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Misuse of Prescription Drugs

5. Misuse of Prescription Psychotherapeutic Drugs and Use of Other Substances

5.1. Background

This chapter examines the extent to which nonmedical users of prescription psychotherapeutic drugs also use other illicit drugs, alcohol, and cigarettes. All estimates cited in this chapter are based on combined data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (NSDUHs). The analyses focus on persons who have engaged in both nonmedical use of prescription psychotherapeutic drugs and use of other substances (including other illicit drugs, alcohol, cigarettes). The estimated numbers and percentages presented here reflect individuals who have used both types of substances in their lifetime (e.g., "lifetime rates") and in the past year ("past year rates").

The substances discussed in this chapter are considered in pairs, although many individuals have used three or more of them. In addition to persons who have misused a prescription psychotherapeutic drug and used nonprescription substances (illicit drugs, alcohol, or cigarettes), the analyses consider those who have misused prescription psychotherapeutic drugs from different therapeutic classes (e.g., pain relievers and sedatives). The pairs of substances have not necessarily been used together or within a short period of time, but both members of the pair have been used within the individual's lifetime or in the past year. In some instances, however, individuals may have discontinued use of one substance before initiating use of the other; this issue would be particularly relevant for any lifetime nonmedical use of prescription psychotherapeutic drugs and use of other substances.

The chapter first discusses rates of lifetime and past year multiple drug use among the U.S. civilian, noninstitutionalized population aged 12 or older, then compares the rates of use of other drugs, alcohol, and cigarettes depending on whether individuals have or have not misused prescription drugs. Finally, it examines differences in age of onset, according to which pair of drugs was used first.

5.2. Prescription Psychotherapeutic Drug Misuse and Use of Other Substances

Table s 5.1 through 5.5 present estimated numbers and rates of lifetime and past year misuse of prescription psychotherapeutic drugs and use of other substances. These statistics are presented for any psychotherapeutic drug and for each of the four therapeutic drug classes; percentages are calculated among all persons aged 12 or older or among the relevant age groups.

As shown in these tables, the majority of people who misused prescription psychotherapeutic drugs engaged in other illicit drug use as well. This held true for psychotherapeutic drugs overall and for each of the therapeutic drug classes. This pattern also held true for use occurring anytime in the individual's lifetime or within the past year. Patterns observed in the overall population aged 12 or older generally held for youths aged 12 to 17, young adults aged 18 to 25, and adults aged 26 or older. Specific examples are discussed below.

Figure 5.1 Lifetime Nonmedical Use of Prescription Psychotherapeutic Drugs and Lifetime Use of Other Illicit Drugs among Persons Aged 12 or Older: Annual Averages Based on 2002-2004

Figure 5.1     D

a Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

5.3. Other Drug Use among Nonmedical Prescription Psychotherapeutic Drug Users

Table s 5.6 and 5.7 show the rates of other illicit drug use among nonmedical users of prescription psychotherapeutic drugs and among persons who never used psychotherapeutic drugs nonmedically. These rates are for persons aged 12 or older and are based on combined data from 2002, 2003, and 2004.

The majority of persons who had ever misused prescription psychotherapeutic drugs also had used other drugs. Among lifetime nonmedical users of prescription psychotherapeutic drugs, 81.8 percent had engaged in other illicit drug use, and 78.9 percent had used marijuana. In addition, 45.8 percent had used cocaine, 48.3 percent had used hallucinogens, and 31.2 percent had used inhalants.

Similar patterns were observed for the therapeutic classes of prescription psychotherapeutic drugs. In particular, almost all (98.0 percent) lifetime methamphetamine users also were lifetime users of illicit nonpsychotherapeutic drugs. Similarly, lifetime use of illicit nonpsychotherapeutic drugs was reported by 80.4 percent of those who had misused pain relievers in their lifetime, 89.4 percent of those who had misused tranquilizers, 93.4 percent of those who had misused stimulants, and 94.4 percent of those who had misused sedatives. Lifetime use of marijuana was reported by 77.0 percent of lifetime nonmedical users of pain relievers, 87.4 percent of those who misused tranquilizers, 91.7 percent of those who misused stimulants, 96.9 percent of those who had misused methamphetamine, and 92.8 percent of those who misused sedatives.

In addition, nonmedical use of multiple prescription psychotherapeutic drugs was common. Among lifetime nonmedical users of pain relievers, 55.4 percent had misused some other type of prescription psychotherapeutic drug in their lifetime, 41.6 percent had misused tranquilizers, 33.9 percent had misused stimulants, and 18.6 percent had misused sedatives.

