Polysubstance use and misuse or abuse of prescription opioid analgesics: a multi-level analysis of international data

Increasing mortality and morbidity associated with opioid analgesics has led to concerns about their misuse and abuse, even when obtained via a prescription. These concerns have been most pronounced in the United States of America (USA), but limited data make it difficult to determine whether it is a problem in other countries. We investigated opioid analgesic misuse and abuse in participants from the Global Drug Survey 2015 resident in the USA (N=1,334), United Kingdom (N=1,199), France (N=1,258), Germany (N=866), and Australia (N=1,013) who had used at least one prescription opioid analgesic medication in the past year. We also investigated the relationship with polysubstance use, one of the most consistent predictors of problematic opioid analgesic use. Data included misuse and abuse of codeine, hydrocodone, oxycontin, and tramadol; ability to obtain a prescription; different sources for obtaining drugs; and past year use of benzodiazepines and illicit drugs. In multilevel models country of residence accounted for less than 3% of the variance in opioid analgesic misuse or abuse. Adjusting for country of residence and sociodemographic factors, use of illicit drugs and benzodiazepines was associated with four-fold greater odds of misuse (OR 4.36, 95% CI 3.29-5.93) and six-fold greater odds of abuse compared to not using either drug (OR 6.49, 95% CI 4.0-10.48), although the strength of the association with abuse varied by country. Misuse and abuse by those prescribed opioid analgesics appears to be a problem that is not limited to the USA and warrants attention on an international scale.