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Bivariate analysis revealed that age greater than
or equal to 30 years was significantly associated with inappropriate
use (P = 0.047, OR = 4.4 [1.1 to 16.7]). Sex, being status or nonstatus
Indian, and living on or off a reserve were not associated with
inappropriate use.
Discussion
This study found an extremely high prevalence of inappropriate
prescription medication use among an Aboriginal population seeking
addiction treatment. These findings are higher than the rate for
the primarily non-Aboriginal population with addiction (AADAC unpublished
data, 1998) and parallel the higher rate of addictions among the
Aboriginal population. Although our study did not investigate reasons
for the higher rate, it likely reflects many social factors. Our
study prevalence also appears to be higher than the prevalence among
the general non-Aboriginal and Aboriginal populations (2,5,9). For
this comparison, the higher rate may be partly explained by the
fact that respondents were selected from those who sought treatment
for addiction problems; this group may be more prone to use licit
drugs inappropriately.
Directly surveying treatment participants allowed us to capture
those who obtained prescription medications from sources other than
a physician. Those who inappropriately used prescription medication
most commonly obtained it from a friend or a stranger, or bought
it on the street, or had it prescribed by a physician, or all of
the foregoing. These multiple sources suggest that the pharmacy
claims database may significantly underestimate the magnitude of
the problem.
Given the significant number who obtained medication from a prescribing
physician, appropriate physician screening is required. This should
include determining whether family and friends with addiction disorders
can access patient prescription medication. Physicians need to caution
patients not to share medication and to securely store medication.
Pharmacists need to apply a warning label to addictive medication,
stating that sharing may cause harm. A large number of respondents
purchased medication illegally, and legal strategies that address
this source need to be employed. Addiction services for Aboriginal
populations need to screen for prescription medication use with
a culturally appropriate tool. Such a tool will need to use face-to-face,
rather than telephone, interview techniques. It should also be administered
in a culturally sensitive manner wherein the interviewer initially
shares personal information. Treatment programs will need to address
prescription medication use and possible concurrent client withdrawal,
given that the high frequency of use may equate with physical dependence.
Lastly, consideration should be given to the fact that provincial
regulation of prescription medication is associated with reduced
inappropriate use (2).
Our study identified interesting demographic information on prescription
medication misuse. Within the general population, those aged 20
to 49 years have been found to have higher rates of prescription
medication dependency (5). Our demographic data reveal that age
greater than or equal to 30 years is associated with inappropriate
use, which is similar to the general population rate. Age greater
than 29 years can thus be useful for screening. Among those in the
general population aged 14 to 24 years, preference for medication
used without medical legitimation—which is similar to the definition
of misuse—is equal between the sexes (6). In our study, Aboriginal
male respondents were just as likely to indicate inappropriate use
as were female respondents, which, again, is similar to the pattern
in the general population. Last, our sample group consisted mainly
of status Aboriginals. Why the nonstatus Aboriginal population did
not access treatment at NAS is unclear; therefore, additional research—particularly
qualitative research—is needed to clarify this important issue.
Future research should also include a comparison group of non-Aboriginal
subjects accessing similar addiction services. Income assistance
and socioeconomic status needs to be examined as well.
This cross-sectional descriptive study had several limitations.
First, potential social-response bias for inappropriate use could
have underestimated its prevalence. However, the anonymity of the
questionnaire and the high prevalence found suggest that this bias
is less likely to be found.
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Second, the survey listed the most commonly used medications rather
than asking participants to identify medications used; listing medications
may have led to overreporting of their use. Third, information on
why treatment was sought was missing or incorrectly completed in
several cases, so particular results need to be interpreted with
caution. Finally, sex, residence, and status were not associated
with inappropriate use, which may reflect the limited sample size.
The findings of this study confirm the suspicion raised by Anderson
and McEwan that inappropriately used prescription medication is
a significant problem among Aboriginal persons who seek addiction
treatment (2). These results support the proposition that addiction
treatment programs serving Aboriginal populations need to screen
for and provide prescription medication treatment and, possibly,
concurrent medication withdrawal management. Provincial regulation
of prescription medication should also be considered when addressing
this problem.
Acknowledgement
A grant was awarded from the Leroy LeRiche Endowment fund for Research
and Education in Substance Abuse, University of Calgary.
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Manuscript received June 2001, revised, and
accepted March 2002.
1 Formerly, Community Medicine Resident, Department of Community
Health Sciences, University of Calgary, Calgary, Alberta; now Community
Medicine Specialist, First Nations and Inuit Health Branch, Vancouver,
British Columbia.
2 Clinical Scholar, Division of Medicine, Foothills Hospital,
Calgary, Alberta.
3 Director, Addiction Centre at the Foothills Medical Centre;
University of Calgary, Calgary, Alberta.
Address for correspondence:
Dr D Wardman, Suite 540, 757-West Hastings Street, Vancouver, BC
V6C 3E6
e-mail: Dennis_Wardman@hc-sc.gc.ca
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