Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups: 2015–2017 National Survey on Drug Use and Health

Abstract

BACKGROUND: Prescription opioid misuse among older adults has received little attention to date. Potential age variation in characteristics of and motivations for prescription opioid misuse has not been fully characterized yet has important implications for preventing diversion and misuse. OBJECTIVE: To examine (1) age-specific patterns of source of misused prescription opioid pain relievers and motives for misuse and (2) age-specific and source-specific associations with opioid use disorder (OUD), heroin use, benzodiazepine misuse, and OUD treatment utilization. DESIGN: Cross-sectional study using 3 waves (2015)(2016)(2017) of the National Survey on Drug Use and Health (68% average response rate) PARTICIPANTS: Respondents aged 12 and older with pastyear prescription opioid pain reliever misuse (n = 8228) MAIN MEASURES: Source for the most-recently misused prescription pain reliever (categorized as medical, social, or illicit/other), motive for last episode of misuse, OUD, heroin use, benzodiazepine misuse, and OUD treatment. KEY RESULTS: Adults 50 and older comprised approximately 25% of all individuals reporting past-year prescription opioid misuse. A social source was most common for individuals under age 50 while a medical source was most common for individuals 50 and older. The most commonly reported motive for misuse was to "relieve physical pain"; the frequency of this response increased across age groups (47% aged 12-17 to 87% aged 65+). Among adults age 50 and older with prescription opioid misuse, 17% met criteria for OUD, 15% reported pastyear benzodiazepine misuse, and 3% reported past-year heroin use. CONCLUSIONS: Physicians continue to be a direct source of prescription opioids for misuse, particularly for older adults. Ongoing clinical initiatives regarding optimal opioid prescribing practices are needed in addition to effective non-opioid strategies for pain management. Clinical initiatives should also include screening adult and adolescent patients for non-medical use of prescription opioids as well as improving access to OUD treatment for individuals of all ages.

Prescription Drug Misuse: Taking a Lifespan Perspective

“…124 More recent research on opioid PDM suggests also increasing self-treatment (ie, pain relief ) motives with aging, with concomitant decreases in recreational motives. 80,90 Fourth, PDM correlates and consequences are similar across medication classes and age groups, except for overdose, which is primarily a consequence of opioid or combined opioid-benzodiazepine misuse and concentrated in early middle adults. PDM is robustly associated with problematic substance use, SUD, and psychopathology.…”

“…88 A local sample of college undergraduates was similar in that pain relief only was endorsed by less than half of participants, with particularly low rates (29.7%) in those with past-year opioid PDM. 89 Opioid PDM to relieve pain markedly increases with age, peaking in those 65 years and older, per both nationally representative NSDUH data across the US population 80,90 and data from Florida in adults aged 60 and older. 91 In contrast, there are decreases in opioid PDM motivated to get high or experiment, which peak either in adolescence or young adulthood.…”

“…91 In contrast, there are decreases in opioid PDM motivated to get high or experiment, which peak either in adolescence or young adulthood. 80,90 Adolescent and young adult opioid PDM for non-pain relief motives is consistently associated with poorer outcomes, mirroring the general population. [87][88][89]92 Furthermore, analyses of data from Florida found elevated prevalence rates of SUD and suicidal ideation in adults 60 and older engaged in opioid PDM for non-pain relief motives.…”

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

“…Studies of other opioid interventions, such as PDMPs, could potentially confound producer-and consumer-side responses. 16 Understanding such substitution patterns are especially important given the current focus on using supply-side policies to combat opioid abuse.…”

“…Thus, the reformulation did not have a producer-level substitution response. 16 For example, a PDMP may reduce the supply of opioids diverted from the medical side of the market (e.g., pharmacies). However, the black market could compensate for this supply reduction by funneling in opioids from out-of-state pharmacies with less stringent PDMPs.…”