Nonmedical Use of Prescription-Type Drugs, by County Type

In Brief
  • About 15.7 million persons aged 12 or older used prescription-type drugs nonmedically in the past year, and 6.7 million did so in the past month
  • Past year nonmedical use of prescription-type drugs was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties (5.4 vs. 6.4 and 6.6 percent); past month use was similar among all three types of counties
  • The rate of past year nonmedical use of pain relievers was lower in rural counties than in metropolitan and urbanized non-metropolitan counties (4.2 vs. 4.9 and 5.1 percent), as was the rate of nonmedical use of tranquilizers (1.8 vs. 2.1 and 2.3 percent); the rate of nonmedical use of stimulants and sedatives did not vary by type of county

Nonmedical use of prescription drugs ranks as the second most common class of illicit drug use in the United States.1 Recent data indicate that the rate of use declined slightly between 2010 and 20111 and suggest that National, State, and local efforts to reduce prescription drug misuse may be beginning to have an impact. However, with an annual average of 15.7 million people aged 12 or older having misused prescription drugs between 2005 and 2011, there is still much work left to be done.

State and local public health authorities are better able to understand and effectively serve their communities if they know the prevalence of nonmedical use of prescription drugs in various types of counties (e.g., metropolitan, urbanized non-metropolitan, and rural). Access to drugs and the delivery of prevention and treatment services may differ by county type. Data by county type may be helpful to State and local public health authorities for allocating resources, targeting prevention and treatment interventions, and rapidly identifying emerging problems. The findings in this report highlight the differences in nonmedical prescription drug use by county type using data from the National Survey on Drug Use and Health (NSDUH).

NSDUH asks persons aged 12 or older questions related to their nonmedical use of prescription-type drugs during the past year. Nonmedical use of prescription-type drugs is defined as use of these drugs without a prescription or use that occurs simply for the experience or feeling the drug causes; use of over-the-counter (OTC) drugs and legitimate use of prescription-type drugs are not included. For this report, respondents are assigned to one of three county types, based on designations by the U.S. Department of Agriculture2:

  • "rural" non-metropolitan (hereafter referred to as "rural")—counties are not part of a metropolitan statistical area (MSA)3 and have an urbanized population of less than 20,000;
  • "urbanized" non-metropolitan—counties are located outside of an MSA and have an urbanized population of 20,000 or greater; and
  • metropolitan—counties are located inside of an MSA, regardless of population

All estimates in this report are based on combined data from the 2005 to 2011 NSDUHs.


Types of Counties

According to combined 2005 to 2011 NSDUH data, 209 million persons aged 12 or older (83.6 percent) lived in counties that were in metropolitan areas, 17 million (6.7 percent) lived in counties that were urbanized non-metropolitan, and 24 million (9.7 percent) lived in counties that were rural.


Nonmedical Use of Prescription-Type Drugs

About 15.7 million persons aged 12 or older (6.3 percent) used prescription-type drugs nonmedically in the past year, and 6.7 million (2.7 percent) did so in the past month. Past year nonmedical use of prescription-type drugs was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties (5.4 vs. 6.4 and 6.6 percent) (Figure 1). Past month use, however, was similar among all three types of counties.

Figure 1. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type: 2005 to 2011
This is a bar graph comparing past year and past month nonmedical use of prescription-type drugs among persons aged 12 or older, by county type: 2005 to 2011. Accessible table located below this figure.

Figure 1 Table. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type: 2005 to 2011
County Type Past Year Past Month
Metropolitan 6.4% 2.7%
Urbanized Non-metropolitan 6.6% 2.8%
Rural 5.4% 2.4%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005, 2006 to 2010 (revised March 2012), and 2011.

Similar patterns in past year and past month nonmedical use of prescription-type drugs by county type were seen for both genders (Figure 2). For example, past year use was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties among both males (5.7 vs. 6.9 and 7.1 percent) and females (5.1 vs. 5.8 and 6.1 percent).

Figure 2. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type and Gender: 2005 to 2011
This is a bar graph comparing past year and past month nonmedical use of prescription-type drugs among persons aged 12 or older, by county type and gender: 2005 to 2011. Accessible table located below this figure.

