Highlights

This is a time of widespread concern about the nonmedical use of prescription drugs in the United States. In response to this concern, this report presents findings from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (NSDUHs) on the nonmedical use of prescription-type psychotherapeutic drugs.

NSDUH, formerly called the National Household Survey on Drug Abuse, is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 or older. NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services and is planned and managed by SAMHSA's Office of Applied Studies (OAS). Data collection is conducted under contract with RTI International, Research Triangle Park, North Carolina.¹

NSDUH covers four broad classes of prescription psychotherapeutic drugs—pain relievers, tranquilizers, stimulants, and sedatives—and the specific drugs OxyContin^® (a pain reliever) and methamphetamine (a stimulant). Nonmedical use (or misuse) is defined in NSDUH as use of these medications without a prescription of the respondent's own or simply for the experience or feeling the drug caused. Thus, nonmedical use does not include legitimate use of prescription drugs under a physician's direction or use of over-the-counter medications.

Prevalence and Recent Trends in Misuse of Prescription Drugs

The prevalence of nonmedical use of prescription psychotherapeutic drugs generally remained stable from 2002 through 2004. In 2004, 48.0 million persons aged 12 or older (20.0 percent) had misused psychotherapeutic drugs in their lifetime, 14.6 million (6.1 percent) had done so in the past year, and 6.0 million (2.5 percent) had done so in the past month. This pattern of stable rates generally held as well for specific categories of prescription psychotherapeutic drugs.
Combined data from the 2002 through 2004 surveys indicated that nonmedical use of prescription pain relievers was second only to marijuana use among the Nation's most prevalent illicit drug use behaviors. An annual average of 11.3 million persons aged 12 or older (4.8 percent) were nonmedical users of prescription pain relievers in the past year compared with an annual average of 25.5 million past year users of marijuana.
Among specific age groups, young adults aged 18 to 25 tended to have the highest rates of nonmedical use in the past year, followed by youths aged 12 to 17. For example, the annual average rates of past year misuse of any prescription psychotherapeutic drug were 14.5 percent for young adults, 9.1 percent for youths, and 4.4 percent for adults aged 26 or older.
In the overall population aged 12 or older, males generally had higher rates than females for misuse of pain relievers (5.2 percent for males and 4.3 percent for females), stimulants (1.3 vs. 1.1 percent), and methamphetamine (0.7 vs. 0.5 percent). Among youths aged 12 to 17, however, the rates of nonmedical use in the past year were higher among females than males for any prescription psychotherapeutic drug (9.9 percent for female youths and 8.2 percent for male youths), pain relievers (8.1 vs. 7.0 percent), tranquilizers (2.6 vs. 1.9 percent), and stimulants (2.6 vs. 1.9 percent).
Past year nonmedical use of any prescription psychotherapeutic drug among persons aged 12 or older was more prevalent among non-Hispanic whites (6.7 percent) and Hispanics (6.3 percent) than among non-Hispanic blacks (3.9 percent) or Asians (3.0 percent).
Past year misuse of prescription psychotherapeutic drugs among adults aged 18 or older was lower among college graduates than among adults who had completed less education and higher among unemployed adults than for persons in other employment categories.
The prevalence of any psychotherapeutic drug misuse in the past year was higher in the West (7.3 percent) than in the South (6.3 percent), Midwest (5.8 percent), and Northeast (5.2 percent). However, misuse of tranquilizers tended to be more prevalent in the South (2.6 percent).
Persons aged 12 or older who were living in small metropolitan areas with populations of fewer than 250,000 persons had the highest rates by population density for misuse of any prescription psychotherapeutic drug (7.1 percent), pain relievers (5.4 percent), tranquilizers (2.6 percent), and stimulants (1.7 percent).

