Prescription medication misuse: Time for an expanded conceptualization?

Background. Prescription medication misuse and abuse have received increased attention: inclusion in screening, brief intervention, and referral to treatment (SBIRT) approaches; increased research describing diversion/illicit use; mass media prevention campaigns; and calls to include abuse and diversion items in national survey instruments. Such efforts focus on non-medical use of abusable prescription medications to the exclusion of medical use of medications by individuals without a prescription. This study examined such non-recreational, medical use and compared it to non-medical abuse. Method. Intercept interviews were conducted among 3423 individuals aged 14-45 across the United States. Non-prescribed use, reasons for use, and sources of medication were assessed. Univariate and multivariate analyses were conducted to describe and compare patterns of use. Results. Usage pattern models were developed. Participants were three times more likely to participate in medical rather than non-medical misuse. Three of the 4 most common medications used without a prescription were not in commonly abusable classes. The majority obtained the medications from family or friends, a finding which varied by medication-type. Several other outcomes varied by participant characteristics. Discussion. Non-prescribed, medical use of prescription medications occurs more frequently than non-medical use. While not as sensational nor perhaps as consequential as abuse of psychotherapeutic medications (although that remains to be investigated and participants reported frequent side-effects), such unprescribed (mis)use is an under-examined, poorly understood, public health concern, and our results suggest that an expanded conceptualization of prescription medication misuse is merited and this more inclusive perspective may benefit researchers and healthcare providers.