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Misuse of Prescription Drugs

2. Prevalence and Recent Trends in Misuse of Prescription Drugs

This chapter presents information on the prevalence of nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives, including trends in prevalence rates from 2002 to 2004 and differences in rates of use across demographic groups and geographic areas. Except for trend data, which are based on single years of data, estimates presented in this chapter are based on averages for the 2002, 2003, and 2004 National Surveys on Drug Use and Health (NSDUHs); combining data from these 3 survey years increases the sample size to support detailed estimates and is particularly useful for examining demographic and geographic correlates. Information on frequency of use and prevalence differentials by age at initiation, educational attainment, employment status, college enrollment status (for young adults aged 18 to 22), and pregnancy status (for women aged 15 to 44) also are included in this chapter.

The prevalence rates presented here relate primarily to any nonmedical use of the respective drugs in the 12 months prior to the survey (past year use). However, trends for use at least once in the individual's lifetime (lifetime use) and for use in the 30 days prior to the survey (past month use) also are presented. Where possible, estimates for OxyContin®, a brand of oxycodone marketed in time-release tablet form, and methamphetamine are included as specific drugs in the pain reliever and stimulant categories, respectively. Prior to 2004, however, the only information collected for OxyContin® was lifetime use. Hence, past year and past month use cannot be analyzed for OxyContin® for 2002 and 2003. Similarly, no 3-year averages are shown for this drug.

As indicated in Chapter 1, "nonmedical use" of prescription-type psychotherapeutic drugs, also referred to as "misuse," is defined as use of these substances without a prescription of the respondent's own or simply for the experience or feeling the drug caused. Over-the-counter medications are not included.

2.1. Recent Trends in the Prevalence of Nonmedical Use

Over the period from 2002 to 2004, the rates of past month, past year, and lifetime misuse of any prescription-type psychotherapeutic drug were generally stable in the population aged 12 or older (Figure 2.1 and Table  2.1). In 2004, an estimated 6.0 million persons (2.5 percent) had used prescription drugs nonmedically in the past month; past year use was reported by 14.6 million (6.1 percent), and use at least once in the lifetime was reported by 48.0 million (20.0 percent).

Figure 2.1 Past Year Nonmedical Use of Prescription Psychotherapeutic Drugs among Persons Aged 12 or Older, by Drug Type: Percentages, 2002-2004

Figure 2.1     D

a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
c Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

The percentage of nonmedical users of pain relievers remained stable from 2002 to 2004. In 2004, 1.8 percent of persons aged 12 or older (an estimated 4.4 million persons) reported past month use, 4.7 percent had used in the past year (11.3 million persons), and 13.2 percent had used in their lifetime (31.8 million persons). However, the estimated number of lifetime nonmedical users of pain relievers increased from 29.6 million in 2002 to 31.8 million in 2004.

The prevalence of lifetime misuse of OxyContin® increased from 0.8 percent (an estimated 1.9 million persons) in 2002 to 1.3 percent (3.1 million persons) in 2004. Data on past year and past month use of OxyContin® are not available for 2002 and 2003, but in 2004, an estimated 0.5 percent of persons aged 12 or older (an estimated 1.2 million persons) had misused the drug in the past year and 0.1 percent (325,000 persons) had used it nonmedically in the past month.

Misuse of tranquilizers remained stable over the period from 2002 to 2004. In 2004, 0.7 percent (an estimated 1.6 million persons) of the population aged 12 or older reported nonmedical use of tranquilizers in the past month. An estimated 2.1 percent (5.1 million persons) had misused tranquilizers in the past year, and 8.3 percent (19.9 million) reported using tranquilizers without a prescription or simply for the feeling they caused at least once in their lifetime.

The percentage reporting nonmedical use of stimulants in their lifetime declined from 9.0 percent in 2002 to 8.3 percent in 2004. In 2004, past month misuse of stimulants was reported by 0.5 percent (an estimated 1.2 million persons), and 1.2 percent (2.9 million persons) reported use in the past year. The prevalence of nonmedical methamphetamine use remained stable from 2002 to 2004. In 2004, 0.2 percent (583,000 persons) reported using methamphetamine nonmedically in the past month; comparable rates were 0.3 percent (597,000 persons) in 2002 and 0.3 percent (607,000 persons) in 2003.

The prevalence of sedative misuse in the past month among persons aged 12 or older decreased from 0.2 percent in 2002 to 0.1 percent in 2004, and the estimated number of users decreased from 436,000 to 265,000. Nonmedical sedative use in the past year and lifetime did not change significantly from 2002 to 2004.