Figure 2 Table. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type and Gender: 2005 to 2011
County Type Past Year Past Month
Male Female Male Female
Metropolitan 6.9% 5.8% 3.0% 2.4%
Urbanized Non-metropolitan 7.1% 6.1% 3.2% 2.5%
Rural 5.7% 5.1% 2.7% 2.2%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005, 2006 to 2010 (revised March 2012), and 2011.

Patterns varied, however, when examined by age (Figure 3). Lower rates of past year nonmedical use of prescription-type drugs in rural counties were only seen among persons aged 26 or older. Among adolescents aged 12 to 17, the rate of past year use was lower among those in counties that were in metropolitan areas than among those in urbanized non-metropolitan counties (7.8 vs. 8.7 percent) but was not statistically different from those in rural counties. Among young adults aged 18 to 25, no differences were seen in past year use.

Figure 3. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type and Age Group: 2005 to 2011
This is a bar graph comparing past year and past month nonmedical use of prescription-type drugs among persons aged 12 or older, by county type and age group: 2005 to 2011. Accessible table located below this figure.

Figure 3 Table. Past Year and Past Month Nonmedical Use of Prescription-Type Drugs among Persons Aged 12 or Older, by County Type and Age Group: 2005 to 2011
County Type Past Year Past Month
Aged
12 to 17
Aged
18 to 25
Aged 26
or Older
Aged
12 to 17
Aged
18 to 25
Aged 26
or Older
Metropolitan 7.8% 14.6% 4.7% 3.0% 5.9% 2.1%
Urbanized Non-metropolitan 8.7% 15.5% 4.8% 3.6% 6.4% 2.1%
Rural 8.0% 14.4% 3.8% 3.2% 6.1% 1.8%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005, 2006 to 2010 (revised March 2012), and 2011.

As with the overall rates, rates of past month nonmedical use of prescription-type drugs were generally similar across county type for each of the age groups. The one exception was among adolescents aged 12 to 17. In this age group, the rate of past month use was higher among those in urbanized nonmetropolitan counties than among those in counties that were in metropolitan areas (3.6 vs. 3.0 percent).


Types of Prescription Drugs Used Nonmedically

Overall, 4.8 percent of persons aged 12 or older reported past year nonmedical use of pain relievers, 2.1 percent reported nonmedical use of tranquilizers, 1.2 percent reported nonmedical use of stimulants, and 0.3 percent reported nonmedical use of sedatives. The rate of past year nonmedical use of pain relievers was lower in rural counties than in metropolitan and urbanized non-metropolitan counties (4.2 vs. 4.9 and 5.1 percent), as was the rate of nonmedical use of tranquilizers (1.8 vs. 2.1 and 2.3 percent) (Figure 4). The rate of nonmedical use of stimulants and sedatives did not vary by type of county.

Figure 4. Types of Prescription Drugs Used Nonmedically in the Past Year among Persons Aged 12 or Older, by County Type: 2005 to 2011
This is a bar graph comparing types of prescription drugs used nonmedically in the past year among persons aged 12 or older, by county type: 2005 to 2011. Accessible table located below this figure.

Figure 4 Table. Types of Prescription Drugs Used Nonmedically in the Past Year among Persons Aged 12 or Older, by County Type: 2005 to 2011
County Type Pain Relievers Tranquilizers Stimulants Sedatives
Metropolitan 4.9% 2.1% 1.2% 0.3%
Urbanized Non-metropolitan 5.1% 2.3% 1.3% 0.3%
Rural 4.2% 1.8% 1.1% 0.3%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005, 2006 to 2010 (revised March 2012), and 2011.


