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 May 5, 2008

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 (2006): –91% 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 followup to identify which one(s) Any other drugs in TC are specified by write-in. “PILL CARDS”

7 Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2006 Numbers (in Millions)

Nonmedical Pain Reliever Use: Trends and Patterns

9 Nonmedical Pain Reliever Use, Age 12 or Older: 2002 and 2006 Numbers (in Millions) Lifetime Use Past Month Use Past Year Use (13.6%) (5.1%) (2.1%) Note: Differences between 2002 and 2006 are statistically significant for lifetime, past year, and past month use.

10 Number in Thousands Received Treatment for Pain Reliever Problem During Last Treatment Visit, within Past Year Past Year Nonmedical Pain Reliever Dependence or Abuse Past Year Pain Reliever Dependence or Abuse and Treatment, Age 12+: 2002 and Difference between this estimate and the 2002 estimate is statistically significant at the.05 level.

11 Past Year Nonmedical Use of Pain Relievers, by Age: 2002 and 2006 Percent Used in Past Year + Difference between this estimate and the 2002 estimate is statistically significant at the.05 level. + +

12 Lifetime Nonmedical Use of Selected Pain Relievers, Ages 18-25: 2002 and 2006 Percent Ever Used + Difference between this estimate and the 2002 estimate is statistically significant at the.05 level Darvocet, Darvon, or Tylenol w/Codeine Percocet, Percodan, or Tylox Vicodin, Lortab, or Lorcet

13 Lifetime Nonmedical Use of Selected Pain Relievers, Ages 26-34: 2002 and 2006 Percent Ever Used + Difference between this estimate and the 2002 estimate is statistically significant at the.05 level Darvocet, Darvon, or Tylenol w/Codeine Percocet, Percodan, or Tylox Vicodin, Lortab, or Lorcet

14 Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on

15 Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2006 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 14.8% Drug Dealer/ Stranger 3.9% Bought on Internet 0.1% Other 1 4.9% Free from Friend/Relative 7.3% Bought/Took from Friend/Relative 4.9% One Doctor 80.7% Drug Dealer/ Stranger 1.6% Other 1 2.2% Source Where Respondent Obtained Source Where Friend/Relative Obtained One Doctor 19.1% More than One Doctor 1.6% Free from Friend/Relative 55.7% More than One Doctor 3.3%

16 Sources of Rx Pain Relievers among Persons Who Used Pain Relievers Nonmedically in the Past Year: Combined 2005 and 2006 Percent among Past Year 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

Pain Reliever and OxyContin ® Initiates

18 Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2006 Numbers in Thousands MarijuanaLSD Pain Relievers Cocaine SedativesTranquilizersHeroinInhalantsEcstasy StimulantsOxyContin®

19 Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2006 Age in Years Marijuana StimulantsPain Relievers Heroin LSD TranquilizersCocaine EcstasyInhalants OxyContin® Sedatives

20 Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates, Age 12 or Older : Annual Averages, Percent of New Pain Reliever Users Tranqs, Seds, or Stims Nonmedically HallucinogensCocaineMarijuanaHeroin

21 Lifetime Use of Other Drugs among Past Year Nonmedical OxyContin ® Initiates, Age 12 or Older : Annual Averages, Percent of New OxyContin ® Users Tranqs, Seds, or Stims Nonmedically HallucinogensCocaineMarijuanaHeroin

22 Lifetime Nonmedical Use of Other Pain Relievers among Past Year Nonmedical OxyContin ® Initiates, Age 12 or Older: Annual Averages, Percent Darvocet ®, Darvon ®, or Tylenol ® with Codeine Vicodin ®, Lortab ®, or Lorcet ® Percocet ®, Percodan ®, or Tylox ® ®

Nonmedical OxyContin ® Use: Trends and Patterns

24 Trends in Past Year Indicators of Nonmedical Use of OxyContin ®, Ages 12 and Older: 2004 to 2006 Number in Thousands + Difference between this estimate and the 2006 estimate is statistically significant at the.05 level.

25 Percent Past Year OxyContin® Use Aged Aged Aged Aged Aged 50 or Older Past Year Pain Reliever Dependence or Abuse, with OxyContin ® Use OxyContin ® Use and Pain Reliever Dependence or Abuse with OxyContin ® Use, by Age Group: Annual Averages,

26 Percent Male Female Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin ® Use Past Year Nonmedical OxyContin® Use OxyContin ® Use and Pain Reliever Dependence or Abuse with OxyContin ® Use, by Gender, Age 12+: Annual Averages

27 Percent Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use Past Year Nonmedical OxyContin® Use OxyContin ® Use and Pain Reliever Dependence or Abuse with OxyContin ® Use, by Race/Ethnicity, Age 12+: Annual Averages,

28 OxyContin ® Use and Pain Reliever Dependence or Abuse with OxyContin ® Use, by County Type, Age 12+: Annual Averages, Percent Large Metro Small Metro Nonmetro Past Year Pain Reliever Dependence or Abuse with Nonmedical OxyContin ® Use Past Year OxyContin® Use

29 OxyContin ® Use in Lifetime among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health,

30 Past Year Use of Selected Illicit Drugs among Past Year Nonmedical Pain Reliever Users and Nonusers Aged 12 and Older: Annual Averages, Percent Using in Past Year Marijuana Cocaine Hallucinogens Heroin

31 Dependence and Abuse Among Past Year Users of Selected Substances, Ages 12+: Annual Averages, Percentage of Past Year Users 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.