Recent trends in prescription drug misuse in the United States by age, race/ethnicity, and sex.

BACKGROUND AND OBJECTIVES: To examine changes in United States past-year opioid, stimulant, and benzodiazepine prescription drug misuse (PDM) and poly-PDM by demographics. METHODS: Data were from the 2015-2019 National Survey on Drug Use and Health (N = 282,768), examining annualized PDM change by demographics. RESULTS: Opioid and poly-PDM significantly declined among those under 35 years, White, and multiracial residents. DISCUSSION AND CONCLUSIONS: Age and race/ethnicity are important moderators of recent PDM trends, warranting investigation of mechanisms. SCIENTIFIC SIGNIFICANCE: Results highlight ongoing PDM declines in younger groups but expand the literature by showing limited changes in adults 35 and older and non-opioid PDM.

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older.

OBJECTIVE: To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older. METHODS: Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion. RESULTS: Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM. CONCLUSIONS: US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.

Opioid-involved prescription drug misuse and poly-prescription drug misuse in U.S. older adults.

OBJECTIVES: Although older adult prescription drug misuse (PDM) is associated with concerning consequences, stimulant PDM and poly- PDM involving multiple medication classes each remain understudied. Our objectives were to examine PDM and poly-PDM prevalence by medication class in US older adults and to identify the mental health, SUD, and health-related quality-of-life correlates of poly-PDM. METHOD: Data were from adults 50 and older completing the National Epidemiologic Survey on Alcohol and Related Conditions-III, (N = 14,667). Prevalence of PDM and poly-PDM by medication class was estimated. Logistic regression established odds of four SUD diagnoses, five psychopathology diagnoses and lifetime suicide attempts; linear regression evaluated health-related quality-of-life by PDM/poly-PDM status. RESULTS: Past-year PDM abstinence increased with age (50-54 years: 80.5%; 80 and older: 96.0%), while poly-PDM declined; past-year stimulant PDM was rare (≤0.6%), except when combined with opioid and tranquilizer/sedative PDM. Compared to no past-year PDM, both past-year opioid-only PDM and opioid-involved poly-PDM were associated with poorer health-related quality-of-life and greater odds of psychopathology and SUD, with the highest odds in poly-PDM. CONCLUSION: The presence of any opioid-involved PDM in older adults highlights screening for SUD, psychopathology, and other medical conditions, with the most significant intervention needs likely in those with opioid-involved poly-PDM.

Prescription drug misuse, other substance use, and sexual identity: The significance of educational status and psychological distress in US young adults.

BACKGROUND: The aim was to examine the effects of sexual identity, educational status, and their interaction on the past-year prevalence of controlled prescription use and prescription drug misuse (PDM) in U.S. young adults, 18-25 years. Methods: Data were from the 2015-2017 National Survey on Drug Use and Health (young adult N = 38,298). Past-year prescription opioid, stimulant and benzodiazepine use and PDM were outcomes, with PDM defined as use without a prescription or in ways not intended by the prescriber. Separate regressions by sex evaluated the relationship between prescription medication use or PDM prevalence and sexual identity, educational status/attainment (college student/graduate versus non-college), their interaction and past-year psychological distress. Results: Sexual identity minority young adults had higher rates of prescription use and PDM than heterosexual young adults. After accounting for educational status, though, bisexual men rarely differed from heterosexual men; after including psychological distress, gay men rarely differed from heterosexual men. Versus heterosexual women, lesbian (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [95% CI] = 1.47-2.30) and bisexual (AOR= 1.78, 95% CI = 1.27-2.50) young adult women had higher rates of prescription opioid misuse, after adjusting for educational status, psychological distress and sociodemographics. Versus heterosexual men, benzodiazepine PDM was elevated in gay men (AOR = 1.91, 95% CI= 1.02-3.58). Educational status was generally associated with lower rates of prescription use and PDM, except for stimulant PDM. Conclusions: Screening for psychological distress and PDM is needed in sexual identity minority young adults, especially for prescription opioid misuse among sexual identity minority women. Culturally-sensitive intervention should be considered for those with elevated psychological distress or signs of PDM. Further research on the sex differences found in the link between psychological distress and sexual identity minority opioid and stimulant PDM is warranted.

