A new survey analysis shows prescription opioid, stimulant, sedative and tranquilizer misuse is common by age 50, and is greatly associated with substance abuse disorder risk.
A new cohort analysis provides a more nuanced understanding of the scale and effect of poor prescription management in US patients.
Prescription drug misuse (PDM) is prevalent among nearly half of all US adults, according to data from a 26,000-plus person assessment that spanned 32 years. What’s more, the risk of substance abuse disorder is significantly greater in adults misusing prescriptions than the general population.
A team of investigators from the University of Michigan School of Nursing Center for the Study of Drugs, Alcohol, Smoking and Health (DASH) Center reported new findings this week from follow-up in the Monitoring the Future (MTF) study, an annual, nationally representative classroom survey of approximately 15,000 US high school seniors that began in 1975. The team sought to identify trajectories of prescription opioid, stimulant, sedative and tranquilizer misuse from age 18 through 50 years via early MTF participant follow-up; what they found was a pressing need for improved screening for and awareness of prescription drug misuse tendencies from adolescence all the way through to middle adulthood.
As lead author and DASH Director Sean Esteban McCabe, PhD, told HCPLive®, the new data “serves as a major wake-up call to take a closer look at our country’s relationship with these medications.”
As McCabe and colleagues noted, individuals born between 1965 and 1996 represent 135 million-plus US adults who have had high exposure to controlled medications—but little is understood about the link between high medication exposure and long-term prescription drug misuse in adulthood.
“PDM involving prescription opioids, stimulants, and sedatives or tranquilizers is most prevalent during young adulthood,” investigators wrote. “In the past 2 decades, PDM has increased among adults, and there have been historic highs in PDM-related emergency department visits, overdoses, and deaths. Indeed, there were more than 96,000 past-year drug overdose US deaths.”
The DASH investigators identified PDM trajectories involving controlled medications over 32 years of cohort follow-up data from MTF, then examined the association between such trajectories and risk of substance use disorder as well as the link between adult baseline characteristics and PDM trajectories.
They conducted 10 follow-up assessments with past MTF participants via mail, then conducted analysis from December 2020 to October 2021. Sociodemographic characteristics, PDM and substance use disorder symptoms were measured at baseline, and follow-ups assessed the latter 2 variables. A latent profile analysis (LPA) was used by investigators to create prescription drug misuse trajectory profiles.
Among the 26,575 individuals included in the cohort, 50.8% were female and 79.3% were White. Baseline response rate ranged from 77% to 84%; retention rate over 32 years of assessment was 53%.
The attrition-adjusted rate of respondents to report past-year prescription drug misuse at least once in the last 32 years was 45.7% (95% CI, 44.9 – 46.4). Among those to report past-year PDM, about 4 in 10 reported misuse of multiple prescription drugs (40.3%; 95% CI, 39.3 – 41.3).
McCabe and colleagues observed 4-6 different PDM trajectories based on drug class, and 8 trajectories in the drug class-combined analyses—including early peak trajectories (eg, age 18), later-peak trajectories (eg, age 40), and high-risk trajectory (eg, high-frequency PDM at multiple ages).
All prescription drug misuse trajectories were associated with increased odds of substance use disorder development in middle adulthood; the greatest association was observed with high-risk PDM trajectories, at a 12-fold increased risk of a substance use disorder (adjusted OR [aOR], 12.41; 95% CI, 8.47 – 18.24).
Binge drinking (aOR, 1.69; 95% CI, 1.13 – 2.54), cigarette smoking (aOR, 2.30; 95% CI, 1.60 – 3.29), and marijuana use (aOR, 3.78; 95% CI, 2.38 – 6.01) were all associated with a high-risk trajectory of prescription drug misuse.
Interestingly, investigators observed a significantly greater risk of later-peak PDM trajectory among cohorts from 1985-86 than those from 1976-78 (aOR, 2.49; 95% CI, 1.69 – 3.68).
Investigators identified “common” limitations to large-scale prospective analyses such as this, included differential attrition and survey measure limitations. Additionally, the MTF study did not include the DSM-5 criteria for substance use disorder; they believe the actual prevalence of the disorder is likely higher in this cohort. What’s more, MTF excluded individuals who did not complete high school as well as institutionalized adults.
That said, they concluded their findings indicate that approximately 46% of surveyed adults misused prescription medication at least once between ages 18 and 50.
“While substance use prevention during adolescence is a justified public health focus, clinicians, prescribers, and researchers must better understand long-term PDM trajectories to reduce PDM-related consequences in later adulthood,” investigators wrote. “The findings of the present study indicate that some US adults do not report their most frequent misuse until later in life, which reinforces the importance of educating about and screening for PDM and SUD from adolescence through middle adulthood.”
The study, “Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years,” was published online in JAMA Network Open.