Abstract
The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.
Highlights
The ancient Greeks were keenly aware of the potentially dual nature of a drug
In addition to assessing if prevalence by racial/ethnic group of non-medical use of prescription painkillers (NMUPP) in our sample reflects proportions seen in other data sets, we explored a possible connection between family income while in middle and high school and subsequent report of NMUPP in early adulthood
As the models adjusting for confounders revealed a significant increase in prevalence by increasing level of parental education, in supplemental analyses we explored the main effect on NMUPP of parental education, after controlling for parental income, age, sex, and region
Summary
The ancient Greeks were keenly aware of the potentially dual nature of a drug. Their word for drug, φάρμακoν, carries very different meanings based on the context of its appearance: sometimes it signifies a “cure,” other times “poison” [1]. The ongoing epidemic of unintentional drug overdose in the United States is one inextricably tied to the misuse of medicine originally designed to cure pain, but acting lethally as poison [2]. By 2011, death rates from motor vehicle crashes had for the first time been surpassed by mortality rates due to drug overdose, making it the new leader in unintentional injury mortality [4]. Between 2004 and 2011 visits to emergency departments attributable to nonmedical use of prescription drugs reportedly increased 132% [5]
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