Friends and relatives as sources of prescription opioids for misuse among young adults: The significance of physician source and race/ethnic differences.

Background: Given the public health issues associated with prescription opioid misuse, there is surprisingly little research on sources of prescription opioids for misuse. We know that free from friends/relatives is the most common source, that source is associated with patterns of misuse, and that sources vary based on the sociodemographic characteristics. The current research assesses how friends/relatives obtain the prescription opioids they freely share with others. Methods: Data were from the 2009-2014 National Survey on Drug Use and Health and focused on respondents aged 18 to 25 (N = 106,845), as they report the highest prevalence of opioid misuse and are also more likely to obtain prescription opioids free from friends/relatives. Analyses used weighted cross-tabulations and design-based logistic regression to examine the relationships between sources of prescription opioids shared by friends/relatives and sociodemographic characteristics, substance use disorders, and risk behavior. Results: The most common source was from one physician (68.8%), and 18.4% of respondents reported multiple sources of opioids. We also found significant differences in friend/relative sources based on school enrollment, sex, and race/ethnicity of the person obtaining the opioids. Notably, white respondents were more likely to report theft/fake prescription, purchases, and multiple sources. Finally, friend/relative sources were significantly associated with substance use disorders and other risk behaviors. Conclusions: The current research assesses the sharing of prescription opioids between friends/relatives, highlights physicians as a major source, and identifies whites as a vulnerable group. Policy implications associated with the sharing of prescription opioids among friends/relatives are discussed.

Educational attainment and prescription drug misuse: The importance of push and pull factors for dropping out.

PURPOSE: Young adults who do not complete high school are at increased risk for substance use and offending behavior. A limitation of this research is that dropouts are often treated as a homogeneous group, which ignores the various push (e.g., academic failure or disciplinary problems) and pull (e.g., family responsibility or economic need) factors for leaving school. METHODS: The current study relies on multiple years of data from the National Survey on Drug Use and Health (2009-2014) and examines several dependent variables, including prevalence of prescription drug misuse, frequent prescription drug misuse, and prescription drug-related substance use disorder symptoms. We assess the importance of push and pull factors for dropping out, and compare dropouts to respondents who completed school. RESULTS: Multivariable logistic regression analyses produce two important findings. First, push factors increase the risk of various types of prescription drug misuse compared to pull factors. Additionally, respondents who attend college are at a decreased risk for various types of prescription opioid and sedative/tranquilizer misuse and disorder. DISCUSSION: The current research identifies important differences in prescription drug misuse and disorders among dropouts based on the reason they left school. Additionally, college attendance appears to be a strong protective factor.

Sports involvement, injury history, and non-medical use of prescription opioids among college students: An analysis with a national sample.

BACKGROUND AND OBJECTIVES: The United States is in the midst of a prescription drug epidemic, particularly related to opioids. To more effectively deal with the devastating outcomes associated with non-medical use of prescription opioids (NUPO), research is needed to identify populations at increased risk. The current research builds on a small number of studies that have shown that adolescents involved in competitive sports are more likely to report NUPO. Specifically, we examine the relationship between athlete status, injury history, and NUPO among college students. METHODS: Using data from the National College Health Assessment (NCHA II from 2008 to 2011), we estimated several logistic regression models to examine the individual, and combined, effects of sex, athlete status, and injury history on NUPO. RESULTS: In the NCHA II 8.3% of students reported NUPO, 8.0% identified as a varsity athlete, and 17.4% reported an injury. Looking at factors individually, having an injury, being a varsity athlete, and being male were all significantly associated with NUPO. By combining these factors together we were able to determine that male athletes, athletes with injuries, and male athletes with injuries were at the greatest risk for NUPO, after controlling for relevant covariates. DISCUSSION AND CONCLUSIONS: To create effective prevention and intervention programs that target the health and wellness of college students, it is important to understand which groups of students are most likely to report NUPO. SCIENTIFIC SIGNIFICANCE: This study advances our understanding of the relationship between sports involvement and NUPO. (Am J Addict 2018;27:15-22).

Religious Involvement and Marijuana Use for Medical and Recreational Purposes.