Past Year Initiation of Nonmedical Use of Prescription-Type Drugs

Respondents who reported nonmedical use of prescription type drugs were asked when their first use was4; responses to these questions were used to identify persons at risk for substance use initiation (i.e., persons who had not ever used the substance prior to the 12 months preceding the survey) and to identify recent initiates (i.e., persons who used the substance for the first time in the 12 months prior to the survey). An estimated 2.5 million persons aged 12 or older reported using prescription-type drugs nonmedically for the first time in the past year, representing 1.2 percent of those who were at risk for initiation of use. Rates of initiation were lower among those living in rural counties than among those living in metropolitan and urbanized non-metropolitan counties (1.0 vs. 1.3 and 1.4 percent, respectively). This pattern was seen among males (Figure 5). All three types of counties had similar rates of past year initiation among females and among persons aged both 18 to 25 and 26 or older. Among adolescents aged 12 to 17, the difference in the rate of past year initiation between those living in urbanized non-metropolitan counties and those in metropolitan counties, although small, did reach statistical significance (4.2 vs. 3.6 percent).

Figure 5. Past Year Initiation of Nonmedical Use of Prescription Drugs among Persons Aged 12 or Older at Risk for Initiation, by County Type and Demographic Characteristics: 2005 to 2011
This is a bar graph comparing past year initiation of nonmedical use of prescription drugs among persons aged 12 or older at risk for initiation, by county type and demographic characteristics: 2005 to 2011. Accessible table located below this figure.

Figure 5 Table. Past Year Initiation of Nonmedical Use of Prescription Drugs among Persons Aged 12 or Older at Risk for Initiation, by County Type and Demographic Characteristics: 2005 to 2011
County Type Age Gender
Aged 12 to 17 Aged 18 to 25 Aged 26 or Older Male Female
Metropolitan 3.6% 3.7% 0.5% 1.1% 1.4%
Urbanized Non-metropolitan 4.2% 4.2% 0.5% 1.2% 1.5%
Rural 3.7% 3.5% 0.4% 0.8% 1.2%
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2005, 2006 to 2010 (revised March 2012), and 2011.


Discussion

With at least 5 percent of the population in rural, urbanized non-metropolitan, and metropolitan counties misusing prescription-type drugs in the past year, misuse of these drugs remains a health concern in all communities. Data in this report indicate that misuse of prescription-type drugs is generally less common in rural counties than in metropolitan and urbanized non-metropolitan counties. Prevention and treatment efforts require public health information-sharing efforts that raise awareness of the extent of prescription drug misuse. Although the national rate of nonmedical use of prescription-type drugs declined between 2010 and 2011,1 Federal, State, and local policymakers must continue to plan for and allocate resources to improve prevention, intervention, and treatment programs in varying types of communities to reduce the misuse of prescription-type drugs.


End Notes
1 Center for Behavioral Health Statistics and Quality. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 12-4713, NSDUH Series H-44). Rockville, MD: Substance Abuse and Mental Health Services Administration.
2 Counties were combined into three categories based on the 2003 rural-urban continuum codes originally developed by the U.S. Department of Agriculture. Metropolitan counties are those inside a metropolitan statistical area (MSA) as defined by the Office of Management and Budget in June 2003. Counties outside metropolitan areas are classified based on the number of people in each county who live in an urbanized area, as defined by the Census Bureau at the subcounty level. Urbanicity (i.e., whether an area is rural or urban) is a designation constructed by the census at the block level. This study refers to "rural" non-metropolitan counties as those with fewer than 20,000 people in urbanized areas and "urbanized" non-metropolitan counties as those with 20,000 or more people in urbanized areas; however, there can be rural areas within both metropolitan and urbanized non-metropolitan counties.
3 Metropolitan counties are inside an MSA as defined by the Office of Management and Budget in June 2003. A metropolitan area contains a core urban area with a population of 50,000 or more. Each metropolitan area consists of one or more counties and includes the counties containing the core urban area, as well as any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core. U.S. Census Bureau. (2012). Metropolitan and micropolitan statistical areas main. Retrieved June 14, 2012, from http://www.census.gov/population/metro/
4 Respondents whose age at first use was equal to or 1 year less than their current age were asked to indicate the month in which they initiated their use.



Suggested Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 11, 2013). The NSDUH Report: Nonmedical Use of Prescription-Type Drugs, by County Type. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The combined 2005 to 2011 data used in this report are based on information obtained from 477,000 persons aged 12 or older. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 12-4713, NSDUH Series H-44). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.samhsa.gov/data/NSDUH.aspx.


