
Issue 22	2006

Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates

In Brief
In 2004, among persons aged 12 or older, 2.4 million initiated nonmedical use of prescription pain relievers within the past year There were 615,000 new nonmedical users of OxyContin^® in 2004 Three fourths (73.8 percent) of past year initiates of nonmedical pain reliever use had used another illicit drug prior to using pain relievers nonmedically Nearly all (99.1 percent) past year initiates of nonmedical OxyContin^® use had used another illicit drug prior to using OxyContin^® nonmedically

An estimated 31.8 million Americans have used pain relievers nonmedically in their lifetimes, up from 29.6 million in 2002. OxyContin^® (controlled-release oxycodone hydrochloride) is a prescription pain reliever that first became available in 1995. Although it accounts for a small proportion of overall pain reliever misuse, this drug is of particular concern because of its increasing use in recent years. Lifetime nonmedical use of OxyContin^® increased in the United States from 1.9 to 3.1 million persons between 2002 and 2004.¹

The National Survey on Drug Use and Health (NSDUH) asks respondents aged 12 or older questions related to their nonmedical use of prescription-type drugs, including prescription pain relievers, during their lifetime and past year.² Respondents who used prescription pain relievers nonmedically are asked when they first used them.³

NSDUH also asks respondents to report their use of cigarettes, alcohol, and illicit drugs during the 12 months prior to the interview. Any illicit drug refers to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.

This report focuses on persons aged 12 or older who initiated nonmedical use of pain relievers and OxyContin^® in the 12 months prior to the survey.⁴ In 2004, among persons aged 12 or older, 2.4 million initiated nonmedical use of prescription pain relievers within the past year. This is more than the estimated numbers of initiates for marijuana (2.1 million) or cocaine (1.0 million). In 2004, there were 615,000 new nonmedical users of OxyContin^®. This number includes persons who had used other pain relievers nonmedically prior to using OxyContin^®, as well as those for whom OxyContin^® was the first pain reliever they had used nonmedically.

Characteristics of Recent Initiates of Nonmedical Use of Pain Relievers

Among persons who initiated nonmedical use of pain relievers in the past year, 48.0 percent used Vicodin^®, Lortab^®, or Lorcet^® nonmedically; 34.3 percent had used Darvocet^®, Darvon^®, or Tylenol^® with codeine nonmedically; and 20.0 percent had used Percocet^®, Percodan^®, or Tylox^® nonmedically (Figure 1).⁵

Figure 1. Specific Types of Pain Relievers Used during the Past Year among Initiates of Nonmedical Use of Pain Relievers*: 2004

Figure 1 Table. Specific Types of Pain Relievers Used during the Past Year among Initiates of Nonmedical Use of Pain Relievers*: 2004
Type of Pain Reliever	Percentage
Morphine	4.3
OxyContin^®	8.4
Codeine	14.3
Hydrocodone	18.4
Percocet^®, Percodan^®, or Tylox^®	20.0
Darvocet^®, Darvon^®, or Tylenol^® with Codeine	34.3
Vicodin^®, Lortab^®, or Lorcet^®	48.0

Source: SAMHSA, 2004 NSDUH.

In 2004, over half (54.9 percent) of the persons who initiated nonmedical use of pain relievers were female (Table 1). The average age at first nonmedical use was 23 years. Approximately 75 percent of recent initiates of nonmedical use of pain relievers were non-Hispanic white.

Table 1. Demographic Characteristics of Recent Nonmedical Pain Reliever Use Initiates and OxyContin^® Use Initiates Aged 12 or Older: 2004
Demographics	Any Pain Reliever Initiate			OxyContin^® Initiate
Demographics	N (1,000s)	%	SE	N (1,000s)	%	SE
Total	2,422	100.00	0.00	615	100.0	0.00
Gender
Male	1,093	45.1	2.31	339	55.1	4.37
Female	1,329	54.9	2.31	276	44.9	4.37
Race/Ethnicity
White, non-Hispanic	1,809	74.7	1.94	552	89.8	2.25
Black, non-Hispanic	198	8.2	1.06	7	1.1	0.67
American Indian or Alaska Native, non-Hispanic	11	0.5	0.14	3	0.5	0.22
Native Hawaiian or Other Pacific Islander, non-Hispanic	22	0.9	0.68	**	**	**
Asian, non-Hispanic	58	2.4	0.83	**	**	**
Hispanic	280	11.6	1.59	34	5.6	1.58
Family Income
Less Than $20,000	570	23.5	1.69	152	24.8	3.68
$20,000 - $49,999	795	32.8	2.01	204	33.3	4.05
$50,000 - $74,999	383	15.8	1.57	100	16.3	2.70
$75,000 or More	674	27.8	2.00	157	25.6	4.59

Source: SAMHSA, 2004 NSDUH.

