Prevalence and Patterns of Nonmedical Use of OxyContin ® and Other Pain Relievers

1. Prevalence and Patterns of Nonmedical Use of OxyContin®and Other Pain Relievers Joe Gfroerer Office of Applied Studies Substance Abuse and Mental Health Services Administration Anesthetic and Life Support Drugs and Drug Safety and Risk Management Advisory Committees November 13, 2008

2. National Survey on Drug Use and Health (NSDUH) • Representative nationally and in each State • Civilian, noninstitutional population, age 12+ • Face-to-face interview, 1 hour • Computer-assisted, mainly self-administered • 67,500 respondents each year • Survey changed in 1999 and in 2002, creating breaks in trend • Response rates (2007): • 90% of Households selected • 74% of Persons selected within households (85% for youth, 73% for adults)

3. NSDUH Data on Illicit Drug Use Illicit drug use: Use of an illicit drug , or nonmedical use of prescription drugs; For each drug: • Recency of use • Lifetime, Past year, Past month • Frequency of use • Date of first use • Incidence/First time use within past year • Dependence and abuse • Based on DSM-IV criteria • Received treatment in past year for problem with drug

4. Nonmedical Prescription Drug Use: NSDUH Definition “Not prescribed for you” OR “You took the drug only for the experience or feeling it caused” (Excludes OTC)

5. Prescription Drug Questioning Strategy • Primary focus is on therapeutic classes (TCs): • Pain Relievers, Tranquilizers, Stimulants, Sedatives • Specific pharmaceuticals asked for each TC: • Lifetime use only (except OxyContin® and methamphetamine) • Includes mix of brand-name and generic drugs • Done mainly to help respondents understand the TC • “Pill cards” show specific pharmaceuticals • “Any other drug” in the TC collected as write-in(s)

6. “PILL CARDS” Drug groups above the red line are asked separately Drug groups below the red line are asked in tandem with followup to identify which one(s) Any other drugs in TC are specified by write-in.

7. Lifetime Nonmedical Use of Selected Pain Relievers, Age 12 or Older: 2007 Vicodin®, Lortab®, or Lorcet® Darvocet®, Darvon®, or Tylenol® with Codeine Percocet®, Percodan®, or Tylox® Hydrocodone Codeine OxyContin® Demerol® Morphine Methadone Ultram® Percent Using in Lifetime

8. Nonmedical Pain RelieverUse: Trends and Patterns

9. Nonmedical Pain Reliever Use, Age 12 or Older: 2002 and 2007 Numbers (in Millions) (13.3%+) (12.6%) (5.0%+) (4.7%) (2.1%) (1.9%) Lifetime Use Past YearUse Past MonthUse + Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

10. Past Year Pain Reliever Dependence or Abuse and Treatment, Aged 12 or Older: 2002 and 2007 Numbers (in Thousands) Past Year Nonmedical Pain Reliever Dependence or Abuse Received Treatment for Pain Reliever Problem During Last Treatment Visit, within Past Year + Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

11. Past Year Nonmedical Use of Pain Relievers, by Age: 2002 and 2007 Percent Used in Past Year + Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

12. Lifetime Nonmedical Use of Selected Pain Relievers, Ages 18-25: 2002 and 2007 Percent Ever Used Darvocet®, Darvon®, or Tylenol® w/Codeine Percocet®, Percodan®, or Tylox® Vicodin®, Lortab®, or Lorcet® Codeine Hydrocodone OxyContin® Morphine + Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

13. Lifetime Nonmedical Use of Selected Pain Relievers, Ages 26-34: 2002 and 2007 Percent Ever Used Darvocet®, Darvon®, or Tylenol® w/Codeine Percocet®, Percodan®, or Tylox® Vicodin®, Lortab®, or Lorcet® Codeine Hydrocodone OxyContin® Morphine + Difference between this estimate and the 2002 estimate is statistically significant at the .05 level.

14. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004-2006

15. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2007 Source Where Respondent Obtained Source Where Friend/Relative Obtained Bought on Internet0.5% Drug Dealer/Stranger4.1% More than One Doctor2.9% Other 14.2% More than One Doctor 2.6% Free from Friend/Relative6.6% Free from Friend/Relative56.5% One Doctor 18.1% Bought/Took fromFriend/Relative5.9% OneDoctor 81.0% Drug Dealer/Stranger1.8% Bought/Took from Friend/Relative14.1% Bought on Internet0.1% Other 11.8% Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown. 1 The Other category includes the sources "Wrote Fake Prescription," "Stole from Doctor’s Office/Clinic/Hospital/Pharmacy," and "Some Other Way."