Additional Data Tables

Table 1. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Percentages of Past Month and Past Year Nonmedical Use of Psychotherapeutics among Persons Aged 12 or Older, by County Type: 2005-2011 Combined
County Type Past Month:
Number
Past Month:
Percentage
Past Month:
Standard Error
Past Year:
Number
Past Year:
Percentage
Past Year:
Standard Error
TOTAL 6,680 2.7% 0.04 15,732 6.3% 0.06
Metropolitan
   Counties
5,611 2.7% 0.04 13,313 6.4% 0.07
Urbanized
   Non-metropolitan
   Counties
   478 2.8% 0.13   1,111 6.6% 0.21
Rural Counties    591 2.4% 0.11   1,308 5.4% 0.16
*Low precision; no estimate reported.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
NOTE: Estimates in this table include data from methamphetamine items added in 2005 and 2006 and are not comparable with estimates presented in NSDUH reports prior to the 2007 National Findings report. See Section B.4.8 in Appendix B of the Results from the 2008 National Survey on Drug Use and Health: National Findings.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

Table 2. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Percentages of Past Year Nonmedical Use of Psychotherapeutics among Persons Aged 12 or Older, by County Type, Age Group, and Gender: 2005-2011 Combined
Demographic
Characteristic
Metropolitan:
Number
Metropolitan:
Percentage
Metropolitan:
Standard
Error
Urbanized
Non-
metropolitan:
Number
Urbanized
Non-
metropolitan:
Percentage
Urbanized
Non-
metropolitan:
Standard
Error
Rural:
Number
Rural:
Percentage
Rural:
Standard
Error
TOTAL 13,313   6.4% 0.07 1,111   6.6% 0.21 1,308   5.4% 0.16
Aged 12-17   1,624   7.8% 0.10    145   8.7% 0.38    188   8.0% 0.25
Aged 18-25   4,137 14.6% 0.14    346 15.5% 0.47    397 14.4% 0.42
Aged 26 or
   Older
  7,552   4.7% 0.08    620   4.8% 0.23    723   3.8% 0.18
Male   7,030   6.9% 0.10    577   7.1% 0.32    670   5.7% 0.23
Female   6,283   5.8% 0.07   534   6.1% 0.28    638   5.1% 0.20
*Low precision; no estimate reported.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
NOTE: Estimates in this table include data from methamphetamine items added in 2005 and 2006 and are not comparable with estimates presented in NSDUH reports prior to the 2007 National Findings report. See Section B.4.8 in Appendix B of the Results from the 2008 National Survey on Drug Use and Health: National Findings.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

Table 3. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Percentages of Past Month Nonmedical Use of Psychotherapeutics among Persons Aged 12 or Older, by County Type, Age Group, and Gender: 2005-2011 Combined
Demographic
Characteristic
Metropolitan:
Number
Metropolitan:
Percentage
Metropolitan:
Standard
Error
Urbanized
Non-
metropolitan:
Number
Urbanized
Non-
metropolitan:
Percentage
Urbanized
Non-
metropolitan:
Standard
Error
Rural:
Number
Rural:
Percentage
Rural:
Standard
Error
TOTAL 5,611 2.7% 0.04 478 2.8% 0.13 591 2.4% 0.11
Aged 12-17    637 3.0% 0.06   60 3.6% 0.23   76 3.2% 0.16
Aged 18-25 1,674 5.9% 0.09 144 6.4% 0.29 167 6.1% 0.26
Aged 26 or
   Older
3,301 2.1% 0.05 274 2.1% 0.15 348 1.8% 0.14
Male 3,000 3.0% 0.07 259 3.2% 0.21 316 2.7% 0.16
Female 2,611 2.4% 0.05 218 2.5% 0.16 276 2.2% 0.13
*Low precision; no estimate reported.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
NOTE: Estimates in this table include data from methamphetamine items added in 2005 and 2006 and are not comparable with estimates presented in NSDUH reports prior to the 2007 National Findings report. See Section B.4.8 in Appendix B of the Results from the 2008 National Survey on Drug Use and Health: National Findings.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