2.2. Trends in Prevalence, by Age Group and Gender

Trends in prescription psychotherapeutic drug misuse among persons aged 12 to 17 were generally similar to those seen among persons aged 12 or older (Table  2.2); nonmedical use of any psychotherapeutic drug remained stable from 2002 to 2004 among youths aged 12 to 17. However, lifetime misuse of OxyContin® among this group increased from 0.9 percent in 2002 (an estimated 224,000 users) to 1.2 percent in 2004 (305,000 users) (Figure 2.2).

Figure 2.2 Lifetime Nonmedical Use of OxyContin®, by Age Group: Numbers of Users, 2002-2004

Figure 2.2     D

a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Misuse of stimulants, which showed modest declines in the overall population aged 12 or older, decreased significantly in several categories among youths aged 12 to 17 from 2002 to 2004. Specifically, lifetime misuse of any stimulants decreased from 4.3 percent in 2002 to 3.4 percent in 2004 among youths; past year misuse declined from 2.6 to 2.0 percent over this period; lifetime methamphetamine use decreased from 1.5 to 1.2 percent; and past year methamphetamine use declined from 0.9 to 0.6 percent.

Among young adults aged 18 to 25, most indicators of psychotherapeutic drug misuse were stable, but some showed modest increases between 2002 and 2004 (Table  2.3). The percentage of persons aged 18 to 25 who had ever misused any prescription psychotherapeutic drug in their lifetime increased from 27.7 percent in 2002 to 29.2 percent in 2004. In addition, the past month prevalence of any psychotherapeutic drug among young adults increased from 5.4 percent in 2002 to 6.1 percent in 2004. Similarly, misuse of pain relievers in the lifetime among young adults increased from 22.1 to 24.3 percent over this period, and past month use increased from 4.1 to 4.7 percent. Nonmedical use of OxyContin® in the lifetime increased from 2.6 percent in 2002 to 4.3 percent in 2004. Lifetime misuse of tranquilizers among young adults increased from 11.2 to 12.2 percent over this period.

Among adults aged 26 or older, there were few significant changes in the rates of nonmedical use of psychotherapeutic drugs. An exception was that lifetime misuse of OxyContin® increased from 0.5 percent (an estimated 881,000 persons) in 2002 to 0.8 percent (1.4 million persons) in 2004 (Table  2.4). As shown in Figure 2.2, however, most of that increase occurred between 2002 and 2003. In addition, lifetime nonmedical use of stimulants declined from 9.3 to 8.6 percent over the 3-year period, and past month use of sedatives decreased from 0.2 to 0.1 percent.

The prevalence of nonmedical use of any prescription-type psychotherapeutic drug and of the separate classes of drugs remained mostly stable from 2002 to 2004 for males and females aged 12 or older (Table s 2.5 and 2.6). Lifetime nonmedical use of OxyContin® among persons aged 12 or older increased for both males and females. Among males, lifetime misuse of this type of pain reliever increased from 1.0 percent in 2002 to 1.7 percent in 2004; among females, it increased from 0.6 to 0.9 percent over those years.

2.3. Basic Prevalence Information

Based on the combined data from 2002, 2003, and 2004, an annual average estimate of 14.8 million persons aged 12 or older (6.2 percent of all persons in that age group) used prescription-type psychotherapeutic drugs nonmedically in the past 12 months (Table  2.8). This number includes 11.3 million persons (4.8 percent) who misused pain relievers, 5.0 million (2.1 percent) who misused tranquilizers, 3.0 million (1.2 percent) who misused stimulants, and 850,000 (0.4 percent) who misused sedatives. Included in the stimulant category were 1.4 million persons (0.6 percent) who misused methamphetamine.

To put these statistics in perspective, the annual average estimated number of past year users of any illicit drug was 35.0 million (14.7 percent of the population aged 12 or older) based on combined data from 2002 through 2004. Comparable figures for marijuana were 25.5 million (10.7 percent), and the number of past year cocaine users was estimated to average 5.8 million (2.4 percent) (Figure 2.3). Thus, misuse of pain relievers was second only to marijuana in prevalence among the overall U.S. population aged 12 or older.

Figure 2.3 Past Year Users of Selected Drugs, Including Nonmedical Users of Prescription Psychotherapeutic Drugs: Annual Averages Based on 2002-2004

Figure 2.3     D

1 Includes pain relievers, tranquilizers, stimulants, and sedatives.
2 Nonmedical use only. OxyContin® also is included with pain relievers, and methamphetamine also is included with stimulants. The OxyContin® estimate is based on 2004 data only.
3 Includes crack.
4 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

2.4. Demographic Differentials in Rates of Nonmedical Use

This section discusses differences across demographic groups in the percentage of persons using prescription psychotherapeutic drugs nonmedically in the 12 months prior to the survey. The prevalence rates cited are averages based on combined data from the 2002, 2003, and 2004 NSDUHs.

