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

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

3. Classes of drugs l Analgesics (e.g., Codiene) l Tranquilizers (e.g., Valium) l Sedatives (e.g., Seconal) l Stimulants (e.g., amphetamines)

4. Data Sources l National Household Survey on Drug Abuse (NHSDA), 1985 – 1998 (Age 12+, n = 5,000 – 20,000+) l National Comorbidity Study (NCS) Diagnostic criteria for major psychiatric disorders (DSM-IIIR) (Age 15 – 54, n = 8,098)

5. Reported Lifetime and Past Year Use of Prescription Drugs, NHSDA 1998

6. Past Year Use of Prescription Drugs by Sex, NHSDA, 1998

7. Reported Use of Analgesics in Past Year (By Sex)

8. Reported Use of Tranquilizers in Past Year (By Sex)

9. Reported Use of Sedatives in Past Year (By Sex)

10. Reported Use of Stimulants in Past Year (By Sex)

11. Reported Use of Analgesics in Past Year (Male)

12. Reported Use of Analgesics in Past Year (Female)

13. Reported Past Year Use of Prescription Drugs, Ages 60+

14. Prevalence of Extramedical Analgesic Use in the Past Year (1998)

15. Prevalence of Extramedical Tranquilizer Use in the Past Year (1998)

16. Prevalence of Extramedical Sedative Use in the Past Year (1998)

17. Prevalence of Extramedical Stimulants in the Past Year (1998)

18. Prevalence of Extramedical Analgesic Use in the Past Year

19. 020406080 Age 0.00 0.02 0.04 0.06 0.08 0.10 0.12 Incidence Males Females Cumulative Incidence of Analgesic Use

20. 204060 Age 0.00 0.02 0.04 0.06 Incidence Males Females Cumulative Incidence of Tranquilizer Use

21. 204060 Age 0.00 0.01 0.02 0.03 0.04 Incidence Males Females Cumulative Incidence of Sedative Use

22. 204060 Age 0.00 0.02 0.04 0.06 Incidence Males Females Cumulative Incidence of Stimulant Use

23. Lifetime Prevalence of Extramedical Analgesic Use AnalgesicPercent Codeine2.05 Darvon0.58 Demerol0.77 Morphine0.57 Percodan0.89 Tylenol w/Codeine2.74

24. Lifetime Prevalence of Extramedical Analgesic Use by Sex Sex Analgesic % Male% Female Codeine2.661.57 Darvon0.640.53 Demerol0.930.64 Morphine0.800.39 Percodan1.080.74 Tylenol w/Codeine2.852.65

25. Lifetime Prevalence of Extramedical Analgesic Use by Age Group Age Group Analgesic 12-17 % 18-25 % 26-34 % 35+ % Codeine1.212.982.091.85 Darvon0.070.440.711.15 Demerol0.461.080.770.74 Morphine0.590.700.330.58 Percodan0.121.051.341.18 Tylenol w/Codeine1.893.403.422.43

26. Lifetime Prevalence of Extramedical Analgesic Use by Race Race Analgesic White % Black % Hispanic % Other % Codeine3.101.131.101.52 Darvon0.860.450.250.34 Demerol1.170.400.440.51 Morphine0.810.450.310.34 Percodan1.490.430.310.51 Tylenol w/Codeine3.711.891.743.13

27. Lifetime Prevalence of Extramedical Analgesic Use by Family Income Analgesic Family Income Category <$20,000 % $20,000 to $49,000 % $50,000 + % Codeine1.282.022.15 Darvon0.410.530.64 Demerol0.670.690.73 Morphine0.440.620.53 Percodan0.560.751.01 Tylenol w/Codeine2.102.802.67

28. Prevalence of Extramedical Analgesic Use, Recent Users ( 2 Years or Less) AnalgesicPercent Codeine31.48 Darvon 1.94 Demerol10.90 Morphine 7.75 Percodan 6.05 Tylenol w/Codeine41.65

29. Reported Lifetime and Past Year Dependence of Prescription Drugs, NCS

30. Past Year Dependence of Prescription Drugs by Sex, NCS

31. Rx Drug Dependence : Lifetime Comorbidity with Psychiatric Disorders

32. Cocaine Dependence: Lifetime Comorbidity with Psychiatric Disorders

33. Extramedical Analgesic Dependence : Lifetime Comorbidity with Psychiatric Disorders

34. Cumulative Probability of Analgesic Dependence

35. Odds Ratios & 95% CI for Analgesic Dependence, Given Use Separate model for each psychiatric disorder Model containing Conduct Disorder and Depression OR*95% CIOR*95% CI Female1.20.66 – 2.161.49.80 – 2.79 Conduct Disorder3.111.68 – 5.753.021.63 – 5.62 Antisocial Personality5.102.64 – 9.83 Depression1.56.87 – 2.821.45.80 – 2.64 * Adjusted for age, race, education

36. Testing Causal Pathways between PTSD and Substance Use Disorders Howard D. Chilcoat Naomi Breslau Archives of General Psychiatry 1998

37. Traumatic Event PTSD Drug A/D Potential Pathways

38. PTSD Rx Drug A/D Potential Pathways Relative Risk = 16.9

39. 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 traumatic event

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

42. Findings (cont’d) 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

43. Future Research Directions l Epidemiology of Rx drug misuse remains relatively unexplored l Focus on Rx drug use by girls and young women l Rx misuse in the elderly l Causal relationships between RX drug misuse and other psychiatric disorders