Effects of a Community-Based Intervention to Reduce Availability of Prescription Pain Medication Among American Indians and Alaska Natives in Rural Southern California: An Exploratory Study

Introduction: To address the growing problem of prescription pain medication misuse and abuse among American Indians and Alaska Natives (AI/AN), a community-based prevention intervention to reduce availability of prescription pain medication was developed and implemented on eight Indian reservations in rural Southern California. This exploratory study assessed the effects of this intervention on AI/AN participants’ perceptions and behaviors around prescription pain medication availability.

Methods: Anonymous cross-sectional surveys were obtained at two-time points (pre- and post-intervention). Eligibility criteria included being 18 years of age or older and an enrolled tribal member or a descendent of an enrolled tribal member from a Federally recognized tribe within the United States. In total, 595 eligible individuals participated in the study (N=295 pre-intervention; and N=300 post-intervention). We obtained data about lifetime use of pain medication, whether participants locked up prescription pain medications in the home, their willingness to use a lock box to secure medication, perceived risk of sharing prescription drugs with family, friends, and loved ones, and the likelihood to consider safe methods to dispose of expired prescription pain medication (i.e., return medications to clinic or take them to a collection event). We also asked about experiencing pain as well as demographic characteristics (i.e., gender, age, and education). The study was approved by both research and Tribal institutional review boards. The analysis sample included lifetime users of pain medication who provided complete data for the study (N=453). To explore intervention effects, we included a survey time variable.

Results: Controlling for demographics, current chronic pain, and experiencing high level of pain, results of logistic regression analyses showed positive associations between time (i.e., pre- vs. post-intervention) and participants’ likelihood to report locking up prescription pain medications (OR=1.85, p< .05) and considering only safe methods for disposing of expired medications (OR=1.90, p< .05). No associations were found between time and participants’ willingness to use a lock box if given to them and the perception that it is very dangerous to share prescription pain medication with family, friends, and loved ones.

Conclusions: Results suggest potential effects of a community-based intervention on reducing availability of prescription pain medication on Indian reservations in rural settings. Given the growing problem of prescription pain medication misuse and abuse among AI/AN, results of this exploratory study support the feasibility and importance of intervening in AI/AN communities to reduce availability.