Patterns in Nonmedical Use of Specific Prescription Drugs

Despite overall patterns of stable rates for misuse of any prescription psychotherapeutic drug and for specific classes of psychotherapeutics, significant increases in the prevalence of lifetime misuse from 2002 through 2004 were observed among persons aged 12 or older for pain relievers in the hydrocodone and oxycodone categories (5.9 percent in 2002 to 7.4 percent in 2004 for hydrocodone and 4.3 to 5.0 percent for oxycodone). Similarly, the lifetime prevalence for tranquilizers in the Xanax^®, generic alprazolam, Ativan^®, or generic lorazepam category increased from 3.5 percent in 2002 to 3.9 percent in 2004.
Specific drugs that were most prevalent among persons aged 12 or older who initiated nonmedical use in the past year differed from those that were most prevalent among lifetime misusers overall. For example, Vicodin^®, Lortab^®, or Lorcet^® as a group was the pain reliever with the highest prevalence (50.3 percent) among past year initiates of pain reliever misuse, but Darvocet^®, Darvon^®, or Tylenol^® with codeine as a group had the highest prevalence (62.7 percent) among lifetime misusers of pain relievers overall. Similarly, the sedative with the highest prevalence of misuse (17.4 percent) among past year initiates was Restoril^® or temazepam. Among lifetime sedative misusers, however, 73.0 percent had misused methaqualone, Sopor^®, or Quaalude^®, which is no longer legally available in the United States.

Incidence and Age at Initiation of Prescription Drug Misuse

Rates of initiation in the past year among persons aged 12 or older did not change significantly from 2002 to 2004 for nonmedical use of any prescription psychotherapeutic drug or for any of the four therapeutic drug classes. In 2004, 1.5 percent of persons aged 12 or older who were at risk for initiation first misused any prescription psychotherapeutic drug in the 12 months prior to the survey interview.
An annual average of 2.7 million persons aged 12 or older first misused any prescription psychotherapeutic drug in the past year, based on combined data from the 2002 through 2004 surveys. The annual average number of new users of prescription pain relievers (2.4 million) exceeded that of marijuana (2.1 million).
Consistent with overall prevalence data, youths aged 12 to 17 and young adults aged 18 to 25 were more likely than older adults aged 26 or older to initiate nonmedical use of prescription psychotherapeutic drugs in the past year.
The average age at initiation among past year initiates of prescription psychotherapeutic drug misuse aged 12 or older ranged from 20.5 years for initiates of methamphetamine misuse to 29.5 years for initiates of sedative misuse.

Misuse of Prescription Psychotherapeutic Drugs and Use of Other Substances

Most lifetime nonmedical users of prescription psychotherapeutic drugs aged 12 or older also were lifetime users of other illicit drugs (81.8 percent). In addition, nearly all lifetime methamphetamine users (98.0 percent) were lifetime users of nonprescription illicit drugs.
Lifetime nonmedical users of prescription psychotherapeutic drugs were more likely than persons who had never used psychotherapeutics nonmedically to be lifetime users of other drugs. For example, nonmedical users of any prescription psychotherapeutic drug were 2.5 times more likely than nonusers to be lifetime users of other illicit drugs. Similarly, the risk of other past year illicit drug use was significantly higher among past year nonmedical users of psychotherapeutics than among persons who had not misused psychotherapeutics in the past year.
Among lifetime nonmedical users of pairs of drugs, misuse of pain relievers, tranquilizers, stimulants, methamphetamine, and sedatives often occurred before initial use of crack cocaine, heroin, or Ecstasy. Use of cigarettes, alcohol, marijuana, and hallucinogens usually occurred before first use of these psychotherapeutics. In addition, use of inhalants usually occurred before first use of pain relievers, stimulants, methamphetamine, and sedatives.

