Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates

https://doi.org/10.1016/j.drugalcdep.2007.09.018Get rights and content

Abstract

Background

Non-medical use of prescription opioids carries risks including development of abuse/dependence. Such use may correlate with psychiatric, medical, and substance use characteristics.

Methods

Cross-sectional survey, the 2002–2004 National Survey on Drug Use and Health. Respondents 18 years and older (n = 91,823). Bivariate and multivariable associations were investigated.

Results

The prevalence of past-year non-medical use of prescription opioids was 4.5%. Of those with non-medical use, 12.9% met criteria for abuse/dependence. On multivariable analysis, past-year non-medical use was associated with panic (AOR 1.2; 95% CI 1.04–1.5), depressive (AOR 1.2; 95% CI 1.01–1.5) and social phobic/agoraphobic symptoms (AOR 1.2; 95% CI 1.1–1.4). Among those with past-year non-medical prescription opioid use, those with abuse/dependence were more likely to have panic (AOR 1.7; 95% CI 1.2–2.4) and social phobic/agoraphobic symptoms (AOR 1.7; 95% CI 1.2–2.4). In addition, they were more likely to report fair/poor health (AOR 2.1; 95% CI 1.4–3.0), have misused another class of prescription medication (AOR 1.7; 95% CI 1.2–2.3), have used heroin (AOR 2.9; 95% CI 1.2–6.9) and initiated substance use before the age of 13 (AOR 4.7; 95% CI 1.1–19.9).

Conclusions

Non-medical use of prescription opioids is common. Furthermore, nearly 13% of those with non-medical use meet criteria for abuse/dependence. Panic, social phobia and agoraphobia, low self-rated health status, and other substance misuse among those with non-medical use of prescription opioids should alert clinicians to screen for abuse and dependence.

Introduction

The prevalence of non-medical use of prescription opioids, operationally defined by the United States Substance Abuse and Mental Health Services Administration as taking someone else's prescription medication or taking medication only for the experience it causes, is increasing (Office Applied Studies, 2002, Office Applied Studies, 2005). Such use may be infrequent when compared to appropriate medical use of prescription opioids; however, it may progress to a substance use disorder (e.g. prescription opioid abuse and/or dependence) marked by loss of control and failure in social role-functioning.

Opioid abuse/dependence is a serious chronic disease that, like all addictions, portends diminished quality of life, significant mortality as well as increased societal costs such as lost worker productivity and increased strain on the criminal justice system (Hser et al., 2001, Maddux and Desmond, 1992). It is also a chronic disease for which effective treatments are available.

Inappropriate use of prescription medications has been associated with medical and psychiatric complaints and symptoms (Becker et al., 2007, Chutuape and de Wit, 1995, O’Brien, 2005). Recent studies on misuse of prescription opioids have found associations between lifetime anxiety and mood disorders and lifetime prevalence of prescription opioid use disorders (Conway et al., 2006, Huang et al., 2006) as well as strong correlations between prescription opioid and other prescription drug use disorders (Huang et al., 2006). Few studies have evaluated these associations for those with current, rather than lifetime, psychiatric symptoms. In light of this, we were interested in evaluating the association between specific anxiety and mood disorder-related symptoms and other prescription drug misuse in a sample of patients with current (past-year) prescription opioid misuse.

The purpose of the current study was to investigate the demographic and clinical characteristics associated with non-medical use of prescription opioids. Furthermore, among those with past-year non-medical use, we sought to determine the psychiatric, medical and substance use characteristics associated with the diagnosis of abuse or dependence on prescription opioids. Illuminating these associations may help identify candidate characteristics that clinicians can use to target screening and researchers can test with longitudinal studies.

Section snippets

Data source and study population

We performed an analysis of the 2002–2004 National Survey on Drug Use and Health (NSDUH), a survey conducted by RTI International, sponsored by the Substance Abuse and Mental Health Services Administration, and formatted for public use by the Inter-University Consortium for Political and Social Research. The NSDUH is an annual survey of the civilian, non-institutionalized population aged 12 years and older designed to collect information on the prevalence of substance use and psychiatric

Description of sample

As designed, the NSDUH's overall sample is representative of the U.S. population: 52% of respondents were female and ages ranged from 18 to 80. The majority of respondents was white, completed high school, reported a total family income above $40,000, was employed, and had health insurance. Twenty-two percent of respondents were identified as residing in a rural area. The prevalence of past-year psychiatric symptoms ranged from 1.8% for manic symptoms to 12.9% for social phobic/agoraphobic

Discussion

We have found a prevalence of past-year non-medical use of prescription opioids of 4.5% in a survey of community-dwelling U.S. adults, approximately 10 million people. Such use represents misuse of a controlled medication and raises concern for self-medication, illicit drug use, medication non-adherence, overdose and, of special concern, the potential transition to a substance use disorder. Indeed, we show that nearly 13% of those who report past-year non-medical use (approximately 1.3 million

Conflicts of interest

None.

Acknowledgements

Dr. Becker is supported by a National Institute on Drug Abuse training grant (NIDA #T32DA007238). Dr. Fiellin was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar during the conduct of this study. Dr. Sullivan is a Robert Wood Johnson Physician Faculty Scholar and is supported by the National Institute on Drug Abuse Physician Scientist Award (NIDA K12 DA00167). Tetrault is supported by the Veterans Affairs (VA) Office of Academic Affiliations and Dr. Desai is supported by

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