Impacts of Occupation and Urbanicity on Prescription Pain Reliever Abuse Open Access

Milloy, Aaron (Fall 2020)

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Introduction: In 2017, rural counties had higher age-adjusted rates of natural and semisynthetic

(prescription) opioid overdose deaths (4.9 per 100,000) compared to urban counties (4.3 per

100,000). A Centers for Disease Control report suggested that one potential explanation for why

prescription opioid rates are higher in rural counties is due to having higher rates of chronic pain,

which has also been found to be associated with physical activity in the workplace. People

working in physically strenuous jobs also have the highest rates of workplace injuries. This

combination may cause individuals with more physically strenuous jobs to be more likely to be

prescribed opioids.

Methods: This secondary analysis uses publicly available data acquired through the National

Survey on Drug Use and Health in 2014. In addition to examining descriptive statistics of the

sample population, we estimated adjusted prevalence ratios between past-year prescription pain

reliever misuse and abuse/dependence, using logistic regression models with conditional


Results: Adjusting for demographic and other covariates, neither exposure of interest, urbanicity

and occupational injury risk, were found to have statistically significant association with pastyear

prescription pain reliever misuse or abuse/dependence. Other covariates were found to have

statistically significant associations, including gender, education, marital status, insurance

coverage, overall health, and past-year mental illnesses, which increased in magnitude as

severity of illness increased. In an adjusted model examining past-year pain reliever

abuse/dependence, compared to those with no mental illness, the prevalence ratio was 1.88 (95%

CI: 1.59 – 2.22) for those with mild mental illness in the past year, 2.36 (95% CI: 1.91 – 2.92)

for moderate mental illness, and 2.79 (95% CI: 2.23 – 3.47) for those with serious mental illness

in the past year.

Discussion: Neither urbanicity nor occupational injury risk was found to have an association

with prescription pain reliever misuse or abuse/dependence. Though mental illness was

associated with pain reliever misuse and abuse/dependence, we are unable to infer a causal

relationship. There were limitations in this study, including concerns that those misusing or

being abusive/dependent on pain relievers may no longer be employed full-time.

Table of Contents

Chapter 1: Introduction & Expanded Literature Review 1

Thesis Introduction 2

Literature Review Introduction 3

Rise in Prescription Opioid Abuse 4

Urbanicity 5

Occupation Type 7

Age 10

Gender 12

Race & Ethnicity 12

Education 13

Marital Status 13

Income 14

Insurance Coverage 14

Physical Health 15

Mental Health 16

Presence of Other Substance Abuse 17

Pharmacy & Prescription Practices 18

Military Service 18

Chapter 2: Manuscript 20

Introduction 21

Methods 22

Results 26

Discussion 31

Chapter 3: Expanded Conclusion 35

Conclusions 36

Recommendations 39

References 41

Tables & Figures 47

Appendices 55

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