Prevalence and Patterns of Nonmedical Use of OxyContin ® and Other Pain Relievers Joe Gfroerer...

Prevalence and Patterns of Nonmedical Use of

OxyContin® and Other Pain Relievers

Joe Gfroerer

Office of Applied Studies

Substance Abuse and Mental Health Services Administration

Anesthetic and Life Support Drugs and Drug Safety and Risk Management

Advisory Committees

May 5, 2008

2

National Survey on Drug Use and Health (NSDUH)

• Representative nationally and in each State

• Civilian, noninstitutional population, age 12+

• Face-to-face interview, 1 hour

• Computer-assisted, mainly self-administered

• 67,500 respondents each year

• Survey changed in 1999 and in 2002, creating breaks in trend

• Response rates (2006): – 91% of Households selected

– 74% of Persons selected within households (85% for youth, 73% for adults)

3

NSDUH Data on Illicit Drug Use

Illicit drug use: Use of an illicit drug , or nonmedical use of prescription drugs; For each drug:

• Recency of use

– Lifetime, Past year, Past month

• Frequency of use

• Date of first use

– Incidence/First time use within past year

• Dependence and abuse

– Based on DSM-IV criteria

• Received treatment in past year for problem with drug

4

Nonmedical Prescription Drug Use: NSDUH Definition

“Not prescribed for you”

OR

“You took the drug only for the experience

or feeling it caused”

(Excludes OTC)

5

Prescription Drug Questioning Strategy

• Primary focus is on therapeutic classes (TCs):– Pain Relievers, Tranquilizers, Stimulants, Sedatives

• Specific pharmaceuticals asked for each TC:– Lifetime use only (except OxyContin® and

methamphetamine)

– Includes mix of brand-name and generic drugs

– Done mainly to help respondents understand the TC

– “Pill cards” show specific pharmaceuticals

– “Any other drug” in the TC collected as write-in(s)

6

Drug groups above the red line are asked separately

Drug groups below the red line are asked in tandem with followup to identify which one(s)

Any other drugs in TC are specified by write-in.

“PILL CARDS”

7

Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2006

1.1

1.6

2.5

2.5

4.1

6.8

7.4

11.5

19.5

19.6

0.0 5.0 10.0 15.0 20.0 25.0

Ultram®

Methadone

Morphine

Demerol®

OxyContin®

Codeine

Hydrocodone

Percocet®, Percodan®, or Tylox®

Darvocet®, Darvon®, or Tylenol® with Codeine

Vicodin®, Lortab®, or Lorcet®

Numbers (in Millions)

Nonmedical Pain Reliever Use:

Trends and Patterns

9

Nonmedical Pain Reliever Use, Age 12 or Older: 2002 and 2006

33.5

12.6

5.2

29.6

11.0

4.4

0

5

10

15

20

25

30

35

40 2002 2006

(12.6%)

(1.9%)

(4.7%)

Numbers (in Millions)

Lifetime Use

Past Month Use

Past Year Use

(13.6%)

(5.1%)

(2.1%)

Note: Differences between 2002 and 2006 are statistically significant for lifetime, past year, and past month use.

10

1509

360

1635

547

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800Number in Thousands

20022006

Received Treatment for Pain Reliever Problem During Last Treatment Visit,

within Past Year

Past Year Nonmedical Pain Reliever Dependence or Abuse

Past Year Pain Reliever Dependence or Abuse and Treatment, Age 12+: 2002 and 2006

+

+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

11

Past Year Nonmedical Use of Pain Relievers, by Age: 2002 and 2006

Percent Used in Past Year

7.6

11.4

6.1

2.4

7.2

12.4

7.4

2.7

0

5

10

15

20

12 to 17 18 to 25 26 to 34 35 and older

2002 2006


+

+

12

Lifetime Nonmedical Use of Selected Pain Relievers, Ages 18-25: 2002 and 2006

Percent Ever Used

12.2

7.4

13.3

6.15

2.6

12.3

8.8

18.0

6.17.8

5.1

0

5

10

15

20

Codeine Hydrocodone OxyContin®

2002 2006


+

+

+

+

Darvocet, Darvon, or Tylenol w/Codeine

Percocet, Percodan, or Tylox

Vicodin, Lortab, or Lorcet

13

Lifetime Nonmedical Use of Selected Pain Relievers, Ages 26-34: 2002 and 2006

Percent Ever Used

10.5

5.5

8.9

3.6 2.81

11.7

7.8

14.7

4.25.6

2.7

0

5

10

15

20

Codeine Hydrocodone OxyContin®

2002 2006


+

+

+

+

Darvocet, Darvon, or Tylenol w/Codeine

Percocet, Percodan, or Tylox

Vicodin, Lortab, or Lorcet

14

Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages,

Annual Averages Based on 2002-2004

15

Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past

Year Users Aged 12 or Older: 2006

Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown.1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s

Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

Bought/Took from Friend/Relative

14.8%

Drug Dealer/Stranger

3.9%

Bought on Internet

0.1% Other 1

4.9%

Free from Friend/Relative

7.3%

Bought/Took fromFriend/Relative

4.9%

OneDoctor80.7%


1.6%Other 1

2.2%

Source Where Respondent Obtained

Source Where Friend/Relative Obtained

One Doctor19.1%

More than One Doctor

1.6%


55.7%

More than One Doctor3.3%

16

Sources of Rx Pain Relievers among Persons Who Used Pain Relievers Nonmedically in the