In this article, we use data from the 2016 National Survey on Drug Use and Health (NSDUH) to examine the association between religious involvement and marijuana use for medical and recreational purposes in U.S. adults (N = 41,517). We also consider whether the association between religious involvement and marijuana use varies according to personal health status. Our results show that adults who attend religious services more frequently and hold more salient religious beliefs tend to exhibit lower rates of medical and recreational marijuana use. We also find that these "protective effects" are less pronounced for adults in poor health. Although our findings confirm previous studies of recreational marijuana use, we are the first to examine the association between religious involvement and medical marijuana use. Our moderation analyses suggest that the morality and social control functions of religious involvement may be offset under the conditions of poor health.

Racial/Ethnic differences in factors that place adolescents at risk for prescription opioid misuse.

Although considerable research attention is paid to the misuse of controlled medications, a relatively small number of studies focus on prescription opioid misuse (POM) among racial/ethnic minority adolescents. This study aimed to determine the prevalence of POM among adolescents in the three largest racial/ethnic groups (Whites, Hispanics, Blacks) and identify demographic and psychosocial factors that increase the risk of POM. Additionally, the authors applied concepts from social bonding theory and social learning theory to determine the extent to which these concepts explain adolescent POM among each group. Using data from the 2012 National Survey of Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with an increased risk of POM. Results show that Blacks (6.08%) have the highest prevalence rate of adolescent POM and risk factors vary by race/ethnicity. These findings are important in that they enhance the ability of prescribers to identify high-risk adolescent patients and help to make prevention interventions more culturally relevant.

Prescription drug misuse and gender.

In recent years, prescription drug misuse has become a serious public health issue. A number of studies in this area have identified females to be at an increased risk for prescription drug misuse during adolescence. Guided by Agnew's general strain theory, the current research examined the relationship between prescription drug misuse and gender during adolescence. We used data from the 2010 National Survey on Drug Use and Health, a sample representative of the non-institutionalized population of the United States. Logistic regression models were estimated to examine the relationship between gender, prescription drug misuse, strain, and depression. The findings indicated that females were at an increased for prescription drug misuse. We also found support for general strain theory, as strain and depression were significantly related to prescription drug misuse. In addition, we found evidence that strain was gendered in that elements of general strain theory accounted for the relationship between prescription drug misuse and gender.

Determinants of prescription opioid misuse among Black Americans: Evidence from the 2019 National Survey on Drug Use and Health.

BACKGROUND: Opioid misuse, including prescription opioid misuse, remains a significant public health concern impacting various ethnoracial groups in the United States, including non-Hispanic Black Americans. This study provides more recent evidence on prescription opioid misuse among Black Americans. METHODS: We used data from the 2019 National Survey on Drug Use and Health to examine the prevalence and determinants of prescription opioid misuse among Black American adults aged 18 and older. We compared these findings to non-Hispanic White American adults. RESULTS: The prevalence rate of past-year prescription opioid misuse was very similar among Black (3.4%) and White respondents (3.8%). Adjusted multivariate logistic regression analyses found no significant racial differences in prescription opioid misuse. Religious importance and rurality were negatively associated with misuse only among Black respondents. Depressive episodes, other drug use, age, and risk-taking behaviors were associated with prescription opioid misuse among both Black and White respondents. CONCLUSION: Black and White Americans remain at risk for prescription opioid-related problems. Religiosity and rurality require further investigation to understand how they may impact misuse among Black Americans.

Prescription Drug Misuse with Alcohol Coingestion among US Adolescents: Youth Experiences, Health-related Factors, and Other Substance Use Behaviors.

