Elsevier

Preventive Medicine

Volume 121, April 2019, Pages 94-98
Preventive Medicine

Short Communication
Prescription opioid misuse among middle-aged and older adults in the United States, 2015–2016

https://doi.org/10.1016/j.ypmed.2019.02.018Get rights and content

Abstract

Adults ≥50 years of age have high rates of prescription opioid use. The purpose of this study is to estimate the prevalence and correlates of prescription opioid misuse among middle-aged and older adults in the United States who use prescription opioids. Data from adults age ≥ 50 from the two most recent cohorts (2015 and 2016) of the National Survey of Drug Use and Health were examined (N = 17,608). Characteristics of past-year prescription opioid misusers, including demographics, substance use, depression, chronic disease, and emergency department (ED) use, were compared to adults who used prescription opioids as prescribed in the past year and non-users. We used multivariable logistic regression to determine correlates of prescription opioid misuse among adults who used prescription opioids. Among the entire sample, 61.4% reported no past-year prescription opioid use, 36.0% reported past-year prescription opioid use without misuse, and 2.5% reported past-year prescription opioid misuse. Among past-year prescription opioid users, 6.6% reported misuse. Past-year misuse was higher among males, adults age 50–64, misusers of prescription sedatives, stimulants, and tranquilizers, users of other substances (i.e., tobacco, marijuana, cocaine), and those with alcohol use disorder. Past-year misuse was lower among adults with 2 or more chronic diseases. Past-year prescription misuse of sedatives (AOR 4.08 [95% CI 2.05–8.12]), stimulants (AOR 3.88 [95% CI 2.00–7.53]), and tranquilizers (AOR 10.02 [95% CI 6.48–15.50]) were all associated with past-year opioid misuse. Characteristics of opioid misusers determined in this study—particularly misuse of other substances—may help determine middle-aged and older adults at risk for prescription opioid misuse.

Introduction

There was a fivefold increase in prescription opioid overdose deaths from 1996 to 2016 in the United States (US) (Center for Disease Control, 2018). While studies have estimated the prevalence and characteristics of younger adults who misuse prescription opioids, little research has focused specifically on middle-aged and older adults. This is imperative because middle-aged and older adults (≥50 years of age) use prescription opioids at a higher rate compared to younger adults (B. Han et al., 2017). Due to the physiological changes of aging and increased chronic medical disease burden, older adults are particularly vulnerable to overdose, especially when co-using other prescribed medications (Jones and McAninch, 2015). Understanding prescription opioid misuse among older adults can inform providers of unique risks and the development of focused interventions.

We used nationally representative data from the National Survey on Drug Use and Health (NSDUH), utilizing its revised and updated questions on prescription psychotherapeutic medication misuse beginning in 2015, to estimate the prevalence of prescription opioid misuse and examine characteristics of misuse by middle-aged and older adults who use prescription opioids. Prior to 2015, NSDUH inquired about “nonmedical use”, defined as when a prescription opioid was used when not prescribed to the user or used for the experience or feeling caused by the drug (Blazer and Wu, 2009; Schepis et al., 2018). However, this definition of nonmedical use can be misleading as it is possible for patients to use as prescribed and still enjoy the feeling from its use. This is the first study to our knowledge that uses the revised misuse definition to investigate recent prescription opioid misuse by middle-aged and older adults, a population with the highest rates of prescription opioid use (B. Han et al., 2017).

Section snippets

Methods

Using NSDUH, we analyzed cross-sectional, aggregated data from adults age ≥50 years of age (n = 17,608) participating in the two most recent survey years of NSDUH: 2015 and 2016. Since the outcome of interest (i.e. prescription drug misuse) was relatively rare, similar to previous analyses (Blazer and Wu, 2009; B.H. Han et al., 2017; Hasin et al., 2015), we aggregated years into pairs to increase power. NSDUH surveys probability samples of non-institutionalized individuals in the 50 US states

Results

Of respondents age ≥50, 36.0% (95% CI 35.1–37.0%) reported past-year prescription opioid use as prescribed, and 2.5% (95% CI 2.2–2.9%) reported past-year prescription opioid misuse. By age group: among adults age 50–64, 36.2% (95% CI 34.8–37.5%) reported past-year opioid use as prescribed and 3.6% (95% CI 3.2–4.0%) reported past-year opioid misuse, while among adults age ≥65 35.9% (95% CI 34.5–37.2%) reported past-year opioid use as prescribed and 1.2% (95% CI 0.9–1.5%) reported past-year

Discussion

The use of other substances by older adults who misuse prescription opioids is prevalent. Our estimates for prescription opioid misuse among older adults (3.6% among adults age 50–64 and 1.2% among adults age ≥65) using recent survey years of NSDUH with the updated misuse definition are higher compared to studies using NSDUH's previous “nonmedical use” definition. A study of NSDUH from 2005/2006 estimated prescription opioid misuse to be 1.9% among adults age 50–64 and 0.6% among adults age ≥65

Conclusions

This study indicates there is a population of high-risk older adults who engage in potentially dangerous polysubstance use. Focus needs to be placed on screening at-risk older adults for substance use and prescription drug misuse, and to minimize the overall use of opioids, sedatives, and tranquilizers. Emphasis should be on educating providers to decrease potentially inappropriate medications for older adults who are at high risk for adverse events from prescription drug misuse. Education is

Declaration of interest

The authors declare no conflict of interest and have no financial disclosures.

Acknowledgments

This research was supported by three grants through the National Institute on Drug Abuse: K23DA043651 (Han), K01DA038800 (Palamar) and K24DA038345 (Sherman). The National Institutes of Health provided financial support for the project and the preparation of the manuscript but did not have a role in the design of the study, the analysis of the data, the writing of the manuscript, nor the decision to submit the present research.

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