The rate of use of other drugs was significantly higher among those who had used prescription psychotherapeutic drugs than it was among those who had not. This pattern held for lifetime and past year use and for each of the therapeutic classes of misused prescription drugs. Figure 5.2 illustrates these differentials for lifetime nonmedical pain reliever users versus nonusers.

Figure 5.2 Lifetime Use of Nonpsychotherapeutic Drugs among Lifetime Nonmedical Pain Reliever Users and Nonusers Aged 12 or Older: Annual Averages Based on 2002-2004

Figure 5.2     D

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Compared with persons who had never misused a prescription psychotherapeutic drug in their lifetime (Table  5.6), lifetime nonmedical users of any psychotherapeutic drug were 2.5 times more likely to have ever used any other illicit drug (81.8 percent among lifetime nonmedical users vs. 32.6 percent among lifetime nonmedical nonusers), 2.6 times more likely to have used marijuana (78.9 vs. 30.8 percent), almost 7 times more likely to have used cocaine (45.8 vs. 6.6 percent), approximately 20 times more likely to have used heroin (6.1 vs. 0.3 percent), and 10 times more likely to have used Ecstasy (16.3 vs. 1.6 percent). Lifetime nonmedical users of tranquilizers were almost 8 times more likely as lifetime nonmedical nonusers to have misused pain relievers (64.9 percent for lifetime nonmedical tranquilizer users vs. 8.3 percent for lifetime nonmedical nonusers), 8 times more likely to have misused stimulants (44.1 vs. 5.5 percent), more than 9 times more likely to have used methamphetamine (28.2 vs. 3.0 percent), and more than 17 times more likely to have misused sedatives (30.2 vs. 1.8 percent).

One would expect to find more use of multiple drugs for the lifetime period than for the past year because of longer opportunities for persons (and particularly young adults and older adults) to try drugs over the course of their lives. Consistent with this expectation, rates of past year use of other drugs among past year nonmedical users of prescription psychotherapeutic drugs (Table  5.7) were generally lower than corresponding rates among lifetime nonmedical users (Table  5.6).

Nevertheless, the risk of past year use of other drugs was significantly higher among those who misused prescription psychotherapeutic drugs in the past year than it was for those who did not. For example, past year nonmedical users of tranquilizers were approximately 6 times more likely to have used any nonpsychotherapeutic drug in the past year (65.7 percent) than were persons who had not misused tranquilizers in the past year (10.7 percent). Past year marijuana use was 6.4 times more prevalent among tranquilizer misusers compared with persons who had not misused tranquilizers in the past year (61.3 vs. 9.6 percent, respectively), cocaine use was 15.5 times more prevalent (29.4 vs. 1.9 percent), and hallucinogen use was approximately 18 times more prevalent (23.9 vs. 1.3 percent).

5.4. Order of Onset among Users of Both Prescription Psychotherapeutic Drugs and Other Drugs

Chapter 4 presented the average ages at first use of all drugs covered in NSDUH, including both prescription psychotherapeutic drugs that were used nonmedically and illicit nonpsychotherapeutic drugs (Figure 4.2). This section examines the relative average age at initiation of nonmedical use of prescription psychotherapeutic drugs and initiation of use of other drugs.

For persons aged 12 or older who had misused both a given prescription psychotherapeutic drug and had used another illicit drug in their lifetime, Table  5.8 reports the percentage who used the relevant psychotherapeutic drug first and the percentage who used the other drug first. The percentages do not sum to 100 because of individuals who initiated use of both drugs at the same age. As with other tables in this chapter, the estimates are averages based on combined data for 2002, 2003, and 2004. The discussion in this section focuses on pairs of drugs (e.g., pain relievers and Ecstasy) in which at least half of the users of the pair of drugs used one drug at an earlier age than the other.

The differentials in age at first use in Table  5.8 may not follow patterns that might be inferred from Figure 4.2 because in the present analysis, the domain for calculation is restricted to individuals who had used both drugs. In addition, readers are reminded when using Table  5.8 that particular drugs may have been popular in different historical periods; these historical patterns may influence age-at-onset differentials when the total population aged 12 or older is included in the analysis. For example, crack cocaine was introduced in the early to mid-1980s, and the widespread popularity of Ecstasy as a "club drug" began in the late 1990s. Thus, the subgroup of persons aged 12 or older who had used both pain relievers and crack may differ from those who had used both pain relievers and Ecstasy. In turn, the demographic characteristics of additional subgroups of users of pain relievers and other drugs may differ from persons who had used both pain relievers and crack or pain relievers and Ecstasy.

