The "Who" Behind Pharmaceutical Misuse and Abuse - Understanding Prescription Drug Abusers

1. The “Who” Behind Pharmaceutical Misuse and Abuse – What We Know About Pharmaceutical Abusers Linda Simoni-Wastila, PhD Associate Professor University of Maryland Baltimore School of Pharmacy Acknowledgements: Jerry Lawler, PhD Research Associate University of Maryland Baltimore School of Pharmacy Ashley Slagle, MS Doctoral Candidate and Graduate Research Assistant University of Maryland Baltimore School of Pharmacy National Institute of Drug Abuse (NIDA grant DA R21 DA017730) Montgomery County Public School’s Safe and Drug-Free Schools 2005 Symposium June 20, 2005

2. Purpose of this Presentation • Describe non-medical use and abuse/dependency of prescription drugs • Examine national prevalence of use in adolescents aged 12-17 • Briefly describe patterns of prescription drug use and abuse/misuse • Examine some factors associated with prescription drug use and abuse/dependency • Conclude with some considerations for prevention strategies

3. Some Definitions and Context • Much of the information presented here is based on a nationally-representative database called the National Survey on Drug Use and Health (NSDUH) conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA)

4. Some Definitions and Context • Today’s focus is on prescription drugs that have addiction potential. Four types: • Opioid Analgesics(OxyContin; Dilaudid; morphine; Demerol; Percodan/Percocet) • Minor Tranquilizers(Valium; Halcion; Ativan) • Sedative-Hypnotics(Seconal; Amytal) • Stimulants(Ritalin; Dexedrine)

5. Some Definitions and Context • Non-Medical Use = use that is not medically-mandated, i.e. sharing of medications, using just to get high, recreational use, any use other than prescribed

6. Some Definitions and Context • Abuse = use resulting in • Decline in work, school, or home performance • Legal problems • Use in risky situations • Continued use despite social/personal consequences (APA, DSM-IV, 1994)

7. Some Definitions and Context • Dependency = use resulting in • Tolerance • Withdrawal symptoms • Decline in normal activities • Unsuccessful attempts to cut down or control use • Use for longer period or larger amounts than intended • Use consumes lot of time to acquire and/or recover from effects • Continued use despite knowledge that it caused physical and/or psychological problems (APA, DSM-IV, 1994)

8. Who is Using Prescription Medications?

9. Scope of the Problem • Substance use and resultant disorders have always been problems with youth • Recent evidence suggests that use of most substances, including alcohol, have been declining among adolescents • However, non-medical prescription drug use (NMPDU) has been increasing

10. Scope of the Problem • Q: Who is using prescription drugs in a non-medical context? • A: EVERYONE!!!!!! • 6.3% - 14.8 Million - of US population ≥ 12 years of age reported at least 1 episode of non-medical prescription drug use in past-year (2002 NSDUH) • Three age groups at particular risk: • Older folks (50 and older) • Young adults aged 18 – 25 • Younger folks aged 12 – 17☺

11. Percent of Adolescents Reporting Any Past-Year Non-Medical Prescription Drug Use

12. Percent of Adolescents Meeting Clinical Criteria for Prescription Drug Abuse or Dependency Among Those Reporting Past-Year Non-Medical Use

13. The Real Numbers • 2.33 million children aged 12-17 used at least 1 prescription drug in a non-medical context in 2003 • 1.9 M  Opioid analgesics • 600,000  Tranquilizers and/or sedatives • 575,000  Stimulants • Of these past-year users, more than 350,000 meet clinical criteria for abuse and/or dependency on prescription drugs

14. Patterns of NMPDU • Among past-year NMPD users, 38.3% of adolescents only reported NMPDU and no other substance use (Simoni-Wastila et al, 2005) • Odds of binge drinking, marijuana use, and other illicit substance use are higher among NMPD users versus those who only medically use Rx drugs or who have no prescription drug exposure (Boyd et al, 2005)

15. Prevalence of NMPDU Use (2002 NSDUH) Simoni-Wastila et al, 2005

16. Prevalence of Poly-NMPDU (2002 NSDUH) Simoni-Wastila et al, 2005

17. Factors Associated with NMPDU • Sociodemographics: gender; age; race/ethnicity • Medical exposure • Family and peer usage/availability • Socio-cultural (Quintero et al., 2005): • Stress • Academic demands • Social-recreational • Less risky than “hard” substances

18. Percent of Males and Female Adolescents Reporting Any Past-Year Non-Medical Prescription Drug Use MalesFemales

19. Percent of Males and Females Meeting Clinical Criteria for Prescription Drug Abuse or Dependency Among Those Reporting Past-Year Non-Medical Use MalesFemales

20. Source of Prescription Medications • Peers and family (McCabe et al, 2005) • Males obtain from peers; females from family • Medical exposure (McCabe et al, 2005) • Females more likely than males to report prior lifetime medical use of opioids • Internet? • Other sources? • Do risk factors vary by source? • Do use patterns vary by source?

21. Medical versus Non-Medical Use • To prevent problematic use of prescription drugs with addiction potential, we need policies and strategies that limit abuse and diversion without needlessly limiting appropriate and adequate medical access and use.

22. A Few Questions Research Must Ask – and Answer – for Effective Prevention • Patterns of Use? • Are prescription medications a DOC, or are they used with other substances? Why do young people favor prescription drugs? • Risk and Protective Factors? • How do risk and protective factors differ in NMPDU-only versus poly-substance use? By gender? By race/ethnicity and other factors? • Sources of Prescription Medications? • Where and how are adolescents obtaining prescription drugs? • Medical versus Non-Medical Use? • What is the balance?