BACKGROUND: While alcohol use and prescription drug misuse (PDM) are common among adolescents, there is relatively little research on coingestion. This is disquieting as polysubstance use has become a major contributing factor in drug overdose deaths among young people in the United States. METHODS: The current research uses multiple years of data from the National Survey on Drug Use and Health (2015-2019) to assess characteristics associated with coingestion among adolescents aged 12 to 17 years ( N = 57,352). Multinomial logistic regression analysis is used to identify characteristics associated with past 30-day PDM with and without alcohol coingestion. The primary objective is to determine how youth experiences with parents, involvement in conventional activities, religiosity, social support, and school status are associated with coingestion. RESULTS: Among adolescents who report past 30-day PDM, 18.6% coingest with alcohol and 77.5% of adolescents who coingest report at least one substance use disorder. Several youth experiences were significantly associated with opioid coingestion including increased conflict with parents (relative risk ratio [RRR], 1.27; 95% confidence interval [CI], 1.07-1.48), lower levels of religiosity (RRR, 0.72; 95% CI, 0.52-0.98), less social support (RRR, 0.36; 95% CI, 0.18-0.69), and not being in school (RRR, 3.86; 95% CI, 1.33-11.17). In addition, emergency department visits, depression, and other substance use behaviors were also significantly associated with coingestion. CONCLUSIONS: Findings demonstrate a strong connection between coingestion and substance use disorder among US adolescents. The findings from the current study can inform prevention and intervention efforts by identifying youth experiences and health-related factors that are associated with coingestion.

Religiosity and adolescent substance use: evidence from the national survey on drug use and health.

Prior research indicates that religiosity is associated with lower levels of substance use in adolescence. The extant research, however, is limited by issues related to data quality and analytic strategy. The current research uses the National Survey on Drug Use and Health to further our understanding of the nature of the relationship between religiosity and substance use during adolescence. Results show that religiosity reduces the odds of tobacco use, heavy drinking, prescription drug misuse, marijuana use, and other illicit drug use. These associations are partially explained by respondent and peer attitudes toward substance use and, to a lesser extent, respondent psychological well-being. The influence of respondent substance use attitude is especially pronounced, explaining between 41% (marijuana) and 53% (tobacco) of the association between religiosity and substance use. In fully adjusted models, all mediators account for between 46% (marijuana) and 59% (tobacco) of the association between religiosity and substance use.

Prescription drug and alcohol simultaneous co-ingestion in U.S. young adults: Prevalence and correlates.

Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Types of criminal legal system exposure and polysubstance use: Prevalence and correlates among U.S. adults in the National Survey on Drug Use and Health, 2015-2019.

INTRODUCTION: Criminal legal system (CLS) exposed adults experience higher rates of substance use, substance use disorder (SUD), and overdose. As most CLS exposed adults are not incarcerated, it is important to focus on CLS exposure across the carceral continuum. METHODS: This research used pooled data from adult respondents (N = 206,314) in the National Survey on Drug Use and Health (2015-2019). Survey weighted descriptive statistics and Poisson regression were used to estimate prevalence of polysubstance use (i.e., concurrent use) across CLS exposure types (i.e., arrest, probation, parole), identifying relevant correlates. RESULTS: The prevalence of polysubstance use was higher among CLS exposed adults, and nearly two-thirds of CLS exposed adults who used multiple types of substances indicated having an SUD. Comparing CLS exposure types, polysubstance use was less likely among adults on probation (IRR=0.89, 95%CI=0.84,0.94) or parole (IRR=0.82, 95%CI=0.76,0.87) compared to those arrested. Polysubstance use was also more likely among adults on probation (IRR=1.09, 95%CI =1.01,1.17) compared to those on parole. While some characteristics (i.e., age, ethnicity, SUD) were consistently associated with polysubstance use across types of CLS exposure, other characteristics (i.e., sexual identity, marital status, suicidal ideation) were not. CONCLUSIONS: There is heterogeneity in health risks as a function of CLS exposure type. Further research is needed to identify causal mechanisms and differences based on demographic characteristics. Given high levels of polysubstance use across CLS exposure types, a shift towards a more comprehensive approach in substance use epidemiology may facilitate building an evidence-base to maximize treatment related interventions to reduce polysubstance-involved overdoses.

The relationship between source of diversion and prescription drug misuse, abuse, and dependence.

The current research examines the relationship between how people obtain prescription drugs (source of diversion) and how people misuse prescription drugs (i.e., frequency, abuse, and dependence). We analyzed data from the 2008 National Survey on Drug Use and Health public use file, a sample of 68,736 persons aged 12 and older that is generalizable to the noninstitutionalized population of the United States. A number of regression models were estimated, and findings indicate that source of diversion was significantly correlated to frequency of prescription drug misuse, abuse, and dependence. Given these findings, we believe any attempt to classify prescription drug misusers based on certain characteristics should include source of diversion.