Figure 5.3 presents findings for persons aged 12 or older who, in their lifetime, had misused pain relievers and used each of the drugs shown in the figure (considered separately) and who did not initiate use of pain relievers and these other drugs at the same age. In more cases than not, initial misuse of pain relievers occurred at an earlier age than initial use of crack cocaine, heroin, and Ecstasy. Initial misuse of pain relievers occurred at a later age than initial use of cigarettes, alcohol, marijuana, hallucinogens, inhalants, or LSD. For other drugs, available information did not permit a clear determination of the relative age at onset among those who had used both drugs.

Figure 5.3 Order of First Use of Pain Relievers and First Use of Other Drugs among Lifetime Users of Both Pain Relievers and Other Drugs: Annual Averages Based on 2002-2004

Figure 5.3     D

Note: Percentages do not sum to 100 because of persons who initiated use of both drugs at the same age.
1 Includes crack cocaine.
2 Includes methamphetamine.
3 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Age at onset differentials for misuse of tranquilizers versus other drugs (Figure 5.4) indicate that more people aged 12 or older who had used both drugs initiated tranquilizer misuse at an earlier age than they did for crack cocaine, heroin, or Ecstasy. Initiation of alcohol, cigarettes, marijuana, hallucinogens, LSD, and stimulants more often occurred prior to initiation of tranquilizer misuse.

Figure 5.4 Order of First Use of Tranquilizers and First Use of Other Drugs among Lifetime Users of Both Tranquilizers and Other Drugs: Annual Averages Based on 2002-2004

Figure 5.4     D

Note: Percentages do not sum to 100 because of persons who initiated use of both drugs at the same age.
1 Includes crack cocaine.
2 Includes methamphetamine.
3 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Among persons aged 12 or older who had ever misused stimulants and who had used other drugs in their lifetime, age at initial use of stimulants was more often earlier than their initial use of crack cocaine, heroin, Ecstasy, cocaine, tranquilizers, PCP, and pain relievers (Figure 5.5). Initial use of alcohol, cigarettes, marijuana, and inhalants preceded initial misuse of stimulants for most users of stimulants and these other drugs.

Figure 5.5 Order of First Use of Stimulants and First Use of Other Drugs among Lifetime Users of Both Stimulants and Other Drugs: Annual Averages Based on 2002-2004

Figure 5.5     D

Note: Percentages do not sum to 100 because of persons who initiated use of both drugs at the same age.
1 Includes crack cocaine.
2 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

For those aged 12 or older, Figure 5.6 shows age at onset differentials for methamphetamine versus other drugs among lifetime users of both drugs. In the majority of cases, initial use of methamphetamine occurred at an earlier age than initial use of crack cocaine, heroin, or Ecstasy. Drugs that showed earlier onset than methamphetamine included alcohol, cigarettes, marijuana, hallucinogens, inhalants, and LSD. For other drugs, it was not possible to determine a clear pattern of age at onset differentials.

Figure 5.6 Order of First Use of Methamphetamine and First Use of Other Drugs among Lifetime Users of Both Methamphetamine and Other Drugs: Annual Averages Based on 2002-2004

Figure 5.6     D

Note: Percentages do not sum to 100 because of persons who initiated use of both drugs at the same age.
1 Includes crack cocaine.
2 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

Differentials in age of onset of nonmedical use of sedatives and other drugs among persons aged 12 or older who have used both in their lifetime are presented in Figure 5.7. As indicated in Chapter 4 (Figure 4.2), misuse of sedatives has the highest overall average age of onset of any of the drugs for which such information is collected in NSDUH (i.e., 29.5 years). As shown in Figure 5.7 among lifetime users of sedatives and other drugs, misuse of sedatives was more likely to be initiated at an earlier age than use of crack cocaine, Ecstasy, heroin, cocaine, or PCP. First use of sedatives appeared generally to occur later than initial use of alcohol, cigarettes, marijuana, stimulants, hallucinogens, or inhalants. For other drugs, clear conclusions could not be drawn.

Figure 5.7 Order of First Use of Sedatives and First Use of Other Drugs among Lifetime Users of Both Sedatives and Other Drugs: Annual Averages Based on 2002-2004

Figure 5.7     D

Note: Percentages do not sum to 100 because of persons who initiated use of both drugs at the same age.
1 Includes crack cocaine.
2 Includes lysergic acid diethylamide (LSD), phencyclidine (PCP), and Ecstasy.
3 Includes methamphetamine.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

5.5. Summary

This chapter used combined data from the 2002, 2003, and 2004 surveys to examine use of other drugs among nonmedical users of prescription psychotherapeutic drugs. Findings were presented for both the lifetime and past year periods. This chapter also compared rates of other drug use among nonmedical users of prescription psychotherapeutics with rates among nonusers. Finally, this chapter compared the order of initiation of use for different pairs of psychotherapeutics and other drugs.

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This page was last updated on June 03, 2008.