2.4.1 Age

For any prescription-type psychotherapeutic drug, pain relievers, tranquilizers, stimulants, and methamphetamine, young adults aged 18 to 25 were more likely than youths aged 12 to 17 or adults aged 26 or older to report nonmedical use in the past year (Figure 2.4 and Table  2.8). Adults aged 26 or older generally had the lowest rates of nonmedical use. For any prescription drug, the annual average rates of past year use for 2002 through 2004 were 9.1 percent for youths, 14.5 percent for young adults, and 4.4 percent for adults aged 26 or older.

Figure 2.4 Past Year Nonmedical Use of Prescription Psychotherapeutic Drugs, by Drug Type and Age Group: Annual Averages Based on 2002-2004

Figure 2.4     D

a Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Detailed age breakdowns indicate that the average rate of past year nonmedical use of pain relievers increased steadily with age, from 2.5 percent at age 12 to 12.8 percent at age 17, and peaking at 13.9 percent at age 19 (Figure 2.5 and Table  2.7). The rate then declined to 8.1 percent by age 25 and decreased to 0.4 percent among persons aged 65 or older. Similar differentials by age were observed in prevalence rates for misuse of tranquilizers, with the highest rate, 5.7 percent, occurring among persons aged 19, 20, or 21; the peak rate for stimulants, 4.8 percent, was among persons aged 19; and the top rate for methamphetamine, 2.0 percent, occurred among persons aged 21. Rates for sedative use were low and did not show as strong an association with age as did rates for misuse of other classes of prescription drugs.

Figure 2.5 Past Year Nonmedical Use of Pain Relievers, by Detailed Age Category: Annual Averages Based on 2002-2004

Figure 2.5     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

2.4.2 Gender and Gender-by-Age

Although prevalence differences by gender were not as great as those by age, males were more likely than females to have misused any prescription psychotherapeutic drug (annual estimates of 6.5 vs. 5.9 percent, respectively), pain relievers (5.2 vs. 4.3 percent), stimulants (1.3 vs. 1.1 percent), and methamphetamine (0.7 vs. 0.5 percent) in the past year in 2002, 2003, and 2004 (Table  2.8).

However, examination of the data for different age groups revealed exceptions to the general finding of higher rates of nonmedical use of psychotherapeutic drugs among males than females. Among youths aged 12 to 17, females were somewhat more likely than males to have misused any prescription psychotherapeutic drug (9.9 vs. 8.2 percent), pain relievers (8.1 vs. 7.0 percent), tranquilizers (2.6 vs. 1.9 percent), and stimulants (2.6 vs. 1.9 percent) in the past year (Table  2.9).

2.4.3 Race/Ethnicity

As shown in Figure 2.6 and Table  2.8, past year nonmedical use of any prescription psychotherapeutic drug was more prevalent among non-Hispanic whites (6.7 percent) and Hispanics (6.3 percent) than among blacks (3.9 percent) or Asians (3.0 percent). The prevalence rates for Native Hawaiians or Other Pacific Islanders (10.1 percent), American Indians or Alaska Natives (8.1 percent), and persons reporting two or more races (7.5 percent) also were higher than those for blacks or Asians.

Figure 2.6 Past Year Nonmedical Use of Any Prescription Psychotherapeutic Drug, by Race/Ethnicity: Annual Averages Based on 2002-2004

Figure 2.6     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Similar to rates for any prescription psychotherapeutic drug, the prevalence of past year nonmedical use of pain relievers was higher among whites (5.1 percent) and Hispanics (5.0 percent) than among blacks (3.4 percent) or Asians (2.3 percent). A comparable pattern of racial/ethnic differences was observed for tranquilizers; rates were higher for whites (2.5 percent) than blacks (0.6 percent) or Asians (0.8 percent); however, rates of past year tranquilizer misuse were higher for whites than for Hispanics (1.5 percent). Stimulant misuse in the past year also was more prevalent among whites (1.5 percent) than blacks (0.4 percent), Asians (0.4 percent), or Hispanics (0.9 percent). Similarly, the rate of methamphetamine misuse was higher among whites (0.7 percent) than blacks (0.1 percent) or Asians (0.2 percent). Misuse of sedatives in the past year was more prevalent among whites (0.4 percent) than blacks (0.2 percent), Hispanics (0.2 percent), and Asians (0.1 percent).