In 2004, over half (55.1 percent) of the persons who initiated nonmedical use of OxyContin^® were male. The average age at first nonmedical use of OxyContin^® was 25 years. Almost 90 percent of recent initiates of nonmedical use of OxyContin^® were non-Hispanic white.

Prior Substance Use by Recent Pain Reliever Initiates and Recent OxyContin^® Initiates

Approximately 87 percent of past year initiates of nonmedical pain reliever use had used alcohol prior to using pain relievers nonmedically; 99.4 percent of past year initiates of nonmedical OxyContin^® use had used alcohol prior to using OxyContin^® nonmedically.⁶ Table 2 provides a comparison of substances used prior to nonmedical use of pain relievers and nonmedical use of OxyContin^® among recent initiates. Three fourths (73.8 percent) of past year initiates of nonmedical pain reliever use had used another illicit drug (marijuana, cocaine or crack, heroin, hallucinogens, inhalants, nonmedical use of tranquilizers, nonmedical use of stimulants, or nonmedical use of sedatives) prior to using pain relievers nonmedically. Nearly all (99.1 percent) of past year initiates of nonmedical OxyContin^® use had used another illicit drug prior to using OxyContin^® nonmedically, including 97.1 percent who had used marijuana and 97.4 percent who had used some other pain reliever nonmedically.

**Table 2. Percentages of Substances Used Prior to Initiation of Nonmedical Pain Reliever Use or OxyContin^® Use in the Past Year among Respondents Aged 12 or Older: 2004**
Substance Use Categories	Any Pain Reliever Initiates (Percent)	OxyContin^® Initiates (Percent)
Cigarettes	73.6	95.5
Alcohol	86.9	99.4
Marijuana	66.2	97.1
Cocaine/Crack	13.0	63.8
Heroin	0.7	8.2
Hallucinogens	24.9	71.1
Inhalants	21.3	49.9
Nonmedical Use of Tranquilizers	12.2	59.8
Nonmedical Use of Stimulants	12.4	46.1
Nonmedical Use of Sedatives	1.5	**
Nonmedical Use of Any Other Pain Reliever (Not OxyContin^®)	+	97.4
Use of Marijuana, Cocaine/Crack, Heroin, Hallucinogens, Inhalants, or the Nonmedical Use of Tranquilizers, Stimulants or Sedatives	73.8	99.1
Use of Marijuana, Cocaine/Crack, Heroin, Hallucinogens, Inhalants, or the Nonmedical Use of Tranquilizers, Stimulants, Sedatives, or Any Other Pain Reliever (Not OxyContin^®)	+	99.8

Source: SAMHSA, 2004 NSDUH.

End Notes

¹ Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.
² Nonmedical use is defined as the use of prescription-type drugs not prescribed for the respondent by a physician or used only for the experience or feeling they caused. Nonmedical use of any prescription-type pain relievers does not include use of over-the-counter drugs.
³ Respondents whose age at first nonmedical use of pain relievers is equal to or 1 year less than their current age are asked to indicate the month in which they initiated their nonmedical use of prescription pain relievers.
⁴ Respondents were aged 12 or older at the time of the survey. With initiation having occurred in the 12 months prior to the 2004 survey, some 12-year-old past year initiates represented in this report were 11 years old when they initiated use, but had reached age 12 by the time of the survey.
⁵ Respondents could report the nonmedical use of more than one type of prescription pain reliever. Therefore, percentages sum to more than 100 percent.
⁶ Use of other substances prior to the nonmedical use of pain relievers was established by utilizing a first-use measure that includes the age, year, month, and day of first use. In situations where all four measures were equal between the nonmedical use of pain relievers and the substance of interest, respondents were classified as not having used the substance of interest prior to nonmedical pain reliever use. A similar scheme was used for determination of the use of substances of interest prior to use of OxyContin.

Figure Notes

^* Several pain relievers, including Demerol^®, Dilaudid^®, Fioricet^®, Fiorinal^®, methadone, Phenaphen^® with codeine, propoxyphene, SK-65^®, Stadol^®, Talacen^®, Talwin^®, Talwin^® NX, tramadol, and Ultram^®, were used by fewer than 3 percent of initiates of nonmedical pain relievers during the past year.
^** Low precision; no estimate reported.
⁺ Not Applicable

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). Prior to 2002, this survey was called the National Household Survey on Drug Abuse (NHSDA). The 2004 data are based on information obtained from 67,760 persons aged 12 or older, of whom 1,513 were recent initiates of nonmedical pain relievers and 355 were recent initiates of OxyContin^®. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information and data for this issue are based on the following publication:

Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.oas.samhsa.gov.

Because of improvements and modifications to the 2002 NSDUH, estimates from the 2002, 2003, and 2004 surveys should not be compared with estimates from the 2001 or earlier versions of the survey to examine changes over time.

The NSDUH Report (formerly The NHSDA Report) is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://www.oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

This page was last updated on December 30, 2008.