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Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015–2017 National Survey on Drug Use and Health

  • Megan S. SchulerEmail author
  • Andrew W. Dick
  • Bradley D. Stein
Original Research

Abstract

Background

Prescription opioid misuse among older adults has received little attention to date. Potential age variation in characteristics of and motivations for prescription opioid misuse has not been fully characterized yet has important implications for preventing diversion and misuse.

Objective

To examine (1) age-specific patterns of source of misused prescription opioid pain relievers and motives for misuse and (2) age-specific and source-specific associations with opioid use disorder (OUD), heroin use, benzodiazepine misuse, and OUD treatment utilization.

Design

Cross-sectional study using 3 waves (2015–2017) of the National Survey on Drug Use and Health (68% average response rate)

Participants

Respondents aged 12 and older with past-year prescription opioid pain reliever misuse (n = 8228)

Main Measures

Source for the most-recently misused prescription pain reliever (categorized as medical, social, or illicit/other), motive for last episode of misuse, OUD, heroin use, benzodiazepine misuse, and OUD treatment.

Key Results

Adults 50 and older comprised approximately 25% of all individuals reporting past-year prescription opioid misuse. A social source was most common for individuals under age 50 while a medical source was most common for individuals 50 and older. The most commonly reported motive for misuse was to “relieve physical pain”; the frequency of this response increased across age groups (47% aged 12–17 to 87% aged 65+). Among adults age 50 and older with prescription opioid misuse, 17% met criteria for OUD, 15% reported past-year benzodiazepine misuse, and 3% reported past-year heroin use.

Conclusions

Physicians continue to be a direct source of prescription opioids for misuse, particularly for older adults. Ongoing clinical initiatives regarding optimal opioid prescribing practices are needed in addition to effective non-opioid strategies for pain management. Clinical initiatives should also include screening adult and adolescent patients for non-medical use of prescription opioids as well as improving access to OUD treatment for individuals of all ages.

KEY WORDS

prescription pain reliever opioid misuse OUD treatment diversion medical source age heterogeneity 

Notes

Funding Information

This work was funded by awards R01 DA045800 and P50 DA046351.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA, the NIH, or the US Government.

