The iatrogenic epidemic of prescription drug abuse: County-level determinants of opioid availability and abuse

Background: Opioid use and abuse in the United States continues to expand at an alarming rate. In this study, we examine the county-level determinants of the availability and abuse of prescription opioids to better understand the socio-ecological context, and in particular the role of the healthcare delivery system, on the prescription drug abuse epidemic. Methods: We use community-level information, data from Indiana's prescription drug monitoring program in 2011, and geospatial regression methods to identify county-level correlates of the availability and abuse of prescription opioids among Indiana's 92 counties. Results: The findings suggest that access to healthcare generally, and to dentists and pharmacists in particular, increases the availability of prescription opioids in communities, which, in turn, is associated with higher rates of opioid abuse. Conclusions: The results suggest that the structure of the local healthcare system is a major determinant of community-level access to opioids adding to a growingtody of evidence that the problem of prescription opioid abuse is, at least in part, an "iatrogenic epidemic." (C) 2014 Elsevier Ireland Ltd. All rights reserved.