August 21, 2019 -- Among adults aged 18 years and older, 31 percent used prescription opioids only as prescribed by a physician medically and 4 percent misused them. Thus, the overwhelming majority (88 percent) of all past-12-month prescription opioid users used the drugs for medical purposes only, according to a new study at Columbia University Mailman School of Public Health and Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute. The findings are published in the American Journal of Public Health.
For the 12 percent of misusers, almost 60 percent had misused their own prescription opioids exclusively (27 percent) or with prescribed opioids obtained without a prescription from a nonmedical source (31 percent). Most without-prescription-only misusers (88 percent) obtained their last prescription opioids from a friend or relative. Almost all prescription-only misusers (98 percent) obtained their last prescription opioid from one doctor.
"Identifying the characteristics of prescription opioids misusers compared with those who use opioids only as prescribed is crucial for understanding who is most at risk for adverse outcomes from the drugs and for targeting prevention and treatment efforts," said Denise Kandel, PhD, professor of Sociomedical Sciences in Psychiatry at Columbia Mailman School.
Using data from the 2016-2017 National Surveys on Drug Use and Health, the researchers compared exclusive medical prescription opioid users with three groups of misusers: misusers without prescriptions, misusers of ones' own prescriptions, and both types of misusers. The researchers also examined nicotine use and dependence, and past-12-month alcohol and marijuana use and disorder, defined per DSM-IV criteria for dependence or abuse.
The three most frequently misused prescription opioids were hydrocodone, oxycodone, and tramadol. Fentanyl was used medically to alleviate pain, especially among prescription-only misusers. Without-and-with-prescription misusers had the highest rates of heroin use. Misusers of opioids without prescriptions were younger than other groups.
"We found that misusers were more likely to be depressed than exclusive medical users," said Kandel. The data also showed that prescription opioid misusers were more likely to have been treated for alcohol, to have a marijuana disorder and to perceive drug use as less risky. "They also had higher rates of prescription opioid use disorder, heroin use, and benzodiazepine misuse -- a very hazardous pattern of substance use."
"Failure to obtain pain relief from medical regimen is a major motivating factor for opioid misuse and underscores the urgent need for patients' access to effective pain management," Kandel observed. "From a public health perspective, our findings suggest that strategies to reduce harm from prescription opioids must consider different types of users and misusers."
The longitudinal population data necessary to understand which prescription opioid users are most at risk for negative outcomes are unavailable. "Our study suggests that "prescription opioid misusers who misuse both their own prescriptions and prescription opioid drugs not prescribed to them may be most at risk for overdose."
###
Co-authors are P. C. Griesler, M.C. Hu, and M. Wall of Columbia University and Columbia Mailman School of Public Health. The research was supported by the National Institute on Drug Abuse (R01DA036748).
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.
Journal
American Journal of Public Health