Trends in prescription drug abuse

Although prescription drug abuse affects many Americans, some concerning trends can be seen among older adults, adolescents, and women. Several indicators suggest that prescription drug abuse is on the rise in the United States. According to the 2003 National Survey on Drug Use and Health (NSDUH), an estimated 4.7 million Americans used prescription drugs nonmedically for the first time in 2002 -

• 2.5 million used pain relievers
• 1.2 million used tranquilizers
• 761,000 used stimulants
• 225,000 used sedatives

Pain reliever incidence increased-from 573,000 initiates in 1990 to 2.5 million initiates in 2000-and has remained stable through 2003. In 2002, more than half (55 percent) of the new users were females, and more than half (56 percent) were ages 18 or older.

The Drug Abuse Warning Network (DAWN), which monitors medications and illicit drugs reported in emergency departments (EDs) across the Nation, recently found that two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs). In 2002, benzodiazepines accounted for 100,784 mentions that were classified as drug abuse cases, and opioid pain relievers accounted for more than 119,000 ED mentions. From 1994 to 2002, ED mentions of hydrocodone and oxycodone increased by 170 percent and 450 percent, respectively. While ED visits attributed to drug addiction and drug-taking for psychoactive effects have been increasing, intentional overdose visits have remained stable since 1995.

Persons 65 years of age and above comprise only 13 percent of the population, yet account for approximately one-third of all medications prescribed in the United States. Older patients are more likely to be prescribed long-term and multiple prescriptions, which could lead to unintentional misuse.

The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. In addition to prescription medications, a large percentage of older adults also use OTC medicines and dietary supplements. Because of their high rates of comorbid illnesses, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse and misuse can have more adverse health consequences among the elderly than are likely to be seen in a younger population. Elderly persons who take benzodiazepines are at increased risk for cognitive impairment associated with benzodiazepine use, leading to possible falls (causing hip and thigh fractures), as well as vehicle accidents. However, cognitive impairment may be reversible once the drug is discontinued.

Data from the 2003 NSDUH indicate that 4.0 percent of youth ages 12 to 17 reported nonmedical use of prescription medications in the past month. Rates of abuse were highest among the 18-25 age group (6.0 percent). Among the youngest group surveyed, ages 12-13, a higher percentage reported using psychotherapeutics (1.8 percent) than marijuana (1.0 percent).

The NIDA Monitoring the Future survey of 8th-, 10th-, and 12th-graders found that the nonmedical use of opioids, tranquilizers, sedatives/barbiturates, and amphetamines was unchanged between 2003 and 2004. Specifically, the survey found that 5.0 percent of 12th-graders reported using OxyContin without a prescription in the past year, and 9.3 percent reported using Vicodin, making Vicodin one of the most commonly abused licit drugs in this population. Past year, nonmedical use of tranquilizers (e.g., Valium, Xanax) in 2004 was 2.5 percent for 8th-graders, 5.1 percent for 10th-graders, and 7.3 percent for 12th-graders. Also within the past year, 6.5 percent of 12th-graders used sedatives/ barbiturates (e.g., Amytal, Nembutal) nonmedically, and 10.0 percent used amphetamines (e.g., Ritalin, Benzedrine).

Youth who use other drugs are more likely to abuse prescription medications. According to the 2001 National Household Survey on Drug Abuse (now the NSDUH), 63 percent of youth who had used prescription drugs nonmedically in the past year had also used marijuana in the past year, compared with 17 percent of youth who had not used prescription drugs nonmedically in the past year.

Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and antianxiety drugs—in some cases, 55 percent more likely.

Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12- to 17-year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines).