Author Affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
The public health consequences associated with the nonmedical use of prescription pain relievers such as oxycodone, hydrocodone, and methadone have dramatically increased over the last decade.1 In 2009, 15 597 people died of overdoses involving these drugs—a 109% increase since 2002.2 Prior studies examining prescription pain reliever overdose deaths found that nonmedical use was common among decedents before death.3,4 National estimates of past-year nonmedical use of these drugs, however, have remained stable since 2002.5,6 These estimates include the spectrum of nonmedical users from those who used pain relievers once or twice to those who were more frequent or chronic nonmedical users. This Research Letter attempts to determine if the subset of chronic nonmedical users of pain relievers—those using 200 days or more in the past year—has increased since 2002, in parallel with fatal overdoses of these drugs. Understanding trends in the frequency of nonmedical use can help identify populations at greatest risk for overdoses.
The National Survey on Drug Use and Health (NSDUH), an annual survey of the noninstitutionalized, civilian population 12 years and older, provides national estimates of substance use in the United States. Information on NSDUH survey methodology has been reported elsewhere.6 Data from the NSDUH public use files were combined for years 2002-2003 and 2009-2010 to improve the detection of differences among specific subpopulations.
The NSDUH defines past-year nonmedical use (PYNMU) of prescription pain relievers as use in the prior 12 months without a prescription or use simply for the experience or feeling it causes. Drugs in this category include prescription opioid pain relievers and selected barbiturate combination products. Once respondents are identified as having PYNMU, they are asked to state the number of days they used pain relievers nonmedically in the past year.
Frequency of PYNMU of pain relievers was categorized into the following 4 groups: 1 to 29 days, 30 to 99 days, 100 to 199 days, and 200 to 365 days of nonmedical use. Annual average estimates of PYNMU for 2002-2003 and 2009-2010 were produced using SPSS version 19 Complex Samples (SPSS Inc) to account for sampling methods and weighting in the NSDUH. These estimates were then converted to rates of PYNMU per 1000 people 12 years and older. Two-tailed t tests were used to test significant differences between the periods in the annual average rates of frequency of PYNMU overall, by sex, and by age group. Statistical significance was determined at the P < .05 level.
There was a significant increase in PYNMU of pain relievers of 200 to 365 days between 2002-2003 and 2009-2010 (Table). Any PYNMU and PYNMU of 1 to 29 days, 30 to 99 days, or 100 to 199 days did not increase during the period. The total number of person-days of PYNMU increased 35%, from 451 031 411 in 2002-2003 to 612 829 084 in 2009-2010.
Annual average rates of any PYNMU and 200 to 365 days of PYNMU increased significantly among male respondents between 2002-2003 and 2009-2010. Among female respondents, any PYNMU did not change; a significant decrease in 1 to 29 days of PYNMU was seen during the 2 periods.
Among age groups, any PYNMU among people aged 12 to 17 years decreased during the periods. Both the 26 to 34 years and 50 years and older age groups had increases in any PYNMU. Rates of 200 to 365 days of PYNMU increased significantly among those aged 18 to 25 years, 26 to 34 years, and 35 to 49 years. PYNMU of 200 to 365 days among people 50 years and older more than doubled but did not reach statistical significance (P = .08).
Between 2002-2003 and 2009-2010, the rate of chronic nonmedical use—PYNMU of 200 days or more—increased significantly (74.6%), while overall PYNMU did not change. This finding is important because it parallels increases in overdose deaths, treatment admissions, and other negative effects associated with opioid pain relievers in recent years.1,7
Variation in annual average rates of PYNMU among age groups and sex were also found. Some of the largest increases in PYNMU of 200 to 365 days were among male respondents (105.3%), and people aged 26 to 34 years (81.0%) and 35 to 49 years (134.6%). This is consistent with increases in overdose death rates for opioid pain relievers seen among these groups between 2002 and 2009.8 An encouraging finding is the decrease in any PYNMU among people aged 12 to 17 years.
The finding that nearly 0.4% of people 12 years and older, almost 1 million people, reported using pain relievers nonmedically for 200 days or more in 2009-2010 and roughly 2%, or 4.6 million people, used them for 30 days or more is concerning. The annual average estimate of 613 million person-days of PYNMU implies that each of the 257 million opioid prescriptions dispensed in the United States annually contributes on average to more than 2 days of PYNMU. Coupled with continued increases in opioid pain reliever morbidity and mortality, these findings underscore the need for concerted public health and public safety action to prevent nonmedical use of these drugs. Interventions should focus on populations at greatest risk for chronic nonmedical use: men and persons aged 18 to 49 years.
Correspondence: Dr Jones, Centers for Disease Control and Prevention, Chamblee Campus, 4770 Buford Hwy NE, MS F-62, Atlanta, GA 30341 (firstname.lastname@example.org).
Published Online: June 25, 2012. doi:10.1001 /archinternmed.2012.2533
Financial Disclosure: None reported.
Disclaimer: The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.
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