Is employment status in adults over 25 years old associated with nonmedical prescription opioid and stimulant use?

  • Alexander S. Perlmutter
  • Sarah C. Conner
  • Mirko Savone
  • June H. Kim
  • Luis E. Segura
  • Silvia S. Martins
Original Paper



Nonmedical use of prescription opioid and stimulants (NMUPO and NMUPS, respectively) has declined in recent years, but remains an important public health problem. Evidence regarding their relationships with employment status remains unclear. We determined the relationship between employment status and NMUPO and NMUPS.


We analyzed a cross-sectional, nationally representative, weighted sample of 58,486 adults, ages 26 years and older, using combined 2011–2013 data from the National Survey on Drug Use and Health (NSDUH). We fit two crude and two adjusted multivariable logistic regression models to assess the relationship between our two different outcomes of interest: (1) past-year NMUPO and (2) past-year NMUPS, and our exposure of interest: employment status, categorized as (1) full time, (2) part time, (3) unemployed, and (4) not in the workforce. Our adjusted models featured the following covariates: sex, race, age, marital status, and psychological distress, and other nonmedical use.


Prevalence of NMUPO was higher than NMUPS (3.48 vs. 0.72%). Unemployed participants had the highest odds of NMUPO [aOR 1.45, 95% CI (1.15–1.82)], while those not in the workforce had the highest odds of NMUPS [aOR 1.71, 95% CI (1.22–2.37)]. Additionally, part-time and unemployed individuals had increased odds of NMUPS [aORs, 95% CI 1.59 (1.09–2.31) and 1.67 (1.11–2.37) respectively], while those not in the workforce had decreased odds of NMUPO [aOR 0.82, 95% CI (0.68–0.99)] relative to full-time participants.


There is a need for adult prevention and deterrence programs that target nonmedical prescription drug use, especially among those unemployed or not in the workforce.


Opioid Stimulant Nonmedical prescription drug use Employment Epidemiology 



Attention-deficit hyperactivity disorder


Nonmedical prescription drug(s)


Nonmedical prescription opioid use


Nonmedical prescription stimulant use


National Survey on Drug Use and Health


Prescription Drug Monitoring Program(s)


United States


Compliance with ethical standards

Role of funding source

The data reported herein come from the National Survey of Drug Use and Health (NSDUH) public use files and made publicly available by the Substance Abuse and Mental Health Services Administration (SAMHSA). This study is IRB exempt. Dr. Martins is currently funded by the US National Institutes of Health (NIH), National Institute of Drug Abuse (NIDA—R01DA037866 and R01DA039454), the Eunice Kennedy Shriver National Institute of Child and Human Development (NICHD—R01HD060072), and by a Columbia University President’s Global Innovation Fund. June Kim is funded by the National Institutes of Health (NIH) National Institute of Drug Abuse (NIDA—5T32DA031099-04). Mirko Savone is funded by the Valerie Fund. Luis Segura is funded by the CONACYT doctoral scholarship.

Conflict of interest

Dr. Martins was a consultant for Purdue Pharma until December 2014 on secondary data analysis of data on nonmedical prescription opioid use and alcohol use unrelated to what is described in this manuscript. All other authors have no conflict of interest to declare.