Past Year: Combined 2005 and 2006

Percent among Past Year Users

4.5

0.4

1.6

4.8

4.1

18.0

8.8

57.7

5.1

1.7

4.0

4.6

8.7

27.1

14.3

34.6

0 10 20 30 40 50 60 70

Frequent Users(100+ days)All Users


Prescriptions from 1 Doctor

Bought from Friend/relative


Took from Friend/relative

Prescription from 2+ Doctors

Internet

Other

Pain Reliever and OxyContin® Initiates

18

Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older:

2006Numbers in Thousands

2,1502,063

1,112977

860 845 783

533

267 26491

0

500

1,000

1,500

2,000

2,500

Marijuana LSD

Pain Relievers

Cocaine

SedativesTranquilizers HeroinInhalantsEcstasy

Stimulants OxyContin®

19

Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates

Aged 12 to 49: 2006Age in Years

15.717.4

19.4 20.3 20.6 20.721.9 22.6 23.0 24.0

26.5

0

5

10

15

20

25

30

Marijuana

StimulantsPain Relievers

Heroin

LSD

TranquilizersCocaine

EcstasyInhalants

OxyContin®

Sedatives

20

Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates, Age 12 or Older : Annual Averages, 2004-2006

32

68

19

28

10

10

20

30

40

50

60

70

80

90

100

Percent of New Pain Reliever Users

Tranqs, Seds, or Stims

Nonmedically

HallucinogensCocaineMarijuana Heroin

21

Lifetime Use of Other Drugs among Past Year Nonmedical OxyContin® Initiates,

Age 12 or Older : Annual Averages, 2004-2006

70

95

66 65

12

0

10

20

30

40

50

60

70

80

90

100

Percent of New OxyContin® Users

Tranqs, Seds, or Stims

Nonmedically

HallucinogensCocaineMarijuana Heroin

22

Lifetime Nonmedical Use of Other Pain Relievers among Past Year Nonmedical OxyContin® Initiates, Age 12 or

Older: Annual Averages, 2004-2006

17.4

18.0

21.0

48.4

51.2

55.5

58.2

79.2

0.0 20.0 40.0 60.0 80.0 100.0

Demeral

Methadone

Morphine

Codeine

Hydrocodone

Percent

Darvocet®, Darvon®, or Tylenol® with Codeine

Vicodin®, Lortab®, or Lorcet®

Percocet®, Percodan®, or Tylox®

®

Nonmedical OxyContin® Use:

Trends and Patterns

24

Trends in Past Year Indicators of Nonmedical Use of OxyContin®, Ages 12

and Older: 2004 to 2006Number in Thousands


615

1213

351

526

1226

387

533

1323

330

0

200

400

600

800

1000

1200

1400

Past Year Initiates Past Year Users Past Year Users withDep/Ab

2004

2005

2006

25

0.76

0.23

1.74

0.520.62

0.14

0.32

0.120.080.01

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Percent

Past Year OxyContin® Use

Aged 12-17Aged 18-25Aged 26-34Aged 35-49Aged 50 or Older

Past Year Pain Reliever Dependence or Abuse, with OxyContin® Use

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Age Group: Annual Averages, 2004-2006

26

0.64

0.16

0.40

0.13

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Percent

MaleFemale

Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

Past Year Nonmedical OxyContin® Use

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Gender, Age

12+: Annual Averages 2004-2006

27

0.67

0.20

0.090.02

0.09

0.01

0.23

0.04

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

White

Black

Asian

Hispanic

Percent

Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

Past Year Nonmedical OxyContin® Use

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Race/Ethnicity,

Age 12+: Annual Averages, 2004-2006

28

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by County

Type, Age 12+: Annual Averages, 2004-2006

0.43

0.11

0.63

0.18

0.59

0.23

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Percent

Large MetroSmall MetroNonmetro

Past Year Pain Reliever Dependence or Abuse with Nonmedical OxyContin® Use

Past Year OxyContin® Use

29

OxyContin® Use in Lifetime among Persons Aged 12 or Older, by State: Percentages,

Annual Averages Based on 2002-2006 NSDUHs

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002-2006.

30

Past Year Use of Selected Illicit Drugs among Past Year Nonmedical Pain Reliever Users and Nonusers Aged 12 and

Older: Annual Averages, 2004-2006

75.7

47.7

35.9

12.1

46.1

17.513.2

1.2

8.51.4 0.9 0.1

0

10

20

30

40

50

60

70

80

90 Used OxyContinUsed Pain Relievers, not OxyContinNo Pain Reliever Misuse

Percent Using in Past Year

Marijuana Cocaine Hallucinogens Heroin

31

Dependence and Abuse Among Past Year Users of Selected Substances, Ages 12+: Annual

Averages, 2004-2006

510

20

10 84

9

237

7

8

6

5

4

5

4

0

10

20

30

40

Abuse

Dependence

Percentage of Past Year Users

12

1714

28

14

913

28

Note: Percentages refer to dependence/abuse for each drug among past year users of that drug, except for OxyContin, which reflects pain reliever dependence/abuse among past year OxyContin users.

Prevalence and Patterns of Nonmedical Use of OxyContin ® and Other Pain Relievers Joe Gfroerer...

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