C ONSUMPTION P ATTERNS AND C ONSEQUENCES
Abuse of prescription drugs is a serious and growing public health problem in the United States. According to the National Survey on Drug Use and Health (NSDUH), a total of 50.4 million Americans (20.3%) ages 12 years and older reported lifetime nonmedical use of prescription-type psychotherapeutics, including pain relievers, sedatives, tranquilizers, and stimulants, in 2007. In Indiana alone, over a million Hoosiers reported that they misused psychotherapeutics at least once in their life (20.7%)1 (Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, 2008). The National Institute on Drug Abuse (NIDA) lists the three most commonly abused types of prescription medicine as:
• Opioids, which are primarily prescribed to treat pain – examples include oxycodone (e.g., OxyContin, Percocet), codeine, and morphine;
• Central nervous system (CNS) depressants, such as sedatives and tranquilizers to treat sleep and anxiety disorders – examples include barbiturates (e.g., Mebaral, Nembutal) and benzodiazepines (e.g., Valium, Xanax); and
• Stimulants, which are often prescribed to treat narcolepsy, attention-defi cit hyperactivity disorder (ADHD), and obesity – examples include
dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta) (National Institute on Drug Abuse, 2005; Offi ce of National Drug Control Policy, n.d.).
General Consumption Patterns
According to NSDUH annual averages from 2002 through 2004, a total of 7.6% of Hoosiers (383,000 residents) engaged in the nonmedical use of
psychotherapeutics in the past year, and 2.7% (138,000 residents) reported past-month use. The highest use was reported for pain relievers, which include OxyContin, one of the most abused drugs among the psychotherapeutics. Due to the nature of the data, levels of signifi cance between Indiana and U.S. differences could not be established (see Table 9.1) (Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.).
Table 9.1 Lifetime, Past Year, and Current Nonmedical Use of Psychotherapeutics, Indiana2 and United States3 (National Survey on Drug Use and Health)
Lifetime Use Past Year Use Past Month Use Indiana U.S. Indiana U.S. Indiana U.S.
All Psychotherapeutics 20.7% 20.3% 7.6% 6.6% 2.7% 2.8%
Pain Relievers 15.0% 13.3% 6.1% 5.0% 2.0% 2.1%
OxyContin 2.5% 1.8% 0.8% 0.6% 0.3% 0.1%
Tranquilizers 9.1% 8.2% 2.8% 2.1% 0.8% 0.7%
Sedatives 3.9% 3.4% 0.4% 0.3% 0.1% 0.1%
Stimulants 8.3% 8.7% 1.7% 1.2% 0.8% 0.4%
1Indiana rates are based on annual NSDUH averages from 2002 through 2004.
2Indiana rates are based on annual NSDUH averages from 2002 through 2004.
Source: Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.
Based on 2007 NSDUH results, a total of 6.22%
(95% Confi dence Interval [CI]: 5.20–7.43) of the Indiana population 12 and older (or 323,000 residents) reported nonmedical use of pain relievers in the past year (U.S.:
5.09); the difference between Indiana and the nation was statistically signifi cant.
Furthermore, between January 1, 2007, and June 30, 2008, close to 63 million dosage units of oxycodone (pain reliever) were purchased by retail registrants (pharmacies, hospitals, and practitioners) in Indiana. This represents a per capita rate of 9.9 dosage units for the 18-month period (U.S.
Drug Enforcement Administration, 2008). For information on per capita dosage units by county, see Map 9.1, page163.
All Prescription Drugs Pain Relievers Sedatives &
Tranquilizers Stimulants
Indiana 16.5% 11.3% 6.6% 1.0%
U.S. 12.4% 8.8% 3.7% 1.2%
0%
5%
10%
15%
20%
12 -17 18-25 26 and older
Indiana 7.74% 15.48% 4.39%
U.S. 6.91% 12.28% 3.59%
0%
5%
10%
15%
20%
Adult Consumption Patterns
According to 2007 NSDUH results, young people between the ages of 18 and 25 have the highest rate of prescription pain medication abuse. Indiana’s past-year
usage rate of 15.48% (95% CI: 13.12–18.17), or 107,000 residents, was statistically higher than the nation’s rate (12.28%) (see Figure 9.1).
Figure 9.1 Prevalence of Past-Year Pain Reliever Use in Indiana and the United States, by Age Group (National Survey on Drug Use and Health, 2007)
Source: Substance Abuse and Mental Health Services Administration, Offi ce of Applied Studies, n.d.
