Nonmedical Use of Prescription-Type Drugs, by County Type

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.

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.

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.

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).

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.

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).

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.

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).

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.