Prescription Drug Dependence, Abuse, and Treatment

Rates of dependence or abuse for nonmedical use of psychotherapeutic drugs among persons aged 12 or older did not change significantly from 2002 to 2004. In 2004, approximately 2 million persons aged 12 or older met the criteria for dependence or abuse involving any prescription psychotherapeutic drug that was used nonmedically in the past year. This included 1.4 million for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives.
Based on combined data for 2002 through 2004, young adults aged 18 to 25 had a higher prevalence of dependence or abuse for pain relievers, tranquilizers, and stimulants compared with the rates of dependence or abuse for these medications for persons in other age groups.
Males and females aged 12 or older overall had comparable rates of dependence or abuse, but gender differences occurred among youths aged 12 to 17 and young adults aged 18 to 25. Among youths, females had higher rates than males of dependence or abuse involving any prescription psychotherapeutic drug (1.8 percent for females and 1.1 percent for males), pain relievers (1.4 vs. 0.8 percent), tranquilizers (0.4 vs. 0.3 percent), and stimulants (0.5 vs. 0.3 percent). For young adults, however, males were more likely than females to meet the criteria for dependence or abuse involving pain relievers (1.4 vs. 1.1 percent).
Among persons aged 12 or older who used prescription psychotherapeutic drugs nonmedically in the past year, 13.5 percent met the criteria for dependence on or abuse of at least one prescription psychotherapeutic drug. The prevalence of dependence or abuse among past year misusers of any prescription psychotherapeutic drug was higher for youths aged 12 to 17 than for young adults aged 18 to 25 (15.9 vs. 12.7 percent).
For any prescription psychotherapeutic drug, pain relievers, tranquilizers, and stimulants, the risk of dependence or abuse for psychotherapeutic drugs was greater for persons aged 18 or older who initiated nonmedical use before age 16 compared with those who initiated use at age 16 or older. For sedatives, there was no significant difference in rates of dependence or abuse by age at first use.
An annual average of 290,000 persons who met the criteria for past year dependence or abuse for prescription psychotherapeutic drugs received treatment in the past year for use of any illicit drug, and 209,000 received their last or most current past year treatment specifically for a psychotherapeutic drug that they were dependent on or abusing. Thus, the large majority of persons aged 12 or older who were dependent on or abusing prescription psychotherapeutic drugs in the past year did not receive illicit drug use treatment in the past year.

State Variations in Nonmedical Use of Prescription Psychotherapeutic Drugs

Colorado, Kentucky, and Washington State ranked among the States with the highest prevalences of nonmedical prescription pain reliever use among persons aged 12 or older. The District of Columbia and the midwestern States of Iowa, Nebraska, and South Dakota were among the States with lower prevalences of pain reliever misuse for persons aged 12 or older.
Six of the States with the highest prevalences of tranquilizer misuse in the past year were in the South (Arkansas, Florida, Kentucky, Louisiana, South Carolina, and Tennessee). Five States with low rates of tranquilizer misuse were in the Midwest (Iowa, Minnesota, Nebraska, North Dakota, and South Dakota).
Five of the States with higher prevalences of stimulant misuse were in the West (Montana, Nevada, Oregon, Washington, and Wyoming). Florida, North Carolina, and three States in the Northeast region (Connecticut, New Jersey, and New York) were among the States with the lowest prevalences of past year stimulant misuse for persons aged 12 or older.
Five of the States with the highest prevalences of methamphetamine misuse also were in the West (Arizona, Montana, Nevada, New Mexico, and Wyoming). Northeastern States again were among those with lower prevalences of methamphetamine misuse for persons aged 12 or older.
Three of the nine States with higher prevalences of sedative misuse among persons aged 12 or older were in New England (Connecticut, Massachusetts, and Rhode Island). States with low rates of sedative misuse among persons aged 12 or older included Delaware, Hawaii, and four States in the Midwest (Nebraska, North Dakota, South Dakota, and Wisconsin).

Recent Trends in Methamphetamine Use

The finding that the prevalence of methamphetamine use remained stable from 2002 to 2004 runs counter to concerns about increasing problems associated with the drug and to increases in treatment admissions for methamphetamine or amphetamines. However, there is close correspondence in the patterns of State differences in methamphetamine prevalence (from NSDUH) and rates of admissions to substance abuse treatment from the Treatment Episode Data Set (TEDS) in which methamphetamine or amphetamines were listed as the primary drug of abuse.
NSDUH estimates of the number of persons treated for stimulant problems in the past year in 2002, 2003, and 2004 also are similar in magnitude and trends to the numbers of treatment admissions reported in those years. Furthermore, although the estimated number of past month methamphetamine users did not change significantly from 2002 to 2004, the rate of abuse or dependence among those users increased from 10.6 to 22.3 percent for stimulants and from 27.5 to 59.3 percent for any illicit drug. These observations suggest a convergence of evidence on methamphetamine from NSDUH and TEDS.