Table 4. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Percentages of Types of Past Year Nonmedical Psychotherapeutic Use among Persons Aged 12 or Older, by County Type: 2005-2011 Combined
Type of
Psychotherapeutic
Total:
Number
Total:
Percentage
Total:
Standard Error
Metropolitan:
Number
Metropolitan:
Percentage
Metropolitan:
Standard Error
Pain Relievers 12,105 4.8% 0.05 10,231 4.9% 0.06
Tranquilizers   5,270 2.1% 0.03   4,448 2.1% 0.04
Stimulants1   3,030 1.2% 0.02   2,529 1.2% 0.02
Sedatives    774 0.3% 0.01      657 0.3% 0.01
Type of
Psychotherapeutic
Urbanized Non-
metropolitan:
Number
Urbanized Non-
metropolitan:
Percentage
Urbanized Non-
metropolitan:
Standard Error
Rural:
Number
Rural:
Percentage
Rural:
Standard Error
Pain Relievers 859 5.1% 0.18 1,015 4.2% 0.13
Tranquilizers 385 2.3% 0.14    437 1.8% 0.09
Stimulants1 227 1.3% 0.09    275 1.1% 0.07
Sedatives   55 0.3% 0.05      62 0.3% 0.03
*Low precision; no estimate reported.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs.
NOTE: Estimates in this table include data from methamphetamine items added in 2005 and 2006 and are not comparable with estimates presented in NSDUH reports prior to the 2007 National Findings report. See Section B.4.8 in Appendix B of the Results from the 2008 National Survey on Drug Use and Health: National Findings.
1 Estimates of Nonmedical Use of Stimulants and Methamphetamine in the designated rows include data from new methamphetamine items added in 2005 and 2006 and are not comparable with estimates presented in NSDUH reports prior to the 2007 National Findings report. See Section B.4.8 in Appendix B of the Results from the 2008 National Survey on Drug Use and Health: National Findings.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

Table 5. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Past Year Initiation of Nonmedical Psychotherapeutics among Persons Aged 12 or Older At Risk for Initiation of Psychotherapeutics Use, by County Type: 2005-2011 Combined
County Type Number Percentage Standard Error
TOTAL 2,506 1.2% 0.02
Metropolitan Counties 2,113 1.3% 0.02
Urbanized Non-metropolitan Counties    185 1.4% 0.09
Rural Counties    208 1.0% 0.05
*Low precision; no estimate reported.
NOTE: Past Year Initiates are defined as persons who used the substance(s) for the first time in the 12 months prior to date of interview.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. These estimates do not include data from new methamphetamine initiation items added in 2007 or new methamphetamine use items added in 2005 and 2006.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

Table 6. Estimated Numbers (in 1,000s), Percentages, and Standard Errors of Percentages of Past Year Initiation of Nonmedical Psychotherapeutics among Persons Aged 12 or Older At Risk for Initiation of Psychotherapeutics Use, by County Type, Age Group, and Gender: 2005-2011 Combined
Demographic
Characteristic
Metropolitan:
Number
Metropolitan:
Percentage
Metropolitan:
Standard
Error
Urbanized
Non-
metropolitan:
Number
Urbanized
Non-
metropolitan:
Percentage
Urbanized
Non-
metropolitan:
Standard
Error
Rural:
Number
Rural:
Percentage
Rural:
Standard
Error
TOTAL 2,113 1.3 0.02 185 1.4 0.09 208 1.0 0.05
Aged 12-17    698 3.6% 0.07   64 4.2% 0.24   80 3.7% 0.18
Aged 18-25    781 3.7% 0.08   67 4.2% 0.29   71 3.5% 0.24
Aged 26 or
   Older
   634 0.5% 0.03   54 0.5% 0.09   57 0.4% 0.05
Male    915 1.1% 0.03   76 1.2% 0.10   78 0.8% 0.06
Female 1,197 1.4% 0.03 109 1.5% 0.14 130 1.2% 0.09
*Low precision; no estimate reported.
NOTE: Past Year Initiates are defined as persons who used the substance(s) for the first time in the 12 months prior to date of interview.
NOTE: Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. These estimates do not include data from new methamphetamine initiation items added in 2007 or new methamphetamine use items added in 2005 and 2006.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005-2011.

NSDUH_098