2.4.4 Education

For any prescription psychotherapeutic drug, pain relievers, tranquilizers, stimulants, and methamphetamine, the prevalence of past year nonmedical use among adults aged 18 or older was lowest among college graduates compared with adults who had completed less education (Figure 2.7 and Table  2.12). For example, 2.9 percent of college graduates misused prescription pain relievers in the past year compared with 5.3 percent of adults who did not complete high school, 4.5 percent of those who graduated from high school but did not attend college, and 5.3 percent of those with some college education. In addition, the prevalence of past year misuse of pain relievers was higher for persons who did not complete high school and those with some college education than among persons who graduated from high school but did not attend college.

Figure 2.7 Past Year Nonmedical Use of Prescription Psychotherapeutic Drugs among Persons Aged 18 or Older, by Drug Type and Education: Annual Averages Based on 2002-2004

Figure 2.7     D

Note: Sedatives are not shown because overall analysis indicated that rates for them did not differ significantly by education.
a Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

2.4.5 Employment

For any prescription-type psychotherapeutic drug and for each of the separate categories, the prevalence of past year nonmedical use was higher for adults aged 18 or older who were unemployed than for those employed full time, employed part time, or in the "other" category (Figure 2.8 and Table  2.12). The lowest rates of use were observed among persons in the "other" employment category, which included persons not in the labor force; these lower rates may reflect patterns among persons who are retired, disabled, or keeping house or caring for children full time. Part-time workers generally had higher rates of nonmedical use of prescription drugs than those employed full time. For example, 10.0 percent of unemployed persons misused pain relievers in the past year compared with 5.7 percent of persons employed part time, 4.6 percent of persons employed full time, and 2.8 percent of persons in the "other" employment category.

Figure 2.8 Past Year Nonmedical Use of Prescription Psychotherapeutic Drugs among Persons Aged 18 or Older, by Drug Type and Employment Status: Annual Averages Based on 2002-2004

Figure 2.8     D

a Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

2.4.6 College Enrollment Status

For persons aged 18 to 22, those enrolled as full-time college undergraduate students were less likely to be past year nonmedical users of any psychotherapeutic drug than their non-enrolled counterparts (14.6 vs. 17.0 percent, respectively) (Table  2.19). Full-time students also were less likely than their non-enrolled age peers to have misused pain relievers (11.6 vs. 13.9 percent), tranquilizers (4.5 vs. 6.4 percent), and methamphetamine (0.8 vs. 2.6 percent). For males aged 18 to 22, this pattern of differences between full-time students and their counterparts who were not enrolled as undergraduates was present and was statistically significant for all categories of psychotherapeutic drugs except for any stimulant. In particular, males aged 18 to 22 who were full-time students were less likely than their non-enrolled counterparts to be past year methamphetamine users, even though the rates of any stimulant misuse were not significantly different for these two groups of males. Among females, this pattern also was present, but the differences were not statistically significant for any stimulant and sedatives.

2.4.7 Pregnancy Status

The prevalence of past year prescription psychotherapeutic drug misuse among women aged 15 to 44 was generally lower among those who were currently pregnant than those who were not (Table  2.20). An estimated 6.0 percent of women who were pregnant reported nonmedical use of any prescription-type psychotherapeutic drug in the past year compared with 9.3 percent of those who were not pregnant. This pattern among women aged 15 to 44 was observed for pain relievers (4.4 percent among those who were pregnant vs. 6.9 percent for those who were not), tranquilizers (2.0 vs. 3.3 percent), and any stimulant (1.3 vs. 2.0 percent). When disaggregated according to age, the pattern of lower rates of nonmedical use among women who were pregnant held for those aged 18 to 25 and for those aged 26 or older for any prescription drug, pain relievers, and tranquilizers. Among women aged 15 to 17, however, rates of misuse of any prescription drug, pain relievers, stimulants, methamphetamine, and sedatives tended to be higher among those who were pregnant than those who were not, but these differences did not reach statistical significance.

2.5. Geographic Differentials in Rates of Nonmedical Use

This section presents information on variations on misuse of prescription psychotherapeutic drugs across geographic areas and county type (Table s 2.13 to 2.16). Further information on differences of this type is included in Chapter 7, which covers State-to-State variations.

2.5.1 Region

NSDUH provides estimates for four regions: Northeast, Midwest, South, and West. Although differences were not great, the prevalence of past year nonmedical use of any prescription-type psychotherapeutic drug among persons aged 12 or older was highest in the West (7.3 percent) compared with rates in the South (6.3 percent), Midwest (5.8 percent), and Northeast (5.2 percent). The rate in the South also was higher than that in the Northeast (5.2 percent) (Table  2.13).

