Prevalence and Patterns of Nonmedical Use of OxyContin ® and Other Pain Relievers Joe Gfroerer Office of Applied Studies Substance Abuse and Mental Health

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

November 13, 2008

DirectorPeter Delany, Ph.D, LCSW-CRoom 7-10471 Choke Cherry Road Rockville, MD 20857 240-276-1250

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 (2007): – 90% 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 follow-up to identify which one(s)

Any other drugs in TC are specified by write-in.

“PILL CARDS”

Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2007

7

0.5

0.6

0.9

1.0

1.8

2.7

3.1

4.7

7.6

8.1

0 2 4 6 8 10Percent Using in Lifetime

Ultram®

Methadone

Morphine

Demerol®

OxyContin®

Codeine

Hydrocodone

Percocet®, Percodan®, or Tylox®

Darvocet®, Darvon®, or Tylenol® with Codeine

Vicodin®, Lortab®, or Lorcet®

Nonmedical Pain Reliever Use:

Trends and Patterns

Nonmedical Pain Reliever Use, Age 12 or Older: 2002 and 2007

9

29.6

11.0

4.4 5.2+

12.5+

33.1+

0

5

10

15

20

25

30

35 2002 2007

Numbers (in Millions)

Lifetime Use

Past MonthUse

Past YearUse

(13.3%+)

(5.0%+)

(2.1%)

(12.6%)

(1.9%)

(4.7%)

+ Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

Past Year Pain Reliever Dependence or Abuse and Treatment, Aged 12 or Older: 2002 and 2007

10

360

1,509

1,707

564+

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800 2002 2007

Received Treatment for Pain Reliever Problem During Last Treatment Visit,

within Past Year

Past Year Nonmedical Pain Reliever Dependence or Abuse

Numbers (in Thousands)


Past Year Nonmedical Use of Pain Relievers, by Age: 2002 and 2007

11

Percent Used in Past Year

7.6

11.4

6.1

2.4

12.1

6.9

2.8+

6.7+

0

5

10

15

20

12 to 17 18 to 25 26 to 34 35 and older

2002 2007


Lifetime Nonmedical Use of Selected Pain Relievers, Ages 18-25: 2002 and 2007

12

12.2

7.4

13.3

6.15.0

2.6 2.1

5.7

2.7+

5.2+

7.8+

17.9+

8.8+

11.4+

0

5

10

15

202002 2007

Darvocet®, Darvon®, or

Tylenol® w/Codeine

Percocet®, Percodan®, or

Tylox®

Vicodin®, Lortab®, or

Lorcet®

Percent Ever Used

HydrocodoneCodeine OxyContin® Morphine


Lifetime Nonmedical Use of Selected Pain Relievers, Ages 26-34: 2002 and 2007

13

10.5

5.5

8.9

3.62.8

1.0 0.9

10.4

1.2

2.9+

5.4+

4.0

14.1+

7.6+

0

5

10

15

202002 2007

Darvocet®, Darvon®, or

Tylenol® w/Codeine

Percocet®, Percodan®, or

Tylox®

Vicodin®, Lortab®, or

Lorcet®

Percent Ever Used

HydrocodoneCodeine OxyContin® Morphine


Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region:

Percentages, Annual Averages Based on 2004-2006

14

Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users

Aged 12 or Older: 2007

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

14.1%

Drug Dealer/Stranger

4.1%

Bought on Internet

0.5% Other 1

4.2%

Free from Friend/Relative

6.6%

Bought/Took fromFriend/Relative

5.9%

OneDoctor81.0%


1.8%

Other 1

1.8%

Source Where Respondent Obtained

Source Where Friend/Relative Obtained

One Doctor18.1%

More than One Doctor

2.6%


56.5%

More than One Doctor2.9%

Bought on Internet

0.1%

15

Sources of Rx Pain Relievers among Persons Who Used Pain Relievers Nonmedically in the Past Year:

Combined 2005 and 2006

16Percent among Past Year Users

4.5

0.4

1.6

4.8

4.1

18.0

8.8

57.7

5.1

1.7

4.0

4.6

8.7

27.1

14.3

34.6

0 10 20 30 40 50 60 70

Frequent Users(100+ days)All Users


Prescriptions from 1 Doctor

Bought from Friend/relative


Took from Friend/relative

Prescription from 2+ Doctors

Internet

Other

Initiation: First-time Use within the

Past 12 Months

Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs

Aged 12 or Older: 2007

2.7 Million Initiates of Illicit Drugs

Marijuana56.2%

Pain Relievers19.0%

Note: The percentages add to greater than 100 percent because of a small number of respondents initiating multiple drugs on the same day.

