Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991–1992 and 2001–2002

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Abstract

Objective

To examine changes in the prevalence of non-medical prescription drug use and DSM-IV non-medical prescription abuse and dependence in the United States between 1991–1992 and 2001–2002.

Method

Comparison of the prevalence of past-year non-medical prescription drug use and drug use disorders in the total sample and among lifetime non-medical users in two large national surveys conducted 10 years apart.

Results

From 1991–1992 to 2001–2002, the prevalence of DSM-IV non-medical prescription drug use increased by 53%, from 1.5% to 2.3% (p < 0.001), and the prevalence of drug use disorders increased by 67% from 0.3% to 0.5% (p < 0.001). The conditional prevalence of a disorder among users increased numerically from 19.9% to 23.6%, but this increase was not statistically significant (p = 0.15).

Conclusions

There have been substantial increases in the prevalence of prescription drug non-medical use and prescription drug use disorders in the United States. Given the clinical utility of prescription drugs, urgent action is needed to find approaches that balance the need for access to these medications among those who need them, against their potential for abuse and dependence in subgroups of vulnerable individuals.

Introduction

Prescription drugs such as opioid analgesics, sedatives, anxiolytics and stimulants are essential pharmacological agents for the treatment of acute and chronic pain, insomnia, anxiety, attention-deficit hyperactivity disorder (ADHD), and other psychiatric disorders (Zacny et al., 2003, AAPMAPS, 1997). However, management of these medications is complicated by their potential for the development of abuse or dependence (Zacny et al., 2003, Stoops et al., 2005, Compton and Volkow, 2006). Furthermore, prescription drugs can also increase the risk of psychiatric and other medical disorders (Zacny et al., 2003, Murray et al., 1995, Lucas et al., 1986, Swanson and Volkow, 2002, Barker et al., 2004, McCabe, 2005, Simoni-Wastila and Strickler, 2004), particularly when used in greater amounts than prescribed, or for prolonged periods of time.

While concern is growing that non-medical use of prescription drugs may be increasing in the United States (Zacny et al., 2003, Compton and Volkow, 2006, McCabe, 2005, Cicero and Inciardi, 2005), no long-term information is available about changes in the prevalence of non-medical prescription drug use disorders as defined by DSM-IV (American Psychiatric Association (APA), 1994). A better understanding of the extent and correlates of non-medical use, abuse and dependence on prescription drugs is important to help guide clinicians and policy-makers.

The current study was designed to address this critical gap in knowledge. To assess changes in non-medical use, abuse and dependence on prescription drugs in the United States, we utilized data from two large national surveys, the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey ([NLAES], N = 42,862; Grant et al., 1992) and the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions ([NESARC], N = 43,093; Grant et al., 2003a, Grant et al., 2004). We examined the prevalence and correlates of non-medical use, abuse and dependence on prescription drugs (sedatives, tranquilizers, opioids and amphetamines) in each survey, and compared it across the surveys. To better understand the mechanism of changes in prevalence of DSM-IV abuse and dependence on prescription drugs, we present separately prevalence estimates for use, abuse/dependence, and abuse/dependence among users. This allows us to better understand to which extent changes in the prevalence of non-medical prescription drug use disorders are due to increases in non-medical use versus increases in the prevalence of use disorders among users.

Section snippets

Samples

The NLAES, conducted in 1991–1992, and its successor the NESARC, conducted in 2001–2002, are nationally representative samples of the adult population of the United States, as described previously (Grant et al., 1992, Grant et al., 2003a, Grant et al., 2004). The purpose of both surveys was to provide nationally representative data on the distribution and correlates of alcohol use disorders and associated conditions, of which drug use, abuse and dependence were crucial components. The sample

Non-medical prescription drug use

Past-year non-medical prescription drug use was reported by 1.5% of NLAES respondents in 1991–1992, and 2.3% of NESARC respondents in 2001–2002 (p < 0.001). The prevalence of non-medical use significantly increased across most sociodemographic and clinical correlates (Table 1). There were several significant changes in sociodemographic correlates of past-year non-medical prescription drug use. The odds of non-medical drug use were significantly greater among women in 1991–1992, but not in

Discussion

This is the first study to provide information on national changes in the prevalence and correlates of past-year DSM-IV non-medical prescription drug use disorders in the U.S. We highlight four major results: (1) from 1991–1992 to 2001–2002, the prevalence of past-year non-medical prescription drugs use disorders increased by 67%; (2) the increase was due to increased non-medical use of these drugs, rather than increased prevalence of non-medical drug use disorders among users; (3) most risk

Acknowledgements

The NLAES and NESARC were funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support for the NESARC from the National Institute on Drug Abuse (NIDA). This research was also supported, in part, by the Intramural Program of the National Institutes of Health (Grant), grants K23 DA00482, R01 DA019606 and R01 DA020783 (Blanco) and K05 AA 014223 (Hasin) and the New York State Psychiatric Institute (Blanco and Hasin). The authors wish to thank Valerie Richmond,

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