Across types of psychotherapeutic drugs, the rate of pain reliever misuse was highest in the West (5.5 percent) and lowest in the Northeast (4.0 percent). In contrast, misuse of tranquilizers was higher in the South (2.6 percent) than in the Northeast (1.8 percent), Midwest (1.8 percent), and West (1.9 percent). Similar to pain relievers, the prevalence of methamphetamine misuse was highest in the West (1.2 percent) and lowest in the Northeast (0.1 percent); misuse of any stimulant followed this same geographic pattern. The higher rates of methamphetamine and any stimulant misuse in the West are consistent with data from the Treatment Episode Data Set (TEDS) on trends in admissions to substance treatment for primary abuse of methamphetamine or amphetamines (Office of Applied Studies [OAS], 2004b). The rate of sedative misuse did not differ significantly across geographic regions.

2.5.2 County Type

Small metropolitan areas with populations of fewer than 250,000 had the highest rates of past year misuse of any prescription psychotherapeutic drug (7.1 percent), pain relievers (5.4 percent), tranquilizers (2.6 percent), and stimulants (1.7 percent) among persons aged 12 or older (Table  2.13). Metropolitan areas with a population of 1 million or more had the lowest rates of stimulant (1.1 percent) and methamphetamine (0.5 percent) misuse. An estimated 1.3 percent of persons aged 12 or older in rural areas misused any stimulant in the past year, and 0.7 percent misused methamphetamine. Rural areas had the lowest rates of misuse for any prescription-type psychotherapeutic drug (4.8 percent), pain relievers (3.5 percent), and tranquilizers (1.7 percent).

2.6. Differences in Past Year Use According to Age at Initiation

Among adults aged 26 or older who had misused any prescription psychotherapeutic drug in their lifetime, the rate of past year use was higher among those who initiated use before age 16 (25.7 percent) than among those who first used between the ages of 16 and 20 (18.2 percent) (Figure 2.9 and Table  2.17). Similarly, 30.9 percent of lifetime pain reliever misusers aged 26 or older who first used pain relievers before age 16 continued to use in the past year compared with 23.1 percent of those who first used pain relievers between ages 16 and 20. For persons aged 26 or older who had misused tranquilizers, the rates did not differ significantly for those who initiated use before age 16 and those who initiated use between ages 16 and 20 (15.3 vs. 13.9 percent, respectively). The relationship between early onset and continued use in the past year was somewhat stronger for stimulants (7.5 percent for initiation before age 16 vs. 4.5 percent for initiation between ages 16 and 20). For sedatives, the continuation rate for persons who initiated use before age 16 (5.6 percent) did not differ significantly from the rate among persons who initiated between ages 16 and 20 (3.2 percent). It should be noted that these comparisons do not control for differences in duration of use, recency of initiation, psychosocial or other factors associated with initiation, or other variables that may influence which lifetime users continue to use in the present.

Figure 2.9 Past Year Nonmedical Use of Prescription Psychotherapeutic Drugs among Lifetime Nonmedical Users of Those Drugs Who Were Aged 26 or Older, by Drug Type and Age at First Nonmedical Use: Annual Averages Based on 2002-2004

Figure 2.9     D

a Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

2.7. Frequency of Use

Table  2.18 presents the distribution of past year nonmedical users of psychotherapeutic drugs by the number of days that they used in the past year based on averages for 2002, 2003, and 2004. Among past year nonmedical users aged 12 or older, roughly half of those who misused pain relievers (50.8 percent) and tranquilizers (52.8 percent) reported use on fewer than 12 days over the 12-month period prior to the survey. Approximately one fourth of past year nonmedical users of pain relievers, tranquilizers, or sedatives used on 50 or more days in the past year (24.9, 23.1, and 24.9 percent, respectively). An estimated 40.3 percent of past year methamphetamine users aged 12 or older and 35.1 percent of past year stimulant users reported use on 50 or more days in the past year. In addition, an estimated 46.0 percent of methamphetamine users aged 26 or older took the drug on 50 or more days in the past year.

2.8. Summary

This chapter presented findings for trends in the prevalence of nonmedical use (or misuse) of prescription psychotherapeutic drugs from 2002 through 2004. The chapter also presented data on selected correlates of nonmedical use, based on combined data from the 2002 through 2004 surveys. The emphasis of these combined data was on nonmedical use in the 12-month period prior to the survey (i.e., past year use).

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