Alcohol, Tobacco, and Other Drug Use: Predictors of Prescription Drug Misuse: A Prospective National Analysis

Objective: To explore whether earlier ages of drinking and drug-use onset and past-year alcohol and drug dependence prospectively predict prescription drug misuse. Prescription drugs have replaced heroin and cocaine in contributing to unintentional poisoning overdose deaths, which rose 62% from 1999 to 2004. Methods: In 2001/2002, in-person interviews were conducted with a national, multi-stage probability sample of 43,093 adults ages 18 and older. In 2004/2005, of 39,959 eligible respondents, 34,653 were re-interviewed (cumulative response rate 70.2%). Respondents were asked the age they first started drinking, used drugs, or cigarettes; alcohol and drug use disorder diagnostic questions; a variety of personal and demographic characteristics; and whether they used, without a doctor's prescription, sedatives, tranquilizers, painkillers, or stimulants since the last interview. Results: Five percent misused prescription drugs. Respondents more often did this if, in the past year, they met criteria for drug dependence or abuse [OR 30.7 (21.4, 44.0), 17.3 (13.1, 22.7)], and alcohol dependence and abuse [1.9 (1.5, 2.6), 1.4 (1.0, 1.8)]. Those starting alcohol use and smoking at age 14 or less were more likely than never users to have misused prescription drugs [1.8 (1.2, 2.7), 1.6 (1.3, 2.0)]. Fewer blacks, Hispanics, and married persons misused prescription drugs. The younger the respondent's age, the greater the likelihood of prescription drug misuse. Conclusion: Efforts to prevent prescription drug misuse should not only address prevention and treatment of drug use disorders but also prevention and treatment of alcohol use disorders and strategies to delay onset and prevent alcohol and cigarette use.