Contemporary Trends in Nonmedical Prescription Drug Use As a Function of Individual and Sociodemographic Characteristics: Ages 12 to 90

Introduction: Opioid overdose and death rates are at the highest in history, and are climbing shockingly fast. Although most cases involve heroin and the deadly fentanyl, individual pathways to opioid addiction most often begin with experimentation of nonmedical prescription drug (NMPD) use of painkillers or medically supported use of these pills to control acute and chronic pain. Recent studies document geographic, racial/ethnic, and other subgroup differences in opioid use, and most often in opioid-related mortality rates. Although understanding contemporary trends in overdose and death rates is important, perhaps more crucial to the health and wellbeing of individuals is a firmer understanding of recent age trends in individual behavior and associated factors. Contemporary national data on substance use behavior provide new opportunities to examine different stages along the pathway of opioid misuse. This study models age trends in the rate of NMPD use and tests for age-varying differences in use across sex, racial-ethnic group, experiences of pain, urbanicity, and geographic region.

Methods: This study relied on data from Wave 1 participants (n = 45,961) of the national PATH study, aged 12-90. Using weighted proportions, participants were 52% female and were 65% White, 12% Black, 5% Asian, 1% Other/Multiracial, 16% Hispanic, and 2% American Indian/Alaska Native. Recent pain symptom severity, which was only assessed for those ages 18+, was reported as none for 46%, moderate for 45%, and high for 11%.

Results: An intercept-only weighted TVEM showed a smooth trend in NMPD use rates across age, with a rapid increase in past-year NMPD use for individuals ages 12-20, and a steady rate for individuals ages 20 through late adulthood. Significant sex differences existed during ages 12-18, with higher rates among males, but differences did not exist among adults. This smooth age trend is recovered when examining Whites only, but substantial racial/ethnic differences exist across ages. American Indian/Alaskan Natives had significantly higher rates of use compared to all other groups in ages 21-23 and ages 55+. Black adolescents used at higher rates compared to Whites through age 16, but at lower rates for those ages 23-33. Individuals reporting no to moderate pain levels used NMPD at consistent, low rates across all ages. Those reporting high levels of pain show a rapid increase of use with age, from 3% at age 18 to nearly 7% at age 27; the rate decreased slowly with older ages.

Conclusions: This study allows us to visualize age trends in use and differences across individual and sociodemographic characteristics. Urbanicity and geographic region will be examined. Future analyses may help to deepen our understanding of the risk factors associated with NMPD use.