Figure 9.2 Percentage of Indiana and U.S. Treatment Episodes with Nonmedical Prescription Drug Use Reported at Treatment Admission, by Drug Category (Treatment Episode Data Set, 2007)
Source: Substance Abuse and Mental Health Data Archive, 2008
The State Epidemiology and Outcomes Workgroup survey (2008) collected information on the nonmedical use of prescription drugs among Hoosiers ages 18 and older. Lifetime prevalence for all prescription drug abuse was 4.6% and involved mostly abuse of pain pills (4.1%). We found signifi cant differences in prevalence of nonmedical prescription drug use by gender, race, and age group (see Table 9.2). Furthermore, 97.1% of survey respondents found it unacceptable for people to use prescription drugs to get high, and 86.2% said that people put themselves at great risk when they misuse prescription pain pills to get high once or twice a week (State Epidemiology and Outcomes Workgroup, 2008).
Another method of tracking prescription drug abuse is to examine the Treatment Episode Data Set (TEDS) for individuals who report using pain relievers (opioids),4 CNS depressants (sedatives and tranquilizers),5 and stimulants6
at the time of admission to substance abuse treatment (Substance Abuse and Mental Health Data Archive, 2008).
Overall reported use of these drug categories combined in 2007 was 16.5% in Indiana, which was signifi cantly higher than the nation’s rate of 12.4%. A look at the individual drug types shows that Indiana’s rates were signifi cantly higher for pain relievers and CNS depressants, but not for stimulants (see Figure 9.2).
In Indiana, signifi cant differences in reported prescription drug abuse were seen by gender, race, and age group (see Table 9.3):
• Gender—Women reported higher rates of use across all prescription drug categories.
• Race—Whites had the highest and blacks had the lowest rates across all prescription drug categories.
• Age group—Differences by age group were observed for all prescription drug categories.
4We used TEDS variables “nonprescription methadone” and “other opiates/synthetics” to defi ne pain reliever use.
5We used TEDS variables “benzodiazepines”, “other tranquilizers”, “barbiturates”, and “other sedatives/hypnotics” to defi ne CNS depressant use.
Table 9.3 Percentage of Indiana and U.S. Treatment Episodes with Nonmedical Prescription Drug Use Reported at Treatment Admission, by Drug Category, Gender, Race, and Age Group (Treatment Episode Data Set, 2007)
Table 9.2 Prevalence Estimates for Nonmedical Use of Prescription Medication among Adults in Indiana (Indiana Household Survey on Substance Abuse, 2008)
All Prescription Drugs Pain Relievers Sedatives/Tranquilizers Stimulants
Gender Male 13.5% 9.2% 5.2% 0.8%
Female 22.3% 15.3% 9.3% 1.4%
Race White 19.4% 13.5% 7.7% 1.2%
Black 3.7% 1.8% 1.6% 0.5%
Other 11.0% 6.6% 4.6% 1.0%
Age Group Under 18 12.3% 5.9% 7.4% 1.1%
18 to 24 18.9% 12.2% 8.2% 1.1%
25 to 34 20.4% 15.1% 7.2% 1.3%
35 to 44 12.9% 8.6% 5.3% 0.9%
45 to 54 11.0% 7.8% 4.5% 0.7%
55 and over 11.6% 8.0% 4.6% 0.6%
Lifetime Use Past-Year Use Past-Month Use
Gender Male 6.6% 2.4% 1.2%
Female 2.8% 0.4% 0.1%
Race White 4.5% 1.2% 0.5%
Black 4.0% 1.8% 1.4%
Other 7.3% 3.9% 2.2%
Age Group 18-25 12.5% 6.1% 2.8%
26-34 5.9% 1.8% 1.0%
35-44 3.8% 0.9% 0.5%
45-54 3.6% 0.3% 0.0%
55-64 3.1% 0.1% 0.1%
65+ 0.6% 0.0% 0.0%
Total 4.6% 1.4% 0.7%
Source: Substance Abuse and Mental Health Data Archive, 2008 Source: State Epidemiology and Outcomes Workgroup, 2008
A review of TEDS data from 2000 through 2007 shows that rates for use of certain nonmedical prescription drugs have increased signifi cantly in both Indiana and the nation; this trend includes pain reliever and sedative/
tranquilizer use. However, the pattern was different for stimulant use, rates of which decreased for the years reviewed (P < 0.001) (see Figure 9.3). For county-level information, see Appendix 9A, pages 156-157.
Figure 9.3 Percentage of Indiana and U.S. Treatment Episodes with Nonmedical Prescription Drug Use Reported at Treatment Admission, by Drug Category (Treatment Episode Data Set, 2000–2007)
Source: Substance Abuse and Mental Health Data Archive, 2008
Youth Consumption Patterns
Estimates from the 2007 NSDUH state that 7.74% (95%
CI: 6.29–9.77) of Indiana’s young people between ages 12 and 17 (approximately 42,000 residents) used prescription pain medications for nonmedical purposes in the past year. The national rate of prescription drug abuse by 12- to 17-year-olds was similar at 6.91%.
