Date of Award


Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health


Public Health

First Advisor

Kenneth A. Knapp

Second Advisor

Elizabeth D. Drugge

Third Advisor

Erin Bouldin


Background: Although previous research has found evidence that people misuse prescription opioids, this study is the first ever analysis of the national cross-sectional survey data from the Behavioral Risk Factor Surveillance System to describe the association of prescription opioid use to prescription opioid misuse, defined as using prescription pain medication that was not prescribed. It is intended to provide a new perspective on this existing data source from eight states and to investigate prescription opioid use to prescription opioid misuse while controlling for socio-demographic characteristics, and other risk factors.

Method: The 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the states that asked opioid related questions. The sample included 49,363 respondents, 20,175 (45.0%) of whom identified themselves as using prescription opioids and 19,896 (40.3%) identified as using prescription opioids that were not prescribed to them (prescription misuse of opioids) from four states (Florida, Kansas, Ohio and South Carolina). Bivariate analysis and logistic regression (from four states that asked both prescription opioid use and prescription opioid misuse) were used to analyze both prescription opioid use and misuse in the past 12 months. All data were weighted to represent the populations of the included states.

Results: Prescription opioid use was more common among females, black, non-Hispanic adults; among adults with fair/poor health; and with health problems such as arthritis, cancer, depression, asthma and heart attack; and among those who had any health insurance (p

Conclusion: People who have been prescribed opioids are more likely than others to report misuse of prescription opioids. A significant association was found between prescription opioid use and prescription opioid misuse among males and those who were depressed. Targeted interventions such as resource allocation or referral to other programs (e.g., harm reduction programs) may decrease the likelihood of opioid misuse, especially by those who have been prescribed opioids. Further research is needed on the barriers to treatment of opioid use disorder such as stigma and discrimination by the healthcare providers, health insurance, transportation, appropriate referrals, peer recovery coaches or services, and resources that are available locally should be conducted.

Available for download on Monday, May 06, 2024