Potential Influences on Initiation and Persistence of Extramedical Prescription Pain Reliever Use in the US Population

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Abstract
Objective Extramedical prescription pain reliever use has generated much public concern; however, little is known regarding its epidemiology in the general population. Methods Using data from the annual National Survey on Drug Use and Health (2002 and 2003), we explored demographics, drug use history, and physical/mental problems associated with recent onset use (initiated in past 24 mo, n=1528) and persistent use (initiated more than 2 y and still using within a year of the assessment, n=4400) of prescription pain relievers when taken without a clinician's prescription or not as prescribed. Results Adolescents and young adults were more likely to initiate extramedical use as compared with older individuals. African-Americans were approximately half as likely to initiate extramedical use as compared with whites (odds ratio, OR: 0.56, 95% confidence interval, CI: 0.45, 0.70). Hispanics who began using prescription pain relievers extramedically were more likely to persist as compared with whites (OR: 1.84, 95% CI: 1.52, 2.22). Reporting lifetime use of marijuana (adjusted odds ratio, aOR: 6.86, 95% CI: 5.86, 8.03), cocaine (aOR: 5.36, 95% CI: 4.53, 6.33), and heroin (aOR: 3.87, 95% CI: 2.51, 5.97) was associated with initiation of extramedical prescription pain reliever use. Adults with mental problems were twice as likely to be recent onset users as compared with those without these symptoms, holding constant potential confounders. Discussion This study supplies data that can improve our understanding of factors associated with the extramedical use of prescription pain relievers among 2 distinct stages of use.

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