Prescription Drug Misuse Among Rural and Urban Women with Protective Orders

Background and Purpose: Although a wealth of studies have found a positive relationship between substance use and intimate partner violence (IPV; Cunradi et al., 2002; Golinelli et al., 2009; Najavits et al., 2004; Testa et al., 2003), fewer studies have specifically examined the relationship between IPV and a type of illicit drug use, nonmedical use of prescription drugs (NMPD). The purpose of the study is to examine the association of cumulative lifetime victimization and severity of recent IPV with illicit use of sedative-hypnotics and opiates. Methods: A large sample of women (n = 756) was recruited out of one urban and four rural, Appalachian domestic violence courts. Female interviewers collected data in face-to-face interviews. Bivariate analyses were conducted to compare individuals who reported lifetime nonmedical use of sedative-hypnotics and opiates with individuals who did not, and to inform the selection of variables included in the multivariate analysis. Logistic regression was used to examine risk factors associated with lifetime nonmedical use of sedative-hypnotics and opiates.

Results: Nearly one third of the sample (32.8%) reported lifetime nonmedical use of sedative-hypnotics or opiates: 27.9% sedative-hypnotics, and 19.2% opiates. Prior lifetime victimization was common in the sample. The results of logistic regression indicate the overall model was statistically reliable (χ2 = 182.408, df = 11, p < .001) and the Nagelkerke R2 = .304. Women from the rural communities were 1.7 times more likely to use nonmedically sedative-hypnotics and opiates than women from the urban community. Women who used other illicit drugs in the past 12 months were 4.3 times more likely to report lifetime nonmedical use of sedative-hypnotics and opiates. Women who met criteria for alcohol abuse or dependence were 1.6 times more likely to report lifetime nonmedical use of sedative-hypnotics and opiates. Cumulative lifetime victimization index and unmet health care needs were positively associated, while age was negatively associated with nonmedical use of sedative-hypnotics and opiates. None of the indices for recent IPV were associated with nonmedical use of sedative-hypnotics and opiates.

Conclusions and Implications: Lifetime rates of nonmedical use of sedative-hypnotics and opiates were higher in this sample of recent partner violence victims, particularly in the rural, Appalachian area, than in the general population in the state. Cumulative lifetime exposure to victimization was a significant risk factor for nonmedical use of sedative-hypnotics and opiates.

The study findings have implications for substance abuse prevention and treatment. Women with multiple types of victimization should be targeted for substance abuse prevention efforts (SAMHSA, 1997). Substance abuse treatment programs have an opportunity to address lifetime victimization experiences and their role as a risk factor for substance use, in general, and specifically nonmedical use of sedative-hypnotics and opiates. Greater linkages and collaboration between domestic violence programs and substance abuse treatment programs are needed to overcome the numerous barriers that impede the effective treatment of substance abuse and appropriate response to women experiencing both problems (Logan et al., 2002; SAMHSA, 1997).