Tranquilizers6.5%

Hallucinogens 2.0%

Stimulants4.1%

Inhalants10.7%

Sedatives1.1%

Cocaine 0.6%

18

Marijuana Sedatives

Pain Relievers

Cocaine

LSDTranquilizers HeroinStimulantsEcstasy

Inhalants OxyContin®

Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007

19

2,147 2,090

1,232

906781 775

642554

270198

106

0

500

1,000

1,500

2,000

2,500


17.1 17.6 18.320.2 20.2

21.2 21.8 21.924.0 24.2 24.5

0

5

10

15

20

25

30

Marijuana Sedatives

Inhalants

Cocaine

OxyContin®LSD TranquilizersHeroinEcstasy

PainRelievers

Stimulants

Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007

20

Age in Years

Past Year Pain Reliever Initiation, Overall and with OxyContin® or Morphine Use, among Persons

Aged 12 or Older: 2002-2007Percent of Population

0.870.870.90

1.01+1.03+

0.99

0.080.080.070.080.070.06

0.040.040.030.040.050.050.0

0.2

0.4

0.6

0.8

1.0

1.2

2002 2003 2004 2005 2006 2007

Pain Reliever Initiates with OxyContin® Use

Pain Reliever Initiates with Morphine Use

Pain Reliever Initiates

+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level. 21

0.05 0.05 0.04 0.03 0.04

Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates, Age 12 or Older :

Annual Averages, 2004-2006

22

32

68

19

28

10

10

20

30

40

50

60

70

80

90

100

Percent of New Pain Reliever Users

Tranqs, Seds, or Stims

Nonmedically

HallucinogensCocaineMarijuana Heroin

Lifetime Use of Other Drugs among Past Year Nonmedical OxyContin® Initiates, Age 12 or Older :


23

70

95

66 65

12

0

10

20

30

40

50

60

70

80

90

100

Percent of New OxyContin® Users


Nonmedically


Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates Who Used Morphine, Age 12 or Older:


24

62

85

40

49

9

0

10

20

30

40

50

60

70

80

90

100

Percent of New Pain Reliever Users with Morphine Use


Nonmedically


17.4

18.0

21.0

48.4

51.2

55.5

58.2

79.2

0.0 20.0 40.0 60.0 80.0 100.0

Lifetime Nonmedical Use of Other Pain Relievers among Past Year Nonmedical OxyContin® Initiates,

Age 12 or Older: Annual Averages, 2004-2006

25Percent

Darvocet®, Darvon®, or Tylenol® with Codeine

Vicodin®, Lortab®, or Lorcet®

Percocet®, Percodan®, or Tylox®

Hydrocodone

Codeine

Morphine

Methadone

Demeral®

Nonmedical OxyContin® Use:

Trends and Patterns

Trends in Past Year Indicators of Nonmedical Use of OxyContin®, Ages 12 and Older: 2004 to 2007

27+ Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

615

1,213

526

1,226

387

533

1,323

554

1,422

535

351+330+

0

200

400

600

800

1,000

1,200

1,400

1,600

Past Year Initiates Past Year Users Past Year Users withDep/Ab

2004200520062007


OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Age Group:


28

0.76

0.23

1.74

0.520.62

0.14

0.32

0.120.080.01

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Past Year OxyContin® Use

Aged 12-17Aged 18-25Aged 26-34Aged 35-49Aged 50 or Older

Past Year Pain Reliever Dependence or Abuse, with OxyContin® Use

Percent

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Gender, Age 12+:

Annual Averages 2004-2006

29

0.64

0.16

0.40

0.13

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

MaleFemale

Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

Past Year Nonmedical OxyContin® Use

Percent

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Race/Ethnicity,

Age 12+: Annual Averages, 2004-2006

30

0.67

0.20

0.09

0.02

0.09

0.01

0.23

0.04

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8WhiteBlackAsianHispanic

Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

Past Year Nonmedical OxyContin® Use

Percent

OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by County Type,

Age 12+: Annual Averages, 2004-2006

31

0.43

0.11

0.63

0.18

0.59

0.23

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7 Large MetroSmall MetroNonmetro

Past Year Pain Reliever Dependence or Abuse with Nonmedical OxyContin® Use

Past Year OxyContin® Use

Percent

OxyContin® Use in Lifetime among Persons Aged 12 or Older, by State: Percentages, Annual Averages

Based on 2002-2006 NSDUHs

32Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002-2006.

Past Year Use of Selected Illicit Drugs among Past Year Nonmedical Pain Reliever Users and Nonusers

Aged 12 and Older: Annual Averages, 2004-2006

33

75.7

47.7

35.9

12.1

46.1

17.513.2

1.2

8.5

1.4 0.9 0.10

10

20

30

40

50

60

70

80

90 Used OxyContin®

Used Pain Relievers, not OxyContin®

No Pain Reliever Misuse

Percent Using in Past Year

Marijuana Cocaine Hallucinogens Heroin

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

2004-2006

34

510

20

10 84

9

237

7

8

6

5

4

5

4

0

10

20

30

40

Alcohol

Mar

ijuan

a

Cocai

ne

Stimula

nts

Sedat

ives

Tranquili

zers

Pain R

eliev

ers

Oxy

Contin

Abuse

Dependence

12

1714

28

14

9

13

28

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.

Percentage of Past Year Users

Documents

Prevalence and Patterns of Nonmedical Use of OxyContin ® and Other Pain Relievers Joe Gfroerer Office of Applied Studies Substance Abuse and Mental Health