Several national drug use monitoring studies have reported increases in the use of prescription opioids, particularly among young people. Although the factors causing this increase in prescription opioid use are unknown, the leadership of the National Institute on Drug Abuse (NIDA), and the White House Office of National Drug Control Policy (ONDCP) have expressed concerns that online pharmacies selling medications without a prescription may be playing a role. No prescription websites (NPWs) advertise to sell prescription medications over the internet without a legal prescription. A study published June 17, 2004 by the U.S. General Accounting Office (GAO) found that 10 out of the 11 websites (91 percent) from whom opioid medications were purchased without a prescription delivered the medications as advertised. NPWs remove healthcare professionals from the prescription process increasing the risk for drug misuse, abuse, dependence, and overdose. Of particular concern is the role NPWs might play in initiating opioid use among young people; individuals under 21 years of age are the most frequent users of the internet, and are in the age group where drug use typically begins. Almost nothing is known about the availability of NPWs, or their characteristics, or the people who use them. The development of reliable NPW monitoring methods, the development of basic knowledge about NPWs, and the assessment of their role in un-prescribed opioid use, are critical first steps in developing a public health response to this internet-borne vector for substance abuse. To begin developing this basic knowledge about NPWs and their role in prescription opioid use, this proposal has the following specific aims: 1. Expand the investigators ongoing Opioid NPW monitoring studies by including multiple opioid medication search terms and establishing the reliability of these website monitoring methods; 2. Maintain an expanded Opioid NPW Database with descriptive data on all NPWs identified and archived webpages; 3. Examine the effect of age and change over time in the prevalence of internet purchases for prescription opioids by adding a question about how medications were obtained to an ongoing multi-site, community-based clinical information system; 4. Explore the prevalence of internet purchases in two prescription opioid-using samples by adding a question about how medications were obtained to two ongoing opioid diversion surveillance studies. ? ?
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