2002.


What is the scope of prescription drug misuse?


Misuse of prescription opioids, central


nervous system (CNS) depressants, and stimulants is a serious public health prob- lem in the United States. Although most people take prescription medications re- sponsibly, an estimated 54 million people (more than 20 percent of those aged 12 and older) have used such medications for nonmedical reasons at least once in their lifetime. According to results from the 2014 National Survey on Drug Use and Health, an estimated 2.1 million Ameri- cans used prescription drugs nonmedi- cally for the first time within the past year, which averages to approximately 5,750 initiates per day. Fifty-four percent were females and about 30 percent were ado- lescents. The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely in- clude ease of access. The number of pre- scriptions for some of these medications has increased dramatically since the early 1990s. Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescrip- tion drugs are less harmful than illicit drugs are other possible contributors to the problem.


Although misuse of prescription drugs


affects many Americans, certain popula- tions such as youth, older adults, and women may be at particular risk. In addi- tion, while more men than women cur- rently misuse prescription drugs, the rates of misuse and overdose among women are increasing faster than among men.


Adolescents and Young Adults Nonmedical use of prescription drugs


is highest among young adults aged 18 to 25, with 4.4 percent reporting nonmedical use in the past month. Among youth aged 12 to 17, 2.6 percent reported past-month nonmedical use of prescription medica- tions.


After alcohol, marijuana, and tobac-


co, prescription drugs (taken nonmedi- cally) are among the most commonly used drugs by 12th graders. The NIDA’s Monitor- ing the Future survey of substance use and attitudes in teens found that about 1 in 13 high school seniors reported past-year nonmedical use of the prescription stimu- lant Adderall® in 2015, and nearly 1 in 23 reported misusing the opioid pain reliever Vicodin®.


Although past-year nonmedical use of CNS depressants and opioid pain relievers decreased among 12th graders between 2011 and 2015, this is not the case for the nonmedical use of stimulants. Nonmedical use of Adderall® increased between 2009 and 2013 and has remained elevated. When asked how they obtained prescrip- tion stimulants for nonmedical use, more than half of the adolescents and young adults surveyed said they either bought or received the drugs from a friend or relative. Interestingly, the number who purchased these drugs through the internet was neg- ligible. Youth who misuse prescription medi- cations are also more likely to report use of other drugs. Multiple studies have re- vealed 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. In the case of pre- scription opioids, medical use is also as- sociated with a greater risk of future opioid misuse, particularly in adolescents who disapprove of illegal drug use and have


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little to no history of drug use. Older Adults


More than 80 percent of older patients


(aged 57 to 85 years) use at least one pre- scription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily. This can potentially lead to health issues result- ing from unintentionally using a prescrip- tion 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 makes medication (and other substance) misuse more dangerous in older people than in younger populations. Further, a large percentage of older adults also use over-the-counter medicines and dietary supplements, which (in addition to alcohol) could compound any adverse health consequences resulting from non- medical use of prescription drugs.


Women Overall, more males than females misuse prescription drugs in all age groups except adolescence (12 to 17 years); ado- lescent girls exceed boys in the nonmedi- cal use of all prescription drugs, including pain relievers, sedatives, and stimulants. Among nonmedical users of prescription drugs, females 12 to 17 years old are also more likely to meet substance use disorder criteria for prescription drugs. Addition- ally, while more men than women die of prescription opioid overdose, the rate of overdose is increasing more sharply in women than in men.


How many people suffer adverse health consequences from misuse of prescription drugs? The Drug Abuse Warning Network


(DAWN) monitored emergency depart- ment (ED) visits in selected areas across the nation through 2011. DAWN reported that more than 1.2 million ED visits in 2011 could be attributed to nonmedical use of prescription drugs; this represents about half (50.5 percent) of all ED visits related to drug misuse. Roughly 488,000, or 39.2 percent, of these ED visits involved prescription opioid pain relievers, a rate nearly triple that of 6 years prior. ED visits also more than quadrupled for central nervous system (CNS) stimulants to nearly 41,000 visits in 2011 and increased 138


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