The “Who” Behind Pharmaceutical The “Who” Behind Pharmaceutical Misuse and Abuse – What We Misuse and Abuse – What We Know About Pharmaceutical Know About Pharmaceutical

AbusersAbusersLinda Simoni-Wastila, PhDLinda Simoni-Wastila, PhDAssociate ProfessorAssociate ProfessorUniversity of Maryland Baltimore School of PharmacyUniversity of Maryland Baltimore School of Pharmacy

Acknowledgements:Acknowledgements:

Jerry Lawler, PhDJerry Lawler, PhDResearch AssociateResearch AssociateUniversity of Maryland Baltimore School of PharmacyUniversity of Maryland Baltimore School of Pharmacy

Ashley Slagle, MSAshley Slagle, MSDoctoral Candidate and Graduate Research AssistantDoctoral Candidate and Graduate Research AssistantUniversity of Maryland Baltimore School of PharmacyUniversity of Maryland Baltimore School of Pharmacy

National Institute of Drug Abuse (NIDA grant DA R21 DA017730)National Institute of Drug Abuse (NIDA grant DA R21 DA017730)

Montgomery County Public School’s Safe and Drug-Free SchoolsMontgomery County Public School’s Safe and Drug-Free Schools2005 Symposium2005 Symposium

June 20, 2005June 20, 2005

Purpose of this PresentationPurpose of this Presentation

Describe non-medical use and Describe non-medical use and abuse/dependency of prescription drugsabuse/dependency of prescription drugsExamine national prevalence of use in Examine national prevalence of use in adolescents aged 12-17adolescents aged 12-17Briefly describe patterns of prescription drug use Briefly describe patterns of prescription drug use and abuse/misuseand abuse/misuseExamine some factors associated with Examine some factors associated with prescription drug use and abuse/dependencyprescription drug use and abuse/dependencyConclude with some considerations for Conclude with some considerations for prevention strategiesprevention strategies

Some Definitions and ContextSome Definitions and Context

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

Some Definitions and ContextSome Definitions and Context

Today’s focus is on prescription drugs that Today’s focus is on prescription drugs that have addiction potential. Four types:have addiction potential. Four types:– Opioid AnalgesicsOpioid Analgesics (OxyContin; Dilaudid; morphine; (OxyContin; Dilaudid; morphine;

Demerol; Percodan/Percocet)Demerol; Percodan/Percocet)

– Minor TranquilizersMinor Tranquilizers (Valium; Halcion; Ativan)(Valium; Halcion; Ativan)

– Sedative-HypnoticsSedative-Hypnotics (Seconal; Amytal)(Seconal; Amytal)

– StimulantsStimulants (Ritalin; Dexedrine)(Ritalin; Dexedrine)

Some Definitions and ContextSome Definitions and Context

Non-Medical UseNon-Medical Use = use that is not = use that is not medically-mandated, i.e. sharing of medically-mandated, i.e. sharing of medications, using just to get high, medications, using just to get high, recreational use, any use other than recreational use, any use other than prescribedprescribed

Some Definitions and ContextSome Definitions and Context

AbuseAbuse = use resulting in = use resulting in– Decline in work, school, or home Decline in work, school, or home

performanceperformance

– Legal problemsLegal problems

– Use in risky situationsUse in risky situations– Continued use despite social/personal Continued use despite social/personal

consequences consequences (APA, DSM-IV, 1994)(APA, DSM-IV, 1994)

Some Definitions and ContextSome Definitions and Context

DependencyDependency = use resulting in = use resulting in – ToleranceTolerance– Withdrawal symptomsWithdrawal symptoms– Decline in normal activitiesDecline in normal activities– Unsuccessful attempts to cut down or control useUnsuccessful attempts to cut down or control use– Use for longer period or larger amounts than Use for longer period or larger amounts than

intendedintended– Use consumes lot of time to acquire and/or recover Use consumes lot of time to acquire and/or recover

from effectsfrom effects– Continued use despite knowledge that it caused Continued use despite knowledge that it caused

physical and/or psychological problems physical and/or psychological problems (APA, DSM-IV, (APA, DSM-IV, 1994)1994)

Who is Using Prescription Medications?

Scope of the ProblemScope of the Problem

Substance use and resultant disorders Substance use and resultant disorders have always been problems with youth have always been problems with youth

Recent evidence suggests that use of Recent evidence suggests that use of most substances, including alcohol, have most substances, including alcohol, have been declining among adolescentsbeen declining among adolescents

However, non-medical prescription drug However, non-medical prescription drug use (NMPDU) has been increasinguse (NMPDU) has been increasing

Scope of the ProblemScope of the Problem

Q:Q: Who is using prescription drugs in a non- Who is using prescription drugs in a non-medical context? medical context?

