1. Cheryl Currie, Don Schopflocher, Cam Wild University of Alberta AGRI Conference Banff AB, April 9, 2010

2.  Prescription drug misuse in context  Study background  Prevalence and predictors of PDM  Associations between PDM and gambling Currie, Schopflocher, Wild. Prevalence and correlates of prescription drug misuse in Alberta [under review]

3.  Recent increases in the production and use of psychoactive prescription drugs in North America  Growing concerns about prescription drug misuse  USA – 15 million people misused prescriptions in 2008  2 nd most abused category of psychoactive drugs after cannabis

5.  Most abused prescriptions are those most potent and most available on the licit market  Canada is the world’s top per capita consumer of several high-potency opioids (hydromorphone)  3 rd heaviest consumers of psychoactive prescriptions in the world  Yet to date, little epidemiological information is available about the misuse of psychoactive prescription drugs in this country, despite calls for action

7. Research Questions 1. What was the prevalence of 12-month PDM among adults in Alberta in 2002? 2. What socio-demographic variables and addictive behaviours are associated with PDM?

8.  Telephone survey of 3,511 adults in Alberta  Survey length – 15 minutes  Collected in 2002  Response rate was 57.4%  Data weighted - Alberta 2001 census data

9. 4 prescription drug misuse questions based on the following definition: - Use in larger amounts than prescribed, for a longer period than prescribed, or use on your own without a physician’s prescription. In the past 12 months, did you misuse: 1. prescription pain killers (e.g., Demerol, Codeine) 2. prescription sedatives (e.g., Seconal, Halcion) 3. prescription tranquilizers (e.g., Librium, Valium) 4. prescription amphetamines (e.g., Preludin, Ritalin)

10.  Prevalence of past year PDM was 8.2%  Prescription pain relievers – 4.9%  Sedatives/tranquilizers – 3.2%  Stimulants – 0.8%  Disabled status was the strongest overall predictor of past-year prescription drug misuse – Disabled adults were 4x more likely to misuse prescriptions than other adults.  Adult students also at greater risk.

11. Addictive Behaviour Alcohol Alcohol use ≥ Monthly binge drinking Alcohol dependent Illicit drugs Cannabis use Cocaine/crack user Hallucinogen user Smoking Casual smoker Daily smoker Gambling Current gambler At-risk gambler Problem gambler Prevalence 83.0% 14.4% 3.2% 12.1% 1.7% 1.9% 5.8% 21.7% 64.9% 6.2% 4.7%

12. Addictive Behaviour Alcohol Alcohol use Binge drinker Alcohol dependent Illicit drugs Cannabis user Cocaine/crack user Hallucinogen user Smoking Casual smoker Daily smoker Gambling At-risk gambler Problem gambler Adjusted OR (95% CI) 1.8 (1.2 - 2.9) ns 2.2 (1.3 - 3.7) 2.0 (1.4 - 2.9) 2.7 (1.4 - 5.2) 1.9 (1.1 - 3.6) ns 1.5 (0.9 - 2.4) 2.9 (1.9 - 4.5)

14. Stimulants Sedatives/tranquilizers Pain killers

15. At-Risk & Problem Gamblers (n = 381) 12-Month PDM Prevalence Overall16.3% Gender Males16.4% Females16.1% Age – yrs 18 – 24 24.4%* 25+14.3% Marital status Never married20.3% Married12.7% Divorced/widowed14.6% *p =.03

16. At-Risk & Problem Gamblers (n = 381) 12-Month PDM Prevalence Occupational status Employed full/part time 15.5% Student 20.0% Disabled 36.4% Education Some high school 11.1% High school diploma 17.4% Some university 22.2% University degree 14.4%

17.  Problem gamblers may be misusing prescriptions to:  Cope with gambling losses  Deal with gambling urges  Stay awake while gambling  Reverse may be true  Individuals may engage in both PDM and gambling to escape other life stressors  Confounding by unmeasured factors

18.  Small sample size – further research is needed  Cross sectional study – temporal sequence unknown  No information on motives for PDM among gamblers or prescription drug use  Full CPGI not used – types of gambling favoured by PDMs unknown

19.  Prescription drug misuse was an important public health concern in Alberta in 2002  At that time, Canada was 4 th highest per-capita consumer of prescription narcotics in the world  2009, Canada 3 rd highest per-capita user  There is an urgent need for an ongoing assessment of this evolving phenomenon

20.  This study was the first to examine associations between problem gambling and PDM in a population-based sample.  The prevalence of PDM among problem gamblers was 21.5%.  Further research is needed to shed more light on motives for PDM among problem gamblers.