From the National Institute on Drug Abuse
Clinicians, Patients, and Pharmacists
What is the scope of prescription drug misuse?
Misuse of prescription opioids, central nervous system (CNS) depressants, and stimulants is a serious public health problem in the United States. Although most people take prescription medications responsibly, an estimated 54 million people (more than 20 percent of those aged 12 and older) have used such medications for nonmedical reasons at least once in their lifetime.1 According to results from the 2014 National Survey on Drug Use and Health, an estimated 2.1 million Americans used prescription drugs nonmedically for the first time within the past year, which averages to approximately 5,750 initiates per day. Fifty-four percent were females and about 30 percent were adolescents.1
The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely include ease of access.8 The number of prescriptions for some of these medications has increased dramatically since the early 1990s.9Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem.10,11
Although misuse of prescription drugs affects many Americans, certain populations such as youth, older adults, and women may be at particular risk.12–14 In addition, while more men than women currently misuse prescription drugs, the rates of misuse and overdose among women are increasing faster than among men.
Adolescents and Young Adults
Nonmedical use of prescription drugs is highest among young adults aged 18 to 25, with 4.6 percent reporting nonmedical use in the past month. Among youth aged 12 to 17, 1.6 percent reported past-month nonmedical use of prescription medications.1
After alcohol, marijuana, and tobacco, prescription drugs (taken nonmedically) are among the most commonly used drugs by 12th graders. The NIDA’s Monitoring the Future survey of substance use and attitudes in teens found that about 6 percent of high school seniors reported past-year nonmedical use of the prescription stimulant Adderall® in 2017, and 2 percent reported misusing the opioid pain reliever Vicodin®.15
Although past-year nonmedical use of CNS depressants and opioid pain relievers decreased among 12th graders between 2011 and 2015, this is not the case for the nonmedical use of stimulants. Nonmedical use of Adderall® increased between 2009 and 2013 but has since appeared to decline.15 When asked how they obtained prescription stimulants for nonmedical use, more than half of the adolescents and young adults surveyed said they either bought or received the drugs from a friend or relative. Interestingly, the number who purchased these drugs through the internet was negligible.1
Youth who misuse prescription medications are also more likely to report use of other drugs. Multiple studies have revealed associations between prescription drug misuse and higher rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other illicit drug use among U.S. adolescents, young adults, and college students.16–19 In the case of prescription opioids, medical use is also associated with a greater risk of future opioid misuse, particularly in adolescents who disapprove of illegal drug use and have little to no history of drug use.14
More than 80 percent of older patients (aged 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily.12 This can potentially lead to health issues resulting from unintentionally using a prescription medication in a manner other than how it was prescribed, or from intentional nonmedical use. The high rates of multiple (comorbid) chronic illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions makes medication (and other substance) misuse more dangerous in older people than in younger populations.20 Further, a large percentage of older adults also use over-the-counter medicines and dietary supplements, which (in addition to alcohol) could compound any adverse health consequences resulting from nonmedical use of prescription drugs.12
Overall, more males than females misuse prescription drugs in all age groups except adolescence (12 to 17 years); adolescent girls exceed boys in the nonmedical use of all prescription drugs, including pain relievers, sedatives, and stimulants. Among nonmedical users of prescription drugs, females 12 to 17 years old are also more likely to meet substance use disorder criteria for prescription drugs.21 Additionally, while more men than women die of prescription opioid overdose, the rate of overdose is increasing more sharply in women than in men.22