Misuse of prescription opioids, CNS depressants, and stimulants is a serious public health problem in the United States. Although most people take prescription medications responsibly, in 2017, an estimated 18 million people (more than 6 percent of those aged 12 and older) have misused such medications at least once in the past year.7 According to results from the 2017 National Survey on Drug Use and Health, an estimated 2 million Americans misused prescription pain relievers for the first time within the past year, which averages to approximately 5,480 initiates per day. Additionally, more than one million misused prescription stimulants, 1.5 million misused tranquilizers, and 271,000 misused sedatives for the first time.
The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely include ease of access.9 The number of prescriptions for some of these medications has increased dramatically since the early 1990s.10 Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem.11,12 Although misuse of prescription drugs affects many Americans, certain populations such as youth and older adults may be at particular risk.13,14
Adolescents and Young Adults
Misuse of prescription drugs is highest among young adults ages 18 to 25, with 14.4 percent reporting nonmedical use in the past year. Among youth ages 12 to 17, 4.9 percent reported past-year nonmedical use of prescription medications.16
After alcohol, marijuana, and tobacco, prescription drugs (taken nonmedically) are among the most commonly used drugs by 12th graders. NIDA’s Monitoring the Future survey of substance use and attitudes in teens found that about 6 percent of high school seniors reported past-year nonmedical use of the prescription stimulant Adderall® in 2017, and 2 percent reported misusing the opioid pain reliever Vicodin®.17
Although past-year nonmedical use of CNS depressants has remained fairly stable among 12th graders since 2012, use of prescription opioids has declined sharply. For example, past-year nonmedical use of Vicodin among 12th graders was reported by 9.6 percent in 2002 and declined to 2.0 percent in 2017. Nonmedical use of Adderall® increased between 2009 and 2013, but has been decreasing through 2017.17 When asked how they obtained prescription stimulants for nonmedical use, around 60 percent of the adolescents and young adults surveyed said they either bought or received the drugs from a friend or relative.
Youth who misuse prescription medications are also more likely to report use of other drugs. Multiple studies have revealed associations between prescription drug misuse and higher rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other illicit drug use among U.S. adolescents, young adults, and college students.18–21 In the case of prescription opioids, receiving a legitimate prescription for these drugs during adolescence is also associated with a greater risk of future opioid misuse, particularly in young adults who have little to no history of drug use.14
More than 80 percent of older patients (ages 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily.13 This can potentially lead to health issues resulting from unintentionally using a prescription medication in a manner other than how it was prescribed, or from intentional nonmedical use. The high rates of multiple (comorbid) chronic illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions make medication (and other substance) misuse more dangerous in older people than in younger populations.22 Further, a large percentage of older adults also use over-the-counter medicines and dietary and herbal supplements, which could compound any adverse health consequences resulting from nonmedical use of prescription drugs.13
7. Center for Behavioral Health Statistics and Quality. Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville (MD): SAMHSA; 2018. https://www.samhsa.gov/data/report/2017-nsduh-detailed-tables. Accessed October 19, 2018.
8. Centers for Disease Control and Prevention. Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm. Accessed September 18, 2018.
9. Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician. 2010;13(5):401-435.
10. Daniulaityte R, Falck R, Carlson RG. “I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids. Int J Drug Policy. 2012;23(5):374-384. doi:10.1016/j.drugpo.2012.01.012
11. Webster PC. Oxycodone class action lawsuit filed. CMAJ Can Med Assoc J. 2012;184(7):E345-E346. doi:10.1503/cmaj.109-4158
12. Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States. JAMA. 2008;300(24):2867. doi:10.1001/jama.2008.892
13. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription Opioids in Adolescence and Future Opioid Misuse. Pediatrics. 2015;136(5):e1169-e1177. doi:10.1542/peds.2015-1364
14. Mack KA, Jones CM, Paulozzi LJ. Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women—United States, 1999–2010.; 2013:537-542. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6226a3.htm. Accessed January 31, 2018.
15. Center for Behavioral Health Statistics and Quality. Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018.
16. Miech R, Schulenberg J, Johnston L, Bachman J, O’Malley P, Patrick M. Monitoring the Future National Adolescent Drug Trends in 2017: Findings Released. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2017. http://www.monitoringthefuture.org//pressreleases/17drugpr.pdf. Accessed January 2, 2018.
17. McCabe SE, West BT, Teter CJ, Boyd CJ. Medical and nonmedical use of prescription opioids among high school seniors in the United States. Arch Pediatr Adolesc Med. 2012;166(9):797-802. doi:10.1001/archpediatrics.2012.85
18. Boyd CJ, Esteban S, Teter CJ. Medical and nonmedical use of prescription pain medication by youth in a Detroit-area public school district. Drug Alcohol Depend. 2006;81(1):37-45. doi:10.1016/j.drugalcdep.2005.05.017
19. McCabe SE, Teter CJ, Boyd CJ. Illicit use of prescription pain medication among college students. Drug Alcohol Depend. 2005;77(1):37-47. doi:10.1016/j.drugalcdep.2004.07.005
20. Young AM, Glover N, Havens JR. Nonmedical use of prescription medications among adolescents in the United States: a systematic review. J Adolesc Health Off Publ Soc Adolesc Med. 2012;51(1):6-17. doi:10.1016/j.jadohealth.2012.01.011
21. Wang R, Chen L, Fan L, et al. Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study. PloS One. 2015;10(11):e0142123. doi:10.1371/journal.pone.0142123
22. Cotto JH, Davis E, Dowling GJ, Elcano JC, Staton AB, Weiss SRB. Gender effects on drug use, abuse, and dependence: a special analysis of results from the National Survey on Drug Use and Health. Gend Med. 2010;7(5):402-413. doi:10.1016/j.genm.2010.09.004