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
November 13, 2008
DirectorPeter Delany, Ph.D, LCSW-CRoom 7-10471 Choke Cherry Road Rockville, MD 20857 240-276-1250
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 (2007): – 90% 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 follow-up to identify which one(s)
Any other drugs in TC are specified by write-in.
“PILL CARDS”
Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2007
7
0.5
0.6
0.9
1.0
1.8
2.7
3.1
4.7
7.6
8.1
0 2 4 6 8 10Percent Using in Lifetime
Ultram®
Methadone
Morphine
Demerol®
OxyContin®
Codeine
Hydrocodone
Percocet®, Percodan®, or Tylox®
Darvocet®, Darvon®, or Tylenol® with Codeine
Vicodin®, Lortab®, or Lorcet®
Nonmedical Pain Reliever Use:
Trends and Patterns
Nonmedical Pain Reliever Use, Age 12 or Older: 2002 and 2007
9
29.6
11.0
4.4 5.2+
12.5+
33.1+
0
5
10
15
20
25
30
35 2002 2007
Numbers (in Millions)
Lifetime Use
Past MonthUse
Past YearUse
(13.3%+)
(5.0%+)
(2.1%)
(12.6%)
(1.9%)
(4.7%)
+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.
Past Year Pain Reliever Dependence or Abuse and Treatment, Aged 12 or Older: 2002 and 2007
10
360
1,509
1,707
564+
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800 2002 2007
Received Treatment for Pain Reliever Problem During Last Treatment Visit,
within Past Year
Past Year Nonmedical Pain Reliever Dependence or Abuse
Numbers (in Thousands)
+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.
Past Year Nonmedical Use of Pain Relievers, by Age: 2002 and 2007
11
Percent Used in Past Year
7.6
11.4
6.1
2.4
12.1
6.9
2.8+
6.7+
0
5
10
15
20
12 to 17 18 to 25 26 to 34 35 and older
2002 2007
+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.
Lifetime Nonmedical Use of Selected Pain Relievers, Ages 18-25: 2002 and 2007
12
12.2
7.4
13.3
6.15.0
2.6 2.1
5.7
2.7+
5.2+
7.8+
17.9+
8.8+
11.4+
0
5
10
15
202002 2007
Darvocet®, Darvon®, or
Tylenol® w/Codeine
Percocet®, Percodan®, or
Tylox®
Vicodin®, Lortab®, or
Lorcet®
Percent Ever Used
HydrocodoneCodeine OxyContin® Morphine
+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.
Lifetime Nonmedical Use of Selected Pain Relievers, Ages 26-34: 2002 and 2007
13
10.5
5.5
8.9
3.62.8
1.0 0.9
10.4
1.2
2.9+
5.4+
4.0
14.1+
7.6+
0
5
10
15
202002 2007
Darvocet®, Darvon®, or
Tylenol® w/Codeine
Percocet®, Percodan®, or
Tylox®
Vicodin®, Lortab®, or
Lorcet®
Percent Ever Used
HydrocodoneCodeine OxyContin® Morphine
+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region:
Percentages, Annual Averages Based on 2004-2006
14
Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users
Aged 12 or Older: 2007
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
14.1%
Drug Dealer/Stranger
4.1%
Bought on Internet
0.5% Other 1
4.2%
Free from Friend/Relative
6.6%
Bought/Took fromFriend/Relative
5.9%
OneDoctor81.0%
Drug Dealer/Stranger
1.8%
Other 1
1.8%
Source Where Respondent Obtained
Source Where Friend/Relative Obtained
One Doctor18.1%
More than One Doctor
2.6%
Free from Friend/Relative
56.5%
More than One Doctor2.9%
Bought on Internet
0.1%
15
Sources of Rx Pain Relievers among Persons Who Used Pain Relievers Nonmedically in the Past Year:
Combined 2005 and 2006
16Percent 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
Free from Friend/Relative
Prescriptions from 1 Doctor
Bought from Friend/relative
Drug Dealer/Stranger
Took from Friend/relative
Prescription from 2+ Doctors
Internet
Other
Initiation: First-time Use within the
Past 12 Months
Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs
Aged 12 or Older: 2007
2.7 Million Initiates of Illicit Drugs
Marijuana56.2%
Pain Relievers19.0%
Note: The percentages add to greater than 100 percent because of a small number of respondents initiating multiple drugs on the same day.
