Heterogeneity in Prescription Opioid Pain Reliever Misuse Across Age Groups

2015–2017 National Survey on Drug Use and Health

Published in: Journal of General Internal Medicine (2019). doi: 10.1007/s11606-019-05559-6

Posted on RAND.org on March 05, 2020

by Megan S. Schuler, Andrew W. Dick, Bradley D. Stein

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Prescription opioid misuse among older adults has received little attention to date. Potential age variation in characteristics of and motivations for prescription opioid misuse has not been fully characterized yet has important implications for preventing diversion and misuse.


To examine (1) age-specific patterns of source of misused prescription opioid pain relievers and motives for misuse and (2) age-specific and source-specific associations with opioid use disorder (OUD), heroin use, benzodiazepine misuse, and OUD treatment utilization.


Cross-sectional study using 3 waves (2015–2017) of the National Survey on Drug Use and Health (68% average response rate)


Respondents aged 12 and older with past-year prescription opioid pain reliever misuse (n = 8228)

Main Measures

Source for the most-recently misused prescription pain reliever (categorized as medical, social, or illicit/other), motive for last episode of misuse, OUD, heroin use, benzodiazepine misuse, and OUD treatment.

Key Results

Adults 50 and older comprised approximately 25% of all individuals reporting past-year prescription opioid misuse. A social source was most common for individuals under age 50 while a medical source was most common for individuals 50 and older. The most commonly reported motive for misuse was to "relieve physical pain"; the frequency of this response increased across age groups (47% aged 12–17 to 87% aged 65+). Among adults age 50 and older with prescription opioid misuse, 17% met criteria for OUD, 15% reported past-year benzodiazepine misuse, and 3% reported past-year heroin use.


Physicians continue to be a direct source of prescription opioids for misuse, particularly for older adults. Ongoing clinical initiatives regarding optimal opioid prescribing practices are needed in addition to effective non-opioid strategies for pain management. Clinical initiatives should also include screening adult and adolescent patients for non-medical use of prescription opioids as well as improving access to OUD treatment for individuals of all ages.

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