Other prescription drugs with high potential for abuse, especially among young people, are methylphenidate (Ritalin®) and Adderall®. Both substances are stimulants that enhance brain activity and increase alertness and energy. They are used in the treatment of Attention Defi cit Hyperactivity Disorder (ADHD), Attention Defi cit Disorder (ADD), and narcolepsy. When Ritalin® and Adderall® are taken by an individual without ADD/ADHD, they create a stimulating effect by increasing focus and attentiveness,
making them attractive drugs to teenagers. According to the National Institute on Drug Abuse, teenagers of middle- and upper-class socioeconomic status are most likely to abuse these substances by crushing and snorting the tablets. Some injection drug users combine heroin with Ritalin to strengthen the effect.
According to the 2009 Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents (ATOD) survey, with a few exceptions, the nonmedical use of Ritalin® and Adderall® held steady compared to last year.
However, lifetime, past-year, and past-month use of these drugs decreased among youth in Grade 9 (Indiana Prevention Resource Center, 2009).
Lifetime, past-year, and past-month use of non- prescribed narcotics (opioids) remained stable or decreased for students in all grades, as did nonmedical use of
tranquilizers (Indiana Prevention Resource Center, 2009).
For Indiana prevalence rates of lifetime, annual, and current nonmedical use of tranquilizers, narcotics, and Ritalin®/Adderall® among 12th grade students, see Table 9.4. (For regional prevalence rates, grades 6 through 12,
see Appendix 9B, pages 158-160). The mean (average) age of fi rst time use among Indiana’s students was 14.1 years for Ritalin®/Adderall®, 13.5 years for tranquilizers, and 14.2 years for narcotics use (Indiana Prevention Resource Center, 2009).
Table 9.4 Percentage of Indiana 12th Grade Students Reporting Lifetime, Annual, and Current Nonmedical Use of Tranquilizers, Narcotics, and Ritalin®/Adderall® (Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents Survey, 2007–2009)
Lifetime Use Annual Use Current Use 2007 2008 2009 2007 2008 2009 2007 2008 2009 Tranquilizer 12.9% 12.4% 12.0% 8.3% 7.9% 7.4% 4.0% 4.0% 3.7%
Narcotics 12.1% 12.4% 12.5% 7.6% 8.1% 7.8% 3.8% 4.0% 4.0%
Ritalin®/Adderall® 11.3% 11.8% 11.6% 7.0% 7.2% 7.0% 2.9% 3.3% 3.1%
Source: Indiana Prevention Resource Center, 2009
The Monitoring the Future (MTF) survey collects data on drug use among 8th, 10th, and 12th grade students on the national level (Inter-university
Consortium for Political and Social Research, University of Michigan., n.d.). A comparison of Indiana and U.S.
consumption patterns in high school seniors, from 2000 through 2008, shows that current (past month) use of
tranquilizers in Indiana, even though on the decline, is still higher than in the nation. Past-month use of narcotics has been decreasing among Hoosier students since 2002 and is now similar to U.S. use (see Figure 9.4). However, due to the nature of the data, statistical signifi cance of the results could not be ascertained.
Figure 9.4 Percentage of Indiana and U.S. 12th Grade Students Reporting Current Use of Narcotics and
Tranquilizers (Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents Survey, 2000–2009, and Monitoring the Future Survey, 2000–2008)
Note: Information for 2009 is not available yet at the national level.
Source: Indiana Prevention Resource Center, 2009; Inter-university Consortium for Political and Social Research, University of Michigan., n.d.
All Prescription Drugs Pain Relievers Sedatives &
Tranquilizers Stimulants
Under 18 12.3% 5.9% 7.4% 1.1%
Over 18 16.6% 11.5% 6.6% 1.0%
0%
5%
10%
15%
20%
Another data source for assessing nonmedical prescription drug use is the Treatment Episode Data Set (TEDS). Young Hoosiers (under the age of 18) in treatment reported signifi cantly less use of psychotherapeutics than adults 18 and older. An
examination of use by individual drug category shows that young patients used signifi cantly less pain relievers than their older counterparts. However, rates for sedative/tranquilizer and stimulant use were similar between the two groups (see Figure 9.5).
Figure 9.5 Percentage of Treatment Episodes with Nonmedical Prescription Drug Use Reported at Treatment Admission in Indiana, by Drug Category and Underage Status (Treatment Episode Data Set, 2007)
Source: Substance Abuse and Mental Health Data Archive, 2008