An Epidemiologic Overview of Prescription Drug Misuse

1
An Epidemiologic Overview of Prescription Drug
Misuse

• Howard D. Chilcoat
• Tracy Dusablon
• Department of Mental Hygiene
• Johns Hopkins University
• School of Hygiene and Public Health

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Extramedical Use
Used drug when it was not prescribed for you, or
that you took only for the experience or feeling
that it caused
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Classes of drugs

• Analgesics (e.g., Codiene)
• Tranquilizers (e.g., Valium)
• Sedatives (e.g., Seconal)
• Stimulants (e.g., amphetamines)

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Data Sources

• National Household Survey on Drug Abuse (NHSDA),
  1985 1998
  
• (Age 12, n 5,000 20,000)
• National Comorbidity Study (NCS)
• Diagnostic criteria for major psychiatric
  disorders (DSM-IIIR)
  
• (Age 15 54, n 8,098)

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Reported Lifetime and Past Year Use of
Prescription Drugs, NHSDA 1998
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Past Year Use of Prescription Drugs by Sex,
NHSDA, 1998
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Reported Use of Analgesics in Past Year (By Sex)
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Reported Use of Tranquilizers in Past Year (By
Sex)
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Reported Use of Sedatives in Past Year (By Sex)
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Reported Use of Stimulants in Past Year (By Sex)
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Reported Use of Analgesics in Past Year (Male)
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Reported Use of Analgesics in Past Year (Female)
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Reported Past Year Use of Prescription Drugs ,
Ages 60
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Prevalence of Extramedical Analgesic Use in the
Past Year (1998)
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Prevalence of Extramedical Tranquilizer Use in
the Past Year (1998)
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Prevalence of Extramedical Sedative Use in the
Past Year (1998)
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Prevalence of Extramedical Stimulants in the Past
Year (1998)
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Prevalence of Extramedical Analgesic Use in the
Past Year
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Cumulative Incidence of Analgesic Use

• 0.12

• Males

• Females

• 0.10

• 0.08

• Incidence

• 0.06

• 0.04

• 0.02

• 0.00

• 0

• 20

• 40

• 60

• 80

• Age

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Cumulative Incidence of Tranquilizer Use

• 0.06

• Males

• Females

• 0.04

• Incidence

• 0.02

• 0.00

• 20

• 40

• 60

• Age

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Cumulative Incidence of Sedative Use

• Males

• 0.04

• Females

• 0.03

• Incidence

• 0.02

• 0.01

• 0.00

• 20

• 40

• 60

• Age

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Cumulative Incidence of Stimulant Use

• Males

• Females

• 0.06

• 0.04

• Incidence

• 0.02

• 0.00

• 20

• 40

• 60

• Age

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Lifetime Prevalence of Extramedical Analgesic Use
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Lifetime Prevalence of Extramedical Analgesic Use
by Sex
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Lifetime Prevalence of Extramedical Analgesic Use
by Age Group
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Lifetime Prevalence of Extramedical Analgesic Use
by Race
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Lifetime Prevalence of Extramedical Analgesic Use
by Family Income
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Prevalence of Extramedical Analgesic Use, Recent
Users ( 2 Years or Less)
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Reported Lifetime and Past Year Dependence of
Prescription Drugs, NCS
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Past Year Dependence of Prescription Drugs by
Sex, NCS
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Rx Drug Dependence Lifetime Comorbidity with
Psychiatric Disorders
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Cocaine Dependence Lifetime Comorbidity with
Psychiatric Disorders
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Extramedical Analgesic Dependence Lifetime
Comorbidity with Psychiatric Disorders
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Cumulative Probability of Analgesic Dependence
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Odds Ratios 95 CI for Analgesic Dependence,
Given Use
Adjusted for age, race, education
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Testing Causal Pathways between PTSD and
Substance Use Disorders
Howard D. Chilcoat Naomi Breslau Archives of G
eneral Psychiatry
1998
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Potential Pathways
Traumatic Event
Drug A/D
PTSD
Drug A/D
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Potential Pathways
PTSD
Relative Risk 16.9
Rx Drug A/D
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Prevalence of Drug A/D by lifetime history of PTSD
40
Relative hazards (95 CI) of specified drug use
disorder by prior exposure to traumatic events
and PTSD
All estimates adjusted for sex, race, and
education Reference category never exposed to t
raumatic event
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Findings

• Prevalence (past year) of use of Rx drugs is
  comparable to that of cocaine analgesics most
  commonly misused
  
• Ages 18 25 years highest period of risk for use
  and onset of Rx drugs and analgesics
  
• Girls 12-17 years old might be particularly
  vulnerable
  
• Relative to other drugs, sex differences are
  small, emerge after age 20 years
  
• Whites and higher income more likely to use Rx
  drugs (analgesics) than other race/ethinicities
  

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Findings (contd)

• High level of comorbidity with other psychiatric
  disorders
  
• Strong relationship with antisocial personality
  disorder, cocaine dependence
  
• Lifetime prevalence of Rx drug dependence
  similar to that for cocaine

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Future Research Directions

• Epidemiology of Rx drug misuse remains relatively
  unexplored
  
• Focus on Rx drug use by girls and young women
• Rx misuse in the elderly
• Causal relationships between RX drug misuse and
  other psychiatric disorders