Prescription drug misuse among Asian-American adults: results from a national survey.

Asians have low levels of substance use compared with other groups in the United States. Given the increase in Asian population, we believe it is important to study substance use in this population. Data from the 2002-2003 National Latino and Asian American Study are examined to address two questions. First, which Asian ethnic subgroup is at greatest risk for prescription drug misuse? Second, is acculturation significantly correlated with prescription drug misuse among Asians? Findings indicate that Filipinos are at the greater risk for prescription drug misuse. Also, Asians who are more acculturated are at greater risk for prescription drug misuse.

Sources of prescription opioids and tranquilizers for misuse among U.S. young adults: differences between high school dropouts and graduates and associations with adverse outcomes.

Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.

Sexual Identity and Motivations for Prescription Drug Misuse Among U.S. Adults.

Purpose: Although we know that sexual minority populations, particularly bisexual individuals, tend to be at increased risk for substance use, less research has focused on prescription drug misuse (PDM). The current study is the first to assess differences in motivations for PDM by sexual identity and sex. This is important as research has established a link between certain motivations and adverse outcomes. Methods: This study used data from multiple years of the National Survey on Drug Use and Health (2015-2018). Respondents who reported past-year PDM were asked follow-up questions to identify motivations for PDM. We ran several weighted cross-tabulations to estimate the prevalence and 95% confidence intervals for motivations for PDM by sexual identity (i.e., heterosexual, lesbian or gay, and bisexual) for males and females separately. When chi-square tests were significant, post hoc comparisons using design-based multivariable regressions were conducted. Results: Prevalence rates for both PDM and substance use disorder associated with prescription drugs were higher among sexual minority adults than heterosexual adults. With regard to motives, bisexual females were more likely to endorse recreational motives (i.e., to get high) for prescription opioids, tranquilizers, and stimulants than heterosexual females. Gay males were more likely to endorse self-treatment motives (e.g., to relax, to lose weight) than both bisexual and heterosexual males. Conclusion: High prevalence rates and endorsement of recreational motives identify bisexual females as an important at-risk population. It is important for clinicians to consider how prevention, treatment, and intervention strategies focused on PDM may be improved to best target this unique population.

Poly-prescription drug misuse across the life course: Prevalence and correlates across different adult age cohorts in the U.S.

BACKGROUND: Most research on prescription drug misuse (PDM) focuses on the misuse of specific classes of psychoactive prescription drugs among adolescents or young adults. The current research addressed important gaps in the literature by assessing poly-prescription drug misuse (poly-PDM), the misuse of more than one class of psychoactive prescription drug, across different adult age cohorts. METHODS: We used the 2015-2018 National Survey on Drug Use and Health to examine the prevalence of past-year poly-PDM and specific combinations of PDM. Multinomial logistic regression was used to identify demographic, health-related factors, and substance use behaviors that were significantly associated with poly-PDM. RESULTS: The prevalence of poly-PDM decreases with age and is common among individuals who engage in PDM. Slightly more than one in four respondents in age cohorts 18-25 (31.66%, 95% CI = 30.35, 33.00) and 26-34 (29.92%, 95% CI = 25.82, 30.12) who engage in PDM, misused more than one class of prescription drug. Additionally, poly-PDM was identified as a high-risk type of PDM as roughly 60% of adults younger than 65 who endorse poly-PDM reported having a substance use disorder (SUD). While certain characteristics (i.e., race/ethnicity, marital status, depression, suicidal ideation, illegal drug use, and SUD) were consistently associated with poly-PDM across age cohorts, other characteristics (i.e., sexual identity, income, and justice involvement) varied across age cohorts. Finally, a comparison of poly-PDM to single PDM showed, in all age cohorts, that having an SUD was associated with an increased likelihood of poly-PDM, while Black adults were less likely than whites to report poly-PDM. CONCLUSIONS: By identifying prevalence and correlates of poly-PDM across adult age cohorts, the current research has significant implications. Understanding stability and heterogeneity in the characteristics associated with poly-PDM should inform interventions, identify at-risk groups, and shape public health approaches to dealing with high-risk substance use behavior.