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An Epidemiologic Overview of Prescription Drug Misuse

An Epidemiologic Overview of Prescription Drug Misuse. Howard D. Chilcoat Tracy Dusablon Department of Mental Hygiene Johns Hopkins University School of Hygiene and Public Health. Extramedical Use.

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An Epidemiologic Overview of Prescription Drug Misuse

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  1. An Epidemiologic Overview of Prescription Drug Misuse Howard D. Chilcoat Tracy Dusablon Department of Mental Hygiene Johns Hopkins University School of Hygiene and Public Health

  2. Extramedical Use Used drug when it was not prescribed for you, or that you took only for the experience or feeling that it caused

  3. Classes of drugs • Analgesics (e.g., Codiene) • Tranquilizers (e.g., Valium) • Sedatives (e.g., Seconal) • Stimulants (e.g., amphetamines)

  4. Data Sources • National Household Survey on Drug Abuse (NHSDA), 1985 – 1998 (Age 12+, n = 5,000 – 20,000+) • National Comorbidity Study (NCS) Diagnostic criteria for major psychiatric disorders (DSM-IIIR) (Age 15 – 54, n = 8,098)

  5. Reported Lifetime and Past Year Use of Prescription Drugs, NHSDA 1998

  6. Past Year Use of Prescription Drugs by Sex, NHSDA, 1998

  7. Reported Use of Analgesics in Past Year (By Sex)

  8. Reported Use of Tranquilizers in Past Year (By Sex)

  9. Reported Use of Sedatives in Past Year (By Sex)

  10. Reported Use of Stimulants in Past Year (By Sex)

  11. Reported Use of Analgesics in Past Year (Male)

  12. Reported Use of Analgesics in Past Year (Female)

  13. Reported Past Year Use of Prescription Drugs , Ages 60+

  14. Prevalence of Extramedical Analgesic Use in the Past Year (1998)

  15. Prevalence of Extramedical Tranquilizer Use in the Past Year (1998)

  16. Prevalence of Extramedical Sedative Use in the Past Year (1998)

  17. Prevalence of Extramedical Stimulants in the Past Year (1998)

  18. Prevalence of Extramedical Analgesic Use in the Past Year

  19. Cumulative Incidence of Analgesic Use 0.12 Males Females 0.10 0.08 Incidence 0.06 0.04 0.02 0.00 0 20 40 60 80 Age

  20. Cumulative Incidence of Tranquilizer Use Males 0.06 Females 0.04 Incidence 0.02 0.00 20 40 60 Age

  21. Cumulative Incidence of Sedative Use Males 0.04 Females 0.03 Incidence 0.02 0.01 0.00 20 40 60 Age

  22. Cumulative Incidence of Stimulant Use Males Females 0.06 0.04 Incidence 0.02 0.00 20 40 60 Age

  23. Lifetime Prevalence of Extramedical Analgesic Use

  24. Lifetime Prevalence of Extramedical Analgesic Use by Sex

  25. Lifetime Prevalence of Extramedical Analgesic Use by Age Group

  26. Lifetime Prevalence of Extramedical Analgesic Use by Race

  27. Lifetime Prevalence of Extramedical Analgesic Use by Family Income

  28. Prevalence of Extramedical Analgesic Use, Recent Users ( 2 Years or Less)

  29. Reported Lifetime and Past Year Dependence of Prescription Drugs, NCS

  30. Past Year Dependence of Prescription Drugs by Sex, NCS

  31. Rx Drug Dependence : Lifetime Comorbidity with Psychiatric Disorders

  32. Cocaine Dependence: Lifetime Comorbidity with Psychiatric Disorders

  33. Extramedical Analgesic Dependence : Lifetime Comorbidity with Psychiatric Disorders

  34. Cumulative Probability of Analgesic Dependence

  35. Odds Ratios & 95% CI for Analgesic Dependence, Given Use * Adjusted for age, race, education

  36. Testing Causal Pathways between PTSD and Substance Use Disorders Howard D. Chilcoat Naomi Breslau Archives of General Psychiatry 1998

  37. Potential Pathways Traumatic Event Drug A/D PTSD Drug A/D

  38. Potential Pathways PTSD Relative Risk = 16.9 Rx Drug A/D

  39. Prevalence of Drug A/D by lifetime history of PTSD

  40. Relative hazards (95% CI) of specified drug use disorder by prior exposure to traumatic events and PTSD All estimates adjusted for sex, race, and education Reference category = never exposed to traumatic event

  41. Findings • Prevalence (past year) of use of Rx drugs is comparable to that of cocaine – analgesics most commonly misused • Ages 18 – 25 years highest period of risk for use and onset of Rx drugs and analgesics • Girls 12-17 years old might be particularly vulnerable • Relative to other drugs, sex differences are small, emerge after age 20 years • Whites and higher income more likely to use Rx drugs (analgesics) than other race/ethinicities

  42. Findings (cont’d) • High level of comorbidity with other psychiatric disorders • Strong relationship with antisocial personality disorder, cocaine dependence • Lifetime prevalence of Rx drug dependence similar to that for cocaine

  43. Future Research Directions • Epidemiology of Rx drug misuse remains relatively unexplored • Focus on Rx drug use by girls and young women • Rx misuse in the elderly • Causal relationships between RX drug misuse and other psychiatric disorders

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