Tranquilizers6.5%
Hallucinogens 2.0%
Stimulants4.1%
Inhalants10.7%
Sedatives1.1%
Cocaine 0.6%
18
Marijuana Sedatives
Pain Relievers
Cocaine
LSDTranquilizers HeroinStimulantsEcstasy
Inhalants OxyContin®
Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007
19
2,147 2,090
1,232
906781 775
642554
270198
106
0
500
1,000
1,500
2,000
2,500
Numbers (in Thousands)
17.1 17.6 18.320.2 20.2
21.2 21.8 21.924.0 24.2 24.5
0
5
10
15
20
25
30
Marijuana Sedatives
Inhalants
Cocaine
OxyContin®LSD TranquilizersHeroinEcstasy
PainRelievers
Stimulants
Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007
20
Age in Years
Past Year Pain Reliever Initiation, Overall and with OxyContin® or Morphine Use, among Persons
Aged 12 or Older: 2002-2007Percent of Population
0.870.870.90
1.01+1.03+
0.99
0.080.080.070.080.070.06
0.040.040.030.040.050.050.0
0.2
0.4
0.6
0.8
1.0
1.2
2002 2003 2004 2005 2006 2007
Pain Reliever Initiates with OxyContin® Use
Pain Reliever Initiates with Morphine Use
Pain Reliever Initiates
+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level. 21
0.05 0.05 0.04 0.03 0.04
Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates, Age 12 or Older :
Annual Averages, 2004-2006
22
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
Lifetime Use of Other Drugs among Past Year Nonmedical OxyContin® Initiates, Age 12 or Older :
Annual Averages, 2004-2006
23
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
Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates Who Used Morphine, Age 12 or Older:
Annual Averages, 2004-2007
24
62
85
40
49
9
0
10
20
30
40
50
60
70
80
90
100
Percent of New Pain Reliever Users with Morphine Use
Tranqs, Seds, or Stims
Nonmedically
HallucinogensCocaineMarijuana Heroin
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
Lifetime Nonmedical Use of Other Pain Relievers among Past Year Nonmedical OxyContin® Initiates,
Age 12 or Older: Annual Averages, 2004-2006
25Percent
Darvocet®, Darvon®, or Tylenol® with Codeine
Vicodin®, Lortab®, or Lorcet®
Percocet®, Percodan®, or Tylox®
Hydrocodone
Codeine
Morphine
Methadone
Demeral®
Nonmedical OxyContin® Use:
Trends and Patterns
Trends in Past Year Indicators of Nonmedical Use of OxyContin®, Ages 12 and Older: 2004 to 2007
27+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.
615
1,213
526
1,226
387
533
1,323
554
1,422
535
351+330+
0
200
400
600
800
1,000
1,200
1,400
1,600
Past Year Initiates Past Year Users Past Year Users withDep/Ab
2004200520062007
Numbers (in Thousands)
OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Age Group:
Annual Averages, 2004-2006
28
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
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
Percent
OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Gender, Age 12+:
Annual Averages 2004-2006
29
0.64
0.16
0.40
0.13
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
MaleFemale
Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use
Past Year Nonmedical OxyContin® Use
Percent
OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Race/Ethnicity,
Age 12+: Annual Averages, 2004-2006
30
0.67
0.20
0.09
0.02
0.09
0.01
0.23
0.04
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8WhiteBlackAsianHispanic
Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use
Past Year Nonmedical OxyContin® Use
Percent
OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by County Type,
Age 12+: Annual Averages, 2004-2006
31
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 Large MetroSmall MetroNonmetro
Past Year Pain Reliever Dependence or Abuse with Nonmedical OxyContin® Use
Past Year OxyContin® Use
Percent
OxyContin® Use in Lifetime among Persons Aged 12 or Older, by State: Percentages, Annual Averages
Based on 2002-2006 NSDUHs
32Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002-2006.
Past Year Use of Selected Illicit Drugs among Past Year Nonmedical Pain Reliever Users and Nonusers
Aged 12 and Older: Annual Averages, 2004-2006
33
75.7
47.7
35.9
12.1
46.1
17.513.2
1.2
8.5
1.4 0.9 0.10
10
20
30
40
50
60
70
80
90 Used OxyContin®
Used Pain Relievers, not OxyContin®
No Pain Reliever Misuse
Percent Using in Past Year
Marijuana Cocaine Hallucinogens Heroin
Dependence and Abuse Among Past Year Users of Selected Substances, Ages 12+: Annual Averages,
2004-2006
34
510
20
10 84
9
237
7
8
6
5
4
5
4
0
10
20
30
40
Alcohol
Mar
ijuan
a
Cocai
ne
Stimula
nts
Sedat
ives
Tranquili
zers
Pain R
eliev
ers
Oxy
Contin
Abuse
Dependence
12
1714
28
14
9
13
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.
Percentage of Past Year Users
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