An Epidemiologic Overview of Prescription Drug Misuse Howard D. Chilcoat Tracy Dusablon Department of Mental Hygiene Johns Hopkins University School of Hygiene and Public Health

Extramedical Use Used drug when it was not prescribed for you, or that you took only for the experience or feeling that it caused

Classes of drugs l Analgesics (e.g., Codiene) l Tranquilizers (e.g., Valium) l Sedatives (e.g., Seconal) l Stimulants (e.g., amphetamines)

Data Sources l National Household Survey on Drug Abuse (NHSDA), 1985 – 1998 (Age 12+, n = 5,000 – 20,000+) l National Comorbidity Study (NCS) Diagnostic criteria for major psychiatric disorders (DSM-IIIR) (Age 15 – 54, n = 8,098)

Reported Lifetime and Past Year Use of Prescription Drugs, NHSDA 1998

Past Year Use of Prescription Drugs by Sex, NHSDA, 1998

Reported Use of Analgesics in Past Year (By Sex)

Reported Use of Tranquilizers in Past Year (By Sex)

Reported Use of Sedatives in Past Year (By Sex)

Reported Use of Stimulants in Past Year (By Sex)

Reported Use of Analgesics in Past Year (Male)

Reported Use of Analgesics in Past Year (Female)

Reported Past Year Use of Prescription Drugs, Ages 60+

Prevalence of Extramedical Analgesic Use in the Past Year (1998)

Prevalence of Extramedical Tranquilizer Use in the Past Year (1998)

Prevalence of Extramedical Sedative Use in the Past Year (1998)

Prevalence of Extramedical Stimulants in the Past Year (1998)

Prevalence of Extramedical Analgesic Use in the Past Year

Age Incidence Males Females Cumulative Incidence of Analgesic Use

Age Incidence Males Females Cumulative Incidence of Tranquilizer Use

Age Incidence Males Females Cumulative Incidence of Sedative Use

Age Incidence Males Females Cumulative Incidence of Stimulant Use

Lifetime Prevalence of Extramedical Analgesic Use AnalgesicPercent Codeine2.05 Darvon0.58 Demerol0.77 Morphine0.57 Percodan0.89 Tylenol w/Codeine2.74

Lifetime Prevalence of Extramedical Analgesic Use by Sex Sex Analgesic % Male% Female Codeine Darvon Demerol Morphine Percodan Tylenol w/Codeine

Lifetime Prevalence of Extramedical Analgesic Use by Age Group Age Group Analgesic % % % 35+ % Codeine Darvon Demerol Morphine Percodan Tylenol w/Codeine

Lifetime Prevalence of Extramedical Analgesic Use by Race Race Analgesic White % Black % Hispanic % Other % Codeine Darvon Demerol Morphine Percodan Tylenol w/Codeine

Lifetime Prevalence of Extramedical Analgesic Use by Family Income Analgesic Family Income Category <$20,000 % $20,000 to $49,000 % $50,000 + % Codeine Darvon Demerol Morphine Percodan Tylenol w/Codeine

Prevalence of Extramedical Analgesic Use, Recent Users ( 2 Years or Less) AnalgesicPercent Codeine31.48 Darvon 1.94 Demerol10.90 Morphine 7.75 Percodan 6.05 Tylenol w/Codeine41.65

Reported Lifetime and Past Year Dependence of Prescription Drugs, NCS

Past Year Dependence of Prescription Drugs by Sex, NCS

Rx Drug Dependence : Lifetime Comorbidity with Psychiatric Disorders

Cocaine Dependence: Lifetime Comorbidity with Psychiatric Disorders

Extramedical Analgesic Dependence : Lifetime Comorbidity with Psychiatric Disorders

Cumulative Probability of Analgesic Dependence

Odds Ratios & 95% CI for Analgesic Dependence, Given Use Separate model for each psychiatric disorder Model containing Conduct Disorder and Depression OR*95% CIOR*95% CI Female – – 2.79 Conduct Disorder – – 5.62 Antisocial Personality – 9.83 Depression – – 2.64 * Adjusted for age, race, education

Testing Causal Pathways between PTSD and Substance Use Disorders Howard D. Chilcoat Naomi Breslau Archives of General Psychiatry 1998

Traumatic Event PTSD Drug A/D Potential Pathways

PTSD Rx Drug A/D Potential Pathways Relative Risk = 16.9

Prevalence of Drug A/D by lifetime history of PTSD

Relative hazards (95% CI) of specified drug use disorder by prior exposure to traumatic events and PTSD All estimates adjusted for sex, race, and education Reference category = never exposed to traumatic event

Findings l Prevalence (past year) of use of Rx drugs is comparable to that of cocaine – analgesics most commonly misused l Ages 18 – 25 years highest period of risk for use and onset of Rx drugs and analgesics l Girls years old might be particularly vulnerable l Relative to other drugs, sex differences are small, emerge after age 20 years l Whites and higher income more likely to use Rx drugs (analgesics) than other race/ethinicities

Findings (cont’d) High level of comorbidity with other psychiatric disorders Strong relationship with antisocial personality disorder, cocaine dependence Lifetime prevalence of Rx drug dependence similar to that for cocaine

Future Research Directions l Epidemiology of Rx drug misuse remains relatively unexplored l Focus on Rx drug use by girls and young women l Rx misuse in the elderly l Causal relationships between RX drug misuse and other psychiatric disorders