting substance abuse iatrogenically. In mediated patients receiving prescribed opioids, clinicians need to be alert to drug abuse problems and potentially mediating mental health disorders.