430 likes | 531 Views
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.
E N D
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 Used drug when it was not prescribed for you, or that you took only for the experience or feeling that it caused
Classes of drugs • Analgesics (e.g., Codiene) • Tranquilizers (e.g., Valium) • Sedatives (e.g., Seconal) • Stimulants (e.g., amphetamines)
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)
Reported Lifetime and Past Year Use of Prescription Drugs, NHSDA 1998
Prevalence of Extramedical Analgesic Use in the Past Year (1998)
Prevalence of Extramedical Tranquilizer Use in the Past Year (1998)
Prevalence of Extramedical Sedative Use in the Past Year (1998)
Prevalence of Extramedical Stimulants in the Past Year (1998)
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
Cumulative Incidence of Tranquilizer Use Males 0.06 Females 0.04 Incidence 0.02 0.00 20 40 60 Age
Cumulative Incidence of Sedative Use Males 0.04 Females 0.03 Incidence 0.02 0.01 0.00 20 40 60 Age
Cumulative Incidence of Stimulant Use Males Females 0.06 0.04 Incidence 0.02 0.00 20 40 60 Age
Lifetime Prevalence of Extramedical Analgesic Use by Age Group
Lifetime Prevalence of Extramedical Analgesic Use by Family Income
Prevalence of Extramedical Analgesic Use, Recent Users ( 2 Years or Less)
Reported Lifetime and Past Year Dependence of Prescription Drugs, NCS
Rx Drug Dependence : Lifetime Comorbidity with Psychiatric Disorders
Cocaine Dependence: Lifetime Comorbidity with Psychiatric Disorders
Extramedical Analgesic Dependence : Lifetime Comorbidity with Psychiatric Disorders
Cumulative Probability of Analgesic Dependence
Odds Ratios & 95% CI for Analgesic Dependence, Given Use * Adjusted for age, race, education
Testing Causal Pathways between PTSD and Substance Use Disorders Howard D. Chilcoat Naomi Breslau Archives of General Psychiatry 1998
Potential Pathways Traumatic Event Drug A/D PTSD Drug A/D
Potential Pathways PTSD Relative Risk = 16.9 Rx Drug A/D
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
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
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
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