II. Magnitude of the Problem
Data. Several Federal agencies generated the data cited below, including the National Survey on Drug Use and Health (NSDUH) which monitored 67,760 persons aged 12 or older; treatment episode data sets (TEDS); Monitoring the Future (MTF); and Drug Abuse Warning Network (DAWN).
In 2004, an estimated 2.8 million persons used psychotherapeutics non-medically for the first time within the past year. The number of new users of psychotherapeutics in 2004 was 2.4 million for pain relievers; 1.2 million for tranquilizers; and 793,000 for stimulants. An estimated 19.4 percent of past-year users of prescription drugs were new users—a statistically significant increase of 13 percent over 2003’s 17.2 percent.
The 2004 NSDUH data estimated that 48 million people ages 12 and older had used prescription drugs for non-medical purposes in their lifetimes. Of these, 2.5% (6 million people) were current users. These estimates are unchanged from 2002 and 2003. Among young adults (aged 18 to 25), non-medical use of prescription drugs was significantly higher in 2004 compared with 2002 for lifetime use (an increase from 27.7% to 29.2%) and for past month use (from 5.4% to 6.1%).
The mean age of first use of the various types of prescription drugs is among the highest for any class of drug, equaled only by heroin at 24.4 years. The mean age for first illicit use of pain relievers is 23.3 years; 24.5 years for Oxycontin®; 25.2 years for tranquilizers; 24.1 years for stimulants; and 29.3 years for sedatives. Only the mean age of first use for tranquilizers showed any change from 2003, increasing from 22.9 years.
Non-medical prescription drug use: opioids. Narcotic analgesic drugs are a type of pain reliever derived from natural or synthetic opioids. Examples of these in common brand names include Vicodin®, Percocet®, OxyContin®, and Darvon®. Pain relievers are the most commonly abused prescription drugs, representing 75% of non-medical use for the past month and past year (2004 data). While the numbers of current (4.4 million) and past year (11.3 million) users of pain relievers in 2004 are unchanged from 2002 and 2003, the estimates for lifetime users increased 7 percent between 2002 and 2004 (from 29.6 million to 31.8 million). Specifically, lifetime use of pain relievers increased (22.1% to 24.3%), as did past month use of pain relievers (4.1% to 4.7%).
The type of drug for new initiates is an important parameter of current and possibly future trends. Of the 2.8 million past year initiates into non-medical use of prescription drugs, 2.4 million (85%) were pain reliever initiates. Equally concerning is that new users represented 21.5% of past year pain reliever users. Focusing on specific opioids, 1.2 million Americans used Oxycontin® non-medically in the past year, and of these, 50.7% were new users.
Monitoring the Future (MTF) data also may portend future drug trends. MTF reports that past year use of Oxycontin® among 12th graders increased 39.2 percent over three years—from 4.0% in 2002 (the first year for which data on Oxycontin® were collected) to 5.5% in 2005. Past year use of Vicodin remained stable, averaging 10% among 12th graders.
Non-medical prescription drug use: other drug classes. Of the other classes of prescription drugs, only sedatives showed any change in 2004—a 39 percent decrease in the number of current users compared with 2002 (from 436,000 to 265,000 people) was observed in the general household population. However, among high school seniors, lifetime and past year use of sedatives increased 21.5 percent and 25.2 percent, respectively, since 2001 (from 8.7% to 10.5% and from 5.7% to 7.2%, respectively).
Use of tranquilizers decreased among 8th and 10th graders. Lifetime use of tranquilizers among 8th graders decreased 18.8% (from 5.0% to 4.1%), and 22.9% among 10th graders (from 9.2% to 7.1%). Past year use decreased 34.8% among 10th graders (from 7.3% to 4.8%).
Non-medical prescription drug use: treatment consequences. The Treatment Episode Data Set (TEDS) compiles admission to facilities that are licensed by State substance abuse agencies to provide substance abuse treatment and are collected by SAMHSA. Although most admissions for opioid addiction in 2004 were for heroin, TEDS admissions for primary abuse of opioids other than heroin increased from 2.8 percent of all admissions in 2003 to 3.4 percent in 2004, and increased from 53,730 to 63,853 individuals.
Non-medical prescription drug use: emergency room consequences. Emergency department reports of opioid pain relievers and other prescription drug abuse are increasing. According to SAMHSA's Drug Abuse Warning Network (DAWN) data system, drug abuse related emergency department visits involving narcotic analgesics/combinations increased 163 percent in the nation (from 45,254 visits to 119,185 emergency department visits) between 1995 to 2002. The greatest increases during this period occurred for oxycodone/combinations (512%), methadone (176%), hydrocodone/combinations (159%), and morphine/combinations (116%).
Dependence was the most frequently mentioned motive underlying drug abuse related emergency department visits involving narcotic analgesics (47%), followed by suicide (22%), and psychic effects (15%). The drug abuse motive was unknown for 14% of the analgesic related emergency department visits. Disposition of emergency department patients involving narcotic analgesics was as follows: 53% were admitted for treatment, 44% were treated and released from the hospital, and 3% that either left against medical advice, died, or had an unknown outcome.
Other potential secondary consequences to intended patients include reduced confidence in essential medications, increased physician reluctance to prescribe pain medications and reduced patient access to needed analgesic medications.
