Prescription Opioid Misuse Motives in US Older Adults

Abstract

Objectives: To evaluate age-based differences in prescription opioid misuse (POM) motives and to evaluate substance use and mental and physical health correlates of POM motive categories in older adults.

Design: Data were from the National Survey on Drug Use and Health (NSDUH), a nationally representative US survey.

Setting: The NSDUH is a household survey.

Subjects: A total of 5,826 US residents with past-year POM; 415 were 50 years and older (7.1%).

Methods: Nine POM motives were assessed among those engaged in past-year POM, grouped into three categories: solely physical pain relief, solely non-pain relief, or mixed motives. Prevalence of POM motives were calculated by age group, with logistic models examining age-based differences. Finally, odds of substance use and mental and physical health correlates by motive category were calculated via logistic models in older adults.

Results: POM motivated solely by physical pain relief increased from 35.1% in young adults to 65.4% in older adults; in older adults, 84.7% of POM episodes involved pain relief as a motive. POM for solely non-pain relief or mixed motives was associated with greater odds, vs pain relief only, of past-year benzodiazepine misuse (odds ratio [OR] = 4.43 and 6.15, respectively), any substance use disorder (OR = 5.57 and 5.60, respectively), and suicidal ideation (OR = 4.05 and 3.56, respectively) in older adults.

Conclusions: . POM motives change over the lifespan, with increasing POM for pain relief with aging. Comprehensive nonopioid pain management is needed for those engaged in POM for pain relief, and substance use and mental health treatment are needed for those with non-pain relief motives.

Keywords: Epidemiology; Motives; Opioid; Prescription Misuse.

Figure 1

Prevalence rates of opioid misuse motives by age group (N = 5,826). Source: 2015–2016 National Survey on Drug Use and Health surveys.

Figure 2

Substance use and psychopathology correlates by opioid misuse motive category in older adults (N = 415). Source: 2015–2016 National Survey on Drug Use and Health surveys. Comparisons are between the pain relief only group (reference; N = 267) and either the non–pain relief only group (unshaded; N = 63) or the mixed motive group (shaded; N = 85); the point captures the odds ratio, with 95% confidence intervals included as error bars. * = p < 0.05, ** = p < 0.01, *** p < 0.001. SUD = substance use disorder.