A:A: EVERYONE!!!!!! EVERYONE!!!!!!– 6.3% - 14.8 Million - of US population 6.3% - 14.8 Million - of US population ≥≥ 12 years of 12 years of

age reported at least 1 episode of non-medical age reported at least 1 episode of non-medical prescription drug use in past-year (2002 NSDUH)prescription drug use in past-year (2002 NSDUH)

– Three age groups at particular risk:Three age groups at particular risk:Older folks (50 and older)Older folks (50 and older)

Young adults aged 18 – 25Young adults aged 18 – 25

Younger folks aged 12 – 17Younger folks aged 12 – 17☺☺

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

9.3

7.8

2.3

0.5

2.3

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Any Rx Drug Analgesics Tranquilizers Sedatives Stimulants

Percent of Adolescents Meeting Clinical Percent of Adolescents Meeting Clinical Criteria for Prescription Drug Abuse or Criteria for Prescription Drug Abuse or

Dependency Among Those Reporting Past-Dependency Among Those Reporting Past-Year Non-Medical Use Year Non-Medical Use

15.214.0

16.3

30.3

16.1

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Any Rx Drug Analgesics Tranquilizers Sedatives Stimulants

The Real NumbersThe Real Numbers

2.33 million children aged 12-17 used at 2.33 million children aged 12-17 used at least 1 prescription drug in a non-medical least 1 prescription drug in a non-medical context in 2003context in 2003– 1.9 M 1.9 M Opioid analgesics Opioid analgesics– 600,000 600,000 Tranquilizers and/or sedatives Tranquilizers and/or sedatives– 575,000 575,000 Stimulants Stimulants

Of these past-year users, more than Of these past-year users, more than 350,000 meet clinical criteria for abuse 350,000 meet clinical criteria for abuse and/or dependency on prescription drugsand/or dependency on prescription drugs

Patterns of NMPDUPatterns of NMPDU

Among past-year NMPD users, 38.3% of Among past-year NMPD users, 38.3% of adolescents only reported NMPDU and no adolescents only reported NMPDU and no other substance use other substance use (Simoni-Wastila et al, 2005)(Simoni-Wastila et al, 2005)

Odds of binge drinking, marijuana use, Odds of binge drinking, marijuana use, and other illicit substance use are higher and other illicit substance use are higher among NMPD users versus those who among NMPD users versus those who only medically use Rx drugs or who have only medically use Rx drugs or who have no prescription drug exposure no prescription drug exposure (Boyd et al, 2005)(Boyd et al, 2005)

Prevalence of NMPDU Use Prevalence of NMPDU Use (2002 NSDUH)(2002 NSDUH)

86.5

64.5

4.3

21.2

5.64.0 3.6

10.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

No Drug Use No NMPDU but Other Ilicit NMPDU-only NMPDU + Other Illicit

Adolescents Young Adults Simoni-Wastila et al, 2005

Prevalence of Poly-NMPDU Prevalence of Poly-NMPDU (2002 NSDUH)(2002 NSDUH)

69.266.5

21.824.5

9.0 9.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1 Rx Class 2 Rx Classes 3+ Rx Classes

Adolescents Young Adults

Simoni-Wastila et al, 2005

Factors Associated with NMPDUFactors Associated with NMPDU

Sociodemographics: gender; age; Sociodemographics: gender; age; race/ethnicityrace/ethnicityMedical exposureMedical exposureFamily and peer usage/availabilityFamily and peer usage/availabilitySocio-cultural Socio-cultural (Quintero et al., 2005)(Quintero et al., 2005): : – Stress Stress – Academic demandsAcademic demands– Social-recreationalSocial-recreational– Less risky than “hard” substancesLess risky than “hard” substances

Percent of Males and Female Adolescents Percent of Males and Female Adolescents Reporting Any Past-Year Non-Medical Reporting Any Past-Year Non-Medical

Prescription Drug Use Prescription Drug Use

7.5

8.68.3

7.3

2.7

2.0

0.5 0.6

2.6

2.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Any Rx Drug Analgesics Tranquilizers Sedatives Stimulants

Males Females

Percent of Males and Females Meeting Clinical Percent of Males and Females Meeting Clinical Criteria for Prescription Drug Abuse or Criteria for Prescription Drug Abuse or

Dependency Among Those Reporting Past-Dependency Among Those Reporting Past-Year Non-Medical Use Year Non-Medical Use

16.8

13.715.5

12.5

14.7

17.9

26.0

34.6

16.615.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Any Rx Drug Analgesics Tranquilizers Sedatives Stimulants

Males Females

Source of Prescription MedicationsSource of Prescription Medications

Peers and family Peers and family (McCabe et al, 2005)(McCabe et al, 2005)

– Males obtain from peers; females from familyMales obtain from peers; females from family

Medical exposure Medical exposure (McCabe et al, 2005)(McCabe et al, 2005)

– Females more likely than males to report prior Females more likely than males to report prior lifetime medical use of opioidslifetime medical use of opioids

Internet?Internet?Other sources? Other sources? – Do risk factors vary by source?Do risk factors vary by source?– Do use patterns vary by source?Do use patterns vary by source?

Medical versus Non-Medical UseMedical versus Non-Medical Use

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

A Few Questions Research Must Ask – A Few Questions Research Must Ask – and Answer – for Effective Preventionand Answer – for Effective PreventionPatterns of Use?Patterns of Use?– Are prescription medications a DOC, or are they used with other Are prescription medications a DOC, or are they used with other

substances? Why do young people favor prescription drugs?substances? Why do young people favor prescription drugs?

Risk and Protective Factors?Risk and Protective Factors?– How do risk and protective factors differ in NMPDU-only versus How do risk and protective factors differ in NMPDU-only versus

poly-substance use? By gender? By race/ethnicity and other poly-substance use? By gender? By race/ethnicity and other factors?factors?

Sources of Prescription Medications?Sources of Prescription Medications?– Where and how are adolescents obtaining prescription drugs?Where and how are adolescents obtaining prescription drugs?

Medical versus Non-Medical Use?Medical versus Non-Medical Use?– What is the balance?What is the balance?