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Research
Original Investigation
Nonmedical Prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States, 2003-2013 Beth Han, MD, PhD, MPH; Wilson M. Compton, MD, MPE; Christopher M. Jones, PharmD, MPH; Rong Cai, MS Editorial page 1453 IMPORTANCE Since 1999, the United States has experienced increases in morbidity and
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mortality associated with nonmedical use of prescription opioids. OBJECTIVE To assess national trends in and characteristics of nonmedical prescription opioid use and use disorders and the national trend in related mortality. DESIGN, SETTING, AND PARTICIPANTS Prevalence of nonmedical use and use disorders and related risk factors were based on data from 472 200 persons aged 18 through 64 years who participated in the 2003-2013 National Surveys on Drug Use and Health. Mortality was based on the 2003-2013 National Vital Statistics System’s Multiple Cause of Death Files.
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EXPOSURES Prevalence of nonmedical use of prescription opioids. MAIN OUTCOMES AND MEASURES Nonmedical prescription opioid use and use disorders. RESULTS Among adults aged 18 through 64 years, the prevalence of nonmedical use of prescription opioids decreased from 5.4% (95% CI, 5.08%-5.70%) in 2003 to 4.9% (95% CI, 4.58%-5.22%) in 2013 (absolute difference, −0.5%; 95% CI, −0.11% to −0.89%), but the prevalence of prescription opioid use disorders increased from 0.6% (95% CI, 0.54%-0.76%) in 2003 to 0.9% (95% CI, 0.75%-1.01%) in 2013 (absolute difference, 0.3%; 95% CI, 0.03%-0.43%). The 12-month prevalence of high-frequency use (ⱖ200 days) also increased from 0.3% (95% CI, 0.19%-0.35%) in 2003 to 0.4% (95% CI, 0.31%-0.48%) in 2013 (absolute difference, 0.1%; 95% CI, 0.01%-0.29%). Mortality assessed by drug overdose death rates involving prescription opioids increased from 4.5 per 100 000 (95% CI, 4.42-4.61) in 2003 to 7.8 per 100 000 (95% CI, 7.64-7.89) in 2013 (absolute difference, 3.3; 95% CI, 3.09-3.41) among adults aged 18 through 64 years. The mean number of days of nonmedical use of prescription opioids increased from 2.1 (95% CI, 1.83-2.37) in 2003 to 2.6 (95% CI, 2.27-2.85) in 2013 (absolute difference, 0.5, 95% CI, 0.05-0.86). The model-adjusted prevalence of having prescription opioid use disorders among nonmedical users increased to 15.7% (95% CI, 13.87%-17.67%) in 2010, 16.1% (95% CI, 14.36%-17.99%) in 2011, 17.0% (95% CI, 15.07%-19.12%) in 2012, and 16.9% (95% CI, 14.95%-19.03%) in 2013 from 12.7% (95% CI, 11.04%-14.53%) in 2003. CONCLUSIONS AND RELEVANCE During the 2003-2013 years, among adults aged 18 through 64 years, the percentage of nonmedical use of prescription opioids decreased. In contrast, the prevalence of prescription opioid use disorders, frequency of use, and related mortality increased.
JAMA. 2015;314(14):1468-1478. doi:10.1001/jama.2015.11859 1468
Corresponding Author: Beth Han, MD, PhD, MPH, Substance Abuse and Mental Health Services Administration, One Choke Cherry Rd, Room 2-1079, Rockville, MD 20857 (
[email protected]). (Reprinted) jama.com
Copyright 2015 American Medical Association. All rights reserved.
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Author Affiliations: Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Han, Cai); National Institute on Drug Abuse, the National Institutes of Health, Bethesda, Maryland (Compton); Food and Drug Administration, Silver Spring, Maryland (Jones).
Nonprescription Opioid Use in the United States
S
ince 1999, the United States has experienced increases in morbidity and mortality associated with nonmedical use of prescription opioids.1,2 During this period, emergency department (ED) visits and drug overdose deaths involving these drugs have increased rapidly.2-5 The prevalence of people aged 12 years or older who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV) criteria for prescription opioid dependence increased from 0.4% in 2003 to 0.6% in 2013.6 Moreover, the estimated rates of ED visits involving prescription opioids more than doubled from 82.5 per 100 000 in 2004 to 184.1 per 100 000 in 2011.7 Furthermore, age-adjusted rates for drug-poisoning deaths involving prescription opioids more than tripled from 1.4 per 100 000 population in 1999 to 5.1 in 2013.8 Also in 2013, prescription opioids were involved in more deaths (>16 200) than all illicit drugs combined (14 775).8 Due to these increases in morbidity and mortality, prescription opioid abuse has become a US epidemic.2,9,10 To fully understand the current status of the epidemic and to examine who is currently most affected, an examination of nationally representative US surveillance data is needed. To further develop a detailed picture of the public health implications, we used 2 national data sets to examine trends in the prevalence of nonmedical use of prescription opioids, prescription opioid use disorders, frequency of use, and drug overdose deaths involving prescription opioids. Because nonelderly adults are the main population at risk of chronic nonmedical use of prescription opioids and related morbidity and mortality,11 this study focused on adults aged 18 through 64 years.
Methods Data Sources First, we examined data of adults who participated in the 2003-2013 National Surveys on Drug Use and Health (NSDUH), which are conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). They provided nationally representative data on nonmedical use of prescription opioids and use disorders among the civilian, noninstitutionalized population aged 12 years or older in the United States. Excluded from NSDUH were persons without a household address (eg, homeless persons not living in shelters), active-duty military personnel, and institutional residents. The data collection protocol of the NSDUH was approved by the institutional review board at the Research Triangle Institute (RTI) International. Written informed consent was obtained from each study participant. The annual mean weighted response rate of the 2003-2013 NSDUH was 66.3% (range, 60.2%-70.2%),12 according to the definition of response rate 2 for in-person household surveys by the American Association for Public Opinion Research.13 Details regarding NSDUH data collection are provided elsewhere.12 Second, we examined data from the 2003-2013 Multiple Cause of Death Files from the National Vital Statistics System.14 Drug overdose deaths were those assigned an underlying cause of death using the International Classification of Diseases, Tenth jama.com
Original Investigation Research
Revision (ICD-10) codes X40-X44 (unintentional), X60-X64 (suicide), X85 (homicide), and Y10-Y14 (undetermined intent). Prescription opioid overdose deaths were those assigned specific ICD-10 codes T40.2-T40.4. Similar to NSDUH analyses. We limited analyses to drug overdose deaths among adults aged 18 through 64 years in the United States.
Measures The NSDUH defined 12-month nonmedical use of prescription opioids as use in the prior 12 months without a prescription or as use with a prescription simply for the experience or feeling caused by opioids.12 If respondents reported using prescription opioids nonmedically in the past year, they were asked to state the number of days they used them nonmedically. Consistent with previous work,11,15,16 we defined frequent users as those with 100 days or more of nonmedical opioid use in the past year and highly frequent users as those with 200 days or more. For persons reporting nonmedical prescription opioid use, NSDUH collected sources of the medications, including given by a friend or a relative for free, prescribed by 1 or more physicians, stolen from a friend or a relative, bought from a friend or a relative, and bought from a drug dealer or stranger. Age at first nonmedical use of prescription opioids was also assessed (