References

  1. 1.
    Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559–74.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167:293–301.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Hulme S, Bright D, Nielsen S. The source and diversion of pharmaceutical drugs for non-medical use: a systematic review and meta-analysis. Drug Alcohol Depend. 2018;186:242–56.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Elliott KR, Jones E. The association between frequency of opioid misuse and opioid use disorder among youth and adults in the United States. Drug Alcohol Depend. 2019;197:73–77.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154–63.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Cerda M, Santaella J, Marshall BD, Kim JH, Martins SS. Nonmedical prescription opioid use in childhood and early adolescence predicts transitions to heroin use in young adulthood: a national study. J Pediatr. 2015;167:605–12 e1–2.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Guarino H, Mateu-Gelabert P, Teubl J, Goodbody E. Young adults’ opioid use trajectories: from nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose. Addict Behav. 2018;86:118–23.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Ciccarone D. The triple wave epidemic: supply and demand drivers of the US opioid overdose crisis. Int J Drug Policy. 2019:S0955–3959(19)30018–0.Google Scholar
  9. 9.
    Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011-2016. Natl Vital Stat Rep. 2018;67:1–14.PubMedGoogle Scholar
  10. 10.
    CDC WONDER. Multiple cause of death 1999–2017. 2019.Google Scholar
  11. 11.
    Ciccarone D. Fentanyl in the US heroin supply: a rapidly changing risk environment. Int J Drug Policy. 2017;46:107–11.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Ford JA, Lacerenza C. The relationship between source of diversion and prescription drug misuse, abuse, and dependence. Subst Use Misuse. 2011;46:819–27.PubMedCrossRefGoogle Scholar
  13. 13.
    Daniulaityte R, Falck R, Carlson RG. Sources of pharmaceutical opioids for non-medical use among young adults. J Psychoactive Drugs. 2014;46:198–207.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Schepis TS, McCabe SE, Teter CJ. Sources of opioid medication for misuse in older adults: results from a nationally representative survey. Pain. 2018;159:1543–49.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Schepis TS, Krishnan-Sarin S. Sources of prescriptions for misuse by adolescents: differences in sex, ethnicity, and severity of misuse in a population-based study. J Am Acad Child Adolesc Psychiatry. 2009;48:828–36.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Schepis TS, Wilens TE, McCabe SE. Prescription drug misuse: sources of controlled medications in adolescents. J Am Acad Child Adolesc Psychiatry. 2019;58:670–80 e4.CrossRefGoogle Scholar
  17. 17.
    Hu MC, Griesler P, Wall M, Kandel DB. Age-related patterns in nonmedical prescription opioid use and disorder in the US population at ages 12-34 from 2002 to 2014. Drug Alcohol Depend. 2017;177:237–43.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    McCabe SE, Teter CJ, Boyd CJ, Wilens TE, Schepis TS. Sources of prescription medication misuse among young adults in the United States: the role of educational status. J Clin Psychiatry. 2018;79:17m11958.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Wall M, Cheslack-Postava K, Hu MC, Feng T, Griesler P, Kandel DB. Nonmedical prescription opioids and pathways of drug involvement in the US: generational differences. Drug Alcohol Depend. 2018;182:103–11.PubMedCrossRefGoogle Scholar
  20. 20.
    Rose AJ, McBain R, Schuler MS, et al. Effect of age on opioid prescribing, overdose, and mortality in Massachusetts, 2011 to 2015. J Am Geriatr Soc. 2019;67:128–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Jones CM, McAninch JK. Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines. Am J Prev Med. 2015;49:493–501.PubMedCrossRefGoogle Scholar
  22. 22.
    McBain R, Rose AJ, LaRochelle MR. The U.S. Opioid epidemic: one disease, diverging tales. Prev Med. 2018;112:176–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Saloner B, Bachhuber M, Barry CL. Physicians as a source of medications for nonmedical use: comparison of opioid analgesic, stimulant, and sedative use in a national sample. Psychiatr Serv. 2017;68:56–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Šidák ZK. Rectangular confidence regions for the means of multivariate normal distributions. Journal of the American Statistical Association. 1967;62:626–33.Google Scholar
  25. 25.
    Socias ME, Wood E. Epidemic of deaths from fentanyl overdose. BMJ. 2017;358:j4355.PubMedCrossRefGoogle Scholar
  26. 26.
    Monnat SM. Factors associated with county-level differences in U.S. Drug-related mortality rates. Am J Prev Med. 2018;54:611–19.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Monnat SM, Peters DJ, Berg MT, Hochstetler A. Using census data to understand county-level differences in overall drug mortality and opioid-related mortality by opioid type. Am J Public Health. 2019;109:1084–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Stewart K, Cao Y, Hsu MH, Artigiani E, Wish E. Geospatial analysis of drug poisoning deaths involving heroin in the USA, 2000-2014. J Urban Health. 2017;94:572–86.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Unick GJ, Ciccarone D. US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. Int J Drug Policy. 2017;46:112–19.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Carter MW, Yang BK, Davenport M, Kabel A. Increasing rates of opioid misuse among older adults visiting emergency departments. Innov Aging. 2019;3:igz002.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Huhn AS, Strain EC, Tompkins DA, Dunn KE. A hidden aspect of the US opioid crisis: rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend. 2018;193:142–47.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Cochran G, Rosen D, McCarthy RM, Engel RJ. Risk factors for symptoms of prescription opioid misuse: do older adults differ from younger adult patients? Journal of Gerontological Social Work. 2017;60:443–57.PubMedCrossRefGoogle Scholar
  33. 33.
    Chang YP. Factors associated with prescription opioid misuse in adults aged 50 or older. Nurs Outlook. 2018;66:112–20.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Fink DS, Hu RR, Cerda M, et al. Patterns of major depression and nonmedical use of prescription opioids in the United States. Drug Alcohol Depend. 2015;153:258–64.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Han BH, Sherman SE, Palamar JJ. Prescription opioid misuse among middle-aged and older adults in the United States, 2015-2016. Prev Med. 2019;121:94–98.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Sun EC, Dixit A, Humphreys K, Darnall BD, Baker LC, Mackey S. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Hwang CS, Kang EM, Kornegay CJ, Staffa JA, Jones CM, McAninch JK. Trends in the concomitant prescribing of opioids and benzodiazepines, 2002-2014. Am J Prev Med. 2016;51:151–60.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Alpert A, Powell D, Pacula RL. Supply-side drug policy in the presence of substitutes: evidence from the introduction of abuse-deterrent opioids. American Economic Journal-Economic Policy. 2018;10:1–35.CrossRefGoogle Scholar
  39. 39.
    Evans WN, Lieber E, Power P. How the reformulation of oxycontin ignited the heroin epidemic. National Bureau of Economic Research. 2018;w24475.Google Scholar
  40. 40.
    Gordon AJ, Harding JD. From education to practice: addressing opioid misuse through health care provider training: a special issue of substance abuse journal. Subst Abus. 2017;38:119–21.PubMedCrossRefGoogle Scholar
  41. 41.
    Oldfield BJ, Tetrault JM, Wilkins KM, Edelman EJ, Capurso NA. Opioid overdose prevention education for medical students: adopting harm reduction into mandatory clerkship curricula. Subst Abus. 2019:1–6.Google Scholar
  42. 42.
    Hadland SE, Bagley SM, Rodean J, et al. Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA Pediatrics. 2018;172:1029–37.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Carney BL, Hadland SE, Bagley SM. Medication treatment of adolescent opioid use disorder in primary care. Pediatr Rev. 2018;39:43–45.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Bagley SM, Hadland SE, Carney BL, Saitz R. Addressing stigma in medication treatment of adolescents with opioid use disorder. J Addict Med. 2017;11:415–16.PubMedCrossRefGoogle Scholar
  45. 45.
    Carew AM, Comiskey C. Treatment for opioid use and outcomes in older adults: a systematic literature review. Drug Alcohol Depend. 2018;182:48–57.PubMedCrossRefGoogle Scholar
  46. 46.
    Powell D, Alpert A, Pacula RL. A transitioning epidemic: how the opioid crisis is driving the rise in hepatitis c. Health Aff (Millwood). 2019;38:287–94.PubMedCrossRefGoogle Scholar
  47. 47.
    Samples H, Stuart EA, Olfson M. Opioid use and misuse and suicidal behaviors in a nationally representative sample of US adults. Am J Epidemiol. 2019;188:1245–53.PubMedCrossRefGoogle Scholar
  48. 48.
    Reddy UM, Davis JM, Ren Z, Greene MF, Opioid Use in Pregnancy NAS, Childhood Outcomes Workshop Invited S. Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the eunice kennedy shriver national institute of child health and human development, American college of obstetricians and gynecologists, American academy of pediatrics, society for maternal-fetal medicine, centers for disease control and prevention, and the march of dimes foundation. Obstet Gynecol. 2017;130:10–28.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Dowell D, Haegerich TM, R C. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep. 2016;65:1–49.PubMedCrossRefGoogle Scholar
  50. 50.
    U.S. Preventive Services Task Force. Draft evidence review: illicit drug use, including nonmedical use of prescription drugs: screening. 2019.Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.RAND CorporationBostonUSA
  2. 2.RAND CorporationPittsburghUSA

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