The Link Between Age, Prescription Drug Use and Addiction
New, large-scale research from the University of Michigan School of Nursing (1) has found that those who misuse prescription drugs are more likely to develop a substance use disorder, as described by the US Diagnostic and Statistical Manual (DSM).
The longitudinal study of 26,575 individuals (approximately 50/50 male and female) followed them from high school seniors until age 50.
In this article, we will look at the research, its conclusions and the recommendations for future screening of adults to try to reduce the prescription drug misuse (PDM) problem.
Background to the Research
There has been a recent spike in prescription drug misuse in the US, with people misusing tranquillisers, opioids and stimulants without their doctor’s advice.
In part, this has led to more than 101,000 drug overdose deaths in 2020-21 (2), a trend that has been increasing strongly over the years.
Big questions are being asked as to how to slow down this epidemic of drug misuse in the US.
The authors of this study set out to determine whether there are markers that can be spotted by medical professionals in a patient’s life to refer them to treatment early on before they suffer significant problems.
Previous research has looked at users of individual classes of prescription drugs such as opioids, tranquillisers, and stimulants. However, this research looked at all three classes because many individuals who engage in PDM will misuse multiple medications.
The study also looked at individuals over a 32-year period to assess the factors that doctors could spot as to what might be associated with PDM.
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Study Design
The data comes from the population-wide study, Monitoring The Future (MTF), which involved 11 cohorts of around 15,000 high school seniors.
These participants were asked questions about their lifestyle, health, and habits, every year between 1975 and 1986. Approximately 53% maintained contact until the age of 50. (3)
The researchers created two sets of questions for the test participants to assess PDM use and substance use disorder as part of the MTF study.
PDM Criteria
As part of the MTF study, they asked the participants whether they had taken a specific class of substance on their own without a doctor asking them to do so within the last 12 months.
They then gave the test participants a list of generic brand-name prescription drugs representing the three classes of opioids, tranquillisers, and stimulants.
Finally, on a scale of 1-7, they were asked to indicate the number of times they had taken the substance, ranging from zero to 40 or more times in the last 12 months.
DSM Substance Use Disorder Measures
Though this does not amount to a formal diagnosis, the research team attributed two of the following criteria of substance use disorder (SUD) under the DSM as indicative of having one.
The criteria are:
- At any time the individual had failed to fulfil a major role or obligation due to taking a substance
- If they had continued to use it despite persistent social or personal problems due to using it
- Tolerance to the substance (needing more for the same effect)
- Withdrawal problems, including psychological and physical symptoms
- A persistent desire to cut down use or unsuccessful attempts to cut down
- Health-related issues due to using the substance
- Cravings for the substance between use or during withdrawal
Questions around these criteria were included in the MTF study and were linked statistically with the PDM criteria to assess any associations. The researchers then assessed peak use and trajectories to determine trends between beginning and peak.
The researchers asked further questions in the MTF study to discover; the use of cannabis, cigarettes, alcohol and substances like cocaine, methamphetamine and heroin. These would show links between PDM and recreational drug use.
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Major Findings
Overall, the research showed that 45.7% of the participants had misused prescription drugs between adolescence and age 50. Of these, 40.3% misused more than one class of prescription drugs.
The research also showed that 94% of those who had misused prescription drugs over a sustained period would fulfil the criteria in this paper for a substance use disorder (SUD).
The research made several other important discoveries:
Older Users More Likely to Develop a SUD
Though only 3% of the sample, those who had misused prescription drugs between the ages of 40-50 were significantly more likely to develop a substance use disorder. Which also amounted to 70% of those engaged in PDM.
Given that people are more likely to be prescribed medication for pain at this age, this highlights a risk factor that doctors need to look at before giving the prescription.
In the US, the peak age group for overdose deaths is aged 35-44, relating well to the findings of this study. This study showed the peak for opioid deaths is age 45-54.
Thanks to opioids being used for pain, this shows the overprescription of such drugs can have fatal consequences for the patient.
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Recreational Drug Use in Teens Associated with PDM Use
The study showed that those who misused cannabis, tobacco or alcohol were more likely to misuse prescription drugs later in life.
Those who had been prescribed medications in their teens were more likely to misuse them in young adulthood but not so much in middle adulthood.
However, those who had misused prescription medication in their teens were most likely to misuse them throughout their lives.
Interestingly, there was a difference in reasons for misusing prescription drugs between the younger and older age groups.
Younger people were more likely to use them recreationally to ‘get high’ while older age groups were more likely to use them for medical reasons without their doctor’s advice.
As we showed above, older adults who misused prescription drugs amounted to just 3% of those who misused them. The majority of those who misused them – one in eight – peaked between the ages of 27-28.
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Implications for Screening
Currently, only some adults are screened by their doctors for substance misuse disorder. However, this research shows that the first signs of future substance use disorder can appear in adolescence.
Furthermore, people can develop symptoms of prescription drug misuse at almost any time in their adult lives, leading to serious problems later in life.
Consequently, this research suggests that screening should be carried out throughout a patient’s life, not just when multiple red flags emerge.
With the high availability of prescription opioids, tranquillisers and stimulants for a variety of ailments from anxiety to cancer pain, it is clear that while considering prescribing something for a patient, their risks of misuse need assessing too.
Effective screening can lead to prescribing patients medications with a lower risk of abuse, ultimately benefitting the patient long term.
If you or someone you know is suffering from substance misuse or prescription drug addiction, you can find out what support is available. Give us a call on 0800 088 66 86.
Or if you need immediate support please call our 24-Hour Helpline: 0800 140 4690
References
- Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787580
- CDC Drug Overdose Deaths in the US Top 100,000 Annually https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
- Monitoring The Future website http://monitoringthefuture.org
- CDC Drug Overdose Deaths in the United States, 1999–2020 https://www.cdc.gov/nchs/products/databriefs/db428.htm
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