  1. 1.
    Epidemic: Responding to America’s Prescription Drug Abuse Crisis (2011) Executive Office of the President of the United States, Washington, D.CGoogle Scholar
  2. 2.
    Macrae J, Hyde PS, Slavitt A (2015) HHS launches multi-pronged effort to combat opioid abuse. HHS Blog, vol 2016. SAMHSAGoogle Scholar
  3. 3.
    Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2016) Increases in Drug and Opioid Overdose Deaths—United States, 2000-2014. MMWR Morb Mortal Wkly Rep 64(50–51):1378–1382. doi: 10.15585/mmwr.mm6450a3 CrossRefPubMedGoogle Scholar
  4. 4.
    Goldberger B, Thogmartin J, Johnson H, Paulozzi L, Rudd R, Ibrahimova A (2011) Drug overdose deaths—Florida (2003–2009) MMWR 2011. Morb Mort Wkly Rep 60(26):869–872Google Scholar
  5. 5.
    Paulozzi LJ, Budnitz DS, Xi Y (2006) Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf 15(9):618–627. doi: 10.1002/pds.1276 CrossRefPubMedGoogle Scholar
  6. 6.
    Fingerhut LA (2008) Increases in poisoning and Methadone-Related Deaths: United States, 1999–2005. NCHS Health and Stats. Centers for Disease Control and PreventionGoogle Scholar
  7. 7.
    Drug Abuse Warning Network (2012) Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department VisitsGoogle Scholar
  8. 8.
    Hansen RN, Oster G, Edelsberg J, Woody GE, Sullivan SD (2011) Economic costs of nonmedical use of prescription opioids. Clin J Pain 27(3):194–202. doi: 10.1097/AJP.0b013e3181ff04ca CrossRefPubMedGoogle Scholar
  9. 9.
    Cerda M, Santaella J, Marshall BD, Kim JH, Martins SS (2015) Nonmedical prescription opioid use in childhood and early adolescence predicts transitions to heroin use in young adulthood: a National Study. J Pediatr 167(3):605–612.e1-2. doi: 10.1016/j.jpeds.2015.04.071 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    McCabe SE, Schulenberg JE, O’Malley PM, Patrick ME, Kloska DD (2014) Non-medical use of prescription opioids during the transition to adulthood: a multi-cohort national longitudinal study. Addiction 109(1):102–110. doi: 10.1111/add.12347 CrossRefPubMedGoogle Scholar
  11. 11.
    Martins SS, Santaella-Tenorio J, Marshall BD, Maldonado A, Cerda M (2015) Racial/ethnic differences in trends in heroin use and heroin-related risk behaviors among nonmedical prescription opioid users. Drug Alcohol Depend 151:278–283. doi: 10.1016/j.drugalcdep.2015.03.020 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Martin MJ, Martin MJ, Blozis SA, Boeninger DK, Masarik AS (2014) The timing of entry into adult roles and changes in trajectories of problem behaviors during the transition to adulthood. Dev Psychol 50(11):2473–2484. doi: 10.1037/a0037950 CrossRefPubMedGoogle Scholar
  13. 13.
    Miller T, Novak SP, Galvin DM, Spicer RS, Cluff L, Kasat S (2015) School and work status, drug-free workplace protections, and prescription drug misuse among Americans ages 15–25. J Stud Alcohol Drugs 76(2):195–203CrossRefPubMedGoogle Scholar
  14. 14.
    Smith ME, Farah MJ (2011) Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychol Bull 137(5):717–741. doi: 10.1037/a0023825 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK (2013) Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics 131(4):637–644. doi: 10.1542/peds.2012-2354 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Henry AD, Lucca AM (2004) Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers. Work (Reading, Mass) 22(3):169–182Google Scholar
  17. 17.
    Schwarz A (2015) Workers Seeking Productivity in a Pill Are Abusing A.D.H.D. Drugs. The New York TimesGoogle Scholar
  18. 18.
    Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings (2014). H-48. Substance Abuse and Mental Health Services Administration, Rockville, MarylandGoogle Scholar
  19. 19.
    Jordan BK, Karg RS, Batts KR, Epstein JF, Wiesen C (2008) A clinical validation of the National Survey on Drug Use and Health assessment of substance use disorders. Addict Behav 33(6):782–798. doi: 10.1016/j.addbeh.2007.12.007 CrossRefPubMedGoogle Scholar
  20. 20.
    Results from the 2008 National Survey on Drug Use and Health: national findings (2009) H-36. Substance Abuse and Mental Health Services Administration, Rockville, MarylandGoogle Scholar
  21. 21.
    Widiger TA, Smith GT (1994) Substance use disorder: abuse, dependence and dyscontrol. Addiction 89(3):267–282. doi: 10.1111/j.1360-0443.1994.tb00889.x CrossRefPubMedGoogle Scholar
  22. 22.