16. Sources of Rx Pain Relievers among Persons Who Used Pain Relievers Nonmedically in the Past Year: Combined 2005 and 2006 Free from Friend/Relative Bought from Friend/relative Prescriptions from 1 Doctor Drug Dealer/Stranger Took from Friend/relative Prescription from 2+ Doctors Internet Other Percent among Past Year Users

17. Initiation: First-time Use within the Past 12 Months

18. Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2007 Inhalants10.7% Pain Relievers19.0% Tranquilizers6.5% Stimulants4.1% Marijuana56.2% Hallucinogens 2.0% Sedatives1.1% Cocaine 0.6% 2.7 Million Initiates of Illicit Drugs Note: The percentages add to greater than 100 percent because of a small number of respondents initiating multiple drugs on the same day.

19. Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007 Numbers (in Thousands) Marijuana Cocaine Inhalants OxyContin® Sedatives Pain Relievers Tranquilizers Ecstasy Stimulants LSD Heroin

20. Mean Age at First Use for Specific Illicit Drugs among Past Year Initiates Aged 12 to 49: 2007 Age in Years Marijuana Cocaine PainRelievers Stimulants Sedatives Inhalants LSD Ecstasy Heroin OxyContin® Tranquilizers

21. Past Year Pain Reliever Initiation, Overall and with OxyContin® or Morphine Use, among Persons Aged 12 or Older: 2002-2007 Percent of Population Pain Reliever Initiates Pain Reliever Initiates with OxyContin® Use Pain Reliever Initiates with Morphine Use 0.05 0.05 0.04 0.04 0.03 + Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

22. Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates, Age 12 or Older : Annual Averages, 2004-2006 Percent of New Pain RelieverUsers Tranqs, Seds, or Stims Nonmedically Marijuana Cocaine Hallucinogens Heroin

23. Lifetime Use of Other Drugs among Past Year Nonmedical OxyContin® Initiates, Age 12 or Older : Annual Averages, 2004-2006 Percent of New OxyContin® Users Tranqs, Seds, or Stims Nonmedically Marijuana Cocaine Hallucinogens Heroin

24. Lifetime Use of Other Drugs among Past Year Nonmedical Pain Reliever Initiates Who Used Morphine, Age 12 or Older: Annual Averages, 2004-2007 Percent of New Pain Reliever Users with Morphine Use Tranqs, Seds, or Stims Nonmedically Marijuana Cocaine Hallucinogens Heroin

25. Lifetime Nonmedical Use of Other Pain Relievers among Past Year Nonmedical OxyContin® Initiates, Age 12 or Older: Annual Averages, 2004-2006 Vicodin®, Lortab®, or Lorcet® Percocet®, Percodan®, or Tylox® Darvocet®, Darvon®, or Tylenol® with Codeine Hydrocodone Codeine Morphine Methadone Demeral® Percent

26. Nonmedical OxyContin®Use: Trends and Patterns

27. Trends in Past Year Indicators of Nonmedical Use of OxyContin®, Ages 12 and Older: 2004 to 2007 Numbers (in Thousands) + Difference between this estimate and the 2007 estimate is statistically significant at the .05 level.

28. OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Age Group: Annual Averages, 2004-2006 Percent Aged 12-17 Aged 18-25 Aged 26-34 Aged 35-49 Aged 50 or Older Past Year OxyContin®Use Past Year Pain Reliever Dependence or Abuse, with OxyContin® Use

29. OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Gender, Age 12+: Annual Averages 2004-2006 Percent Past Year Nonmedical OxyContin® Use Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

30. OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by Race/Ethnicity, Age 12+: Annual Averages, 2004-2006 Percent Past Year Nonmedical OxyContin® Use Past Year Pain Reliever Dependence or Abuse, with Nonmedical OxyContin® Use

31. OxyContin® Use and Pain Reliever Dependence or Abuse with OxyContin® Use, by County Type, Age 12+: Annual Averages, 2004-2006 Percent Past Year OxyContin® Use Past Year Pain Reliever Dependence or Abuse with Nonmedical OxyContin® Use

32. OxyContin® Use in Lifetime among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2002-2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002-2006.

33. Past Year Use of Selected Illicit Drugs among Past Year Nonmedical Pain Reliever Users and Nonusers Aged 12 and Older: Annual Averages, 2004-2006 Percent Using in Past Year Marijuana Cocaine Hallucinogens Heroin

34. Dependence and Abuse Among Past Year Users of Selected Substances, Ages 12+: Annual Averages, 2004-2006 Percentage of Past Year Users 28 28 17 14 14 13 12 9 Note: Percentages refer to dependence/abuse for each drug among past year users of that drug, except for OxyContin, which reflects pain reliever dependence/abuse among past year OxyContin users.