    Morasco BJ, Turk DC, Donovan DM, Dobscha SK (2013) Risk for prescription opioid misuse among patients with a history of substance use disorder. Drug Alcohol Depend 127(1–3):193–199. doi: 10.1016/j.drugalcdep.2012.06.032 CrossRefPubMedGoogle Scholar
  23. 23.
    Price AM, Ilgen MA, Bohnert AS (2011) Prevalence and correlates of nonmedical use of prescription opioids in patients seen in a residential drug and alcohol treatment program. J Subst Abuse Treat 41(2):208–214. doi: 10.1016/j.jsat.2011.02.003 CrossRefPubMedGoogle Scholar
  24. 24.
    Weyandt LL, Janusis G, Wilson KG, Verdi G, Paquin G, Lopes J, Varejao M, Dussault C (2009) nonmedical prescription stimulant use among a sample of college students: relationship with psychological variables. J Atten Disord. doi: 10.1177/1087054709342212 Google Scholar
  25. 25.
    Substance Abuse and Mental Health Services Administration (2014) 10.8 Million full-time workers have a substance use disorder. The NSDUH Report: Data SpotlightGoogle Scholar
  26. 26.
    Eitle D, Taylor J, Eitle TM (2010) Heavy episodic alcohol use in emerging adulthood: the role of early risk factors and young adult social roles. J Drug Issues 40(2):295–320. doi: 10.1177/002204261004000203 CrossRefGoogle Scholar
  27. 27.
    Johnston L, O’Malley P, Bachman J, Schulenberg J, Miech R (2014) Monitoring the Future national survey results on drug use, 1975–2013: vol 2, College students and adults ages 19–55. Institute for Social Research, The University of Michigan, Ann Arbor, MichiganGoogle Scholar
  28. 28.
    Bachman JG, O’Malley PM, Johnston LD (1984) Drug use among young adults: the impacts of role status and social environment. J Pers Soc Psychol 47(3):629–645CrossRefPubMedGoogle Scholar
  29. 29.
    Gallagher RM (2009) Pharmacological management of persistent pain in older persons. Pain Med 10(6):1062–1083. doi: 10.1111/j.1526-4637.2009.00699.x CrossRefGoogle Scholar
  30. 30.
    Greely H (2008) Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456(7223):702–705CrossRefPubMedGoogle Scholar
  31. 31.
    Andersen I, Brønnum-Hansen H, Kriegbaum M, Hougaard CØ, Hansen FK, Diderichsen F (2016) Increasing illness among people out of labor market—A Danish register-based study. Soc Sci Med 156:21–28. doi: 10.1016/j.socscimed.2016.03.003 CrossRefPubMedGoogle Scholar
  32. 32.
    Pompili M, Innamorati M, Di Vittorio C, Baratta S (2014) Unemployment as a risk factor for completed suicide: a psychological autopsy study. Arch Suicide Res 18(2):181–192. doi: 10.1080/13811118.2013.803449 CrossRefPubMedGoogle Scholar
  33. 33.
    Harvey SB, Modini M, Christensen H, Glozier N (2013) Severe mental illness and work: what can we do to maximise the employment opportunities for individuals with psychosis? Aust N Z J Psychiatry 47(5):421–424CrossRefPubMedGoogle Scholar
  34. 34.
    Baldwin ML, Marcus SC (2014) The impact of mental and substance-use disorders on employment transitions. Health Econ 23(3):332–344. doi: 10.1002/hec.2936 CrossRefPubMedGoogle Scholar
  35. 35.
    Berkman LF, Glass T (2000) Social integration, social networks, social support, and health. Soc Epidemiol 1:137–173Google Scholar
  36. 36.
    Klinenberg E (2015) Heat wave: a social autopsy of disaster in Chicago. University of Chicago Press, ChicagoGoogle Scholar
  37. 37.
    Carpenter CS (2007) Workplace drug testing and worker drug use. Health Serv Res 42(2):795–810CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Fischer B, Keates A, Bühringer G, Reimer J, Rehm J (2014) Non-medical use of prescription opioids and prescription opioid-related harms: why so markedly higher in North America compared to the rest of the world? Addiction 109(2):177–181CrossRefPubMedGoogle Scholar
  39. 39.
    Laxmaiah Manchikanti M, Bert Fellows M, Hary Ailinani M (2010) Therapeutic use, abuse, and nonmedical use of opioids: a 10-year perspective. Pain Phys 13:401–435Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Alexander S. Perlmutter
    • 1
    • 2
  • Sarah C. Conner
    • 3
  • Mirko Savone
    • 1
    • 4
  • June H. Kim
    • 1
  • Luis E. Segura
    • 1
  • Silvia S. Martins
    • 1
  1. 1.Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité UMR1153Université Paris DescartesParisFrance
  3. 3.Boston University School of Public HealthBostonUSA
  4. 4.Department of Pediatric Hematology, Oncology and Stem Cell TransplantationColumbia University Medical CenterNew YorkUSA

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