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.
Objectives: Roughly 6.5 million US residents engaged in prescription tranquilizer/sedative (eg, benzodiazepines, Z-drugs) misuse in 2018, but tranquilizer/sedative misuse motives are understudied, with a need for nationally representative data and examinations of motives by age group. Our aims were to establish tranquilizer/sedative misuse motives and correlates of motives by age cohort, and whether motive-age cohort interactions existed by correlate. Methods: Data were from the 2015 to 2018 US National Survey on Drug Use and Health, with 223,520 total respondents (51.5% female); 6580 noted past-year prescription tranquilizer/sedative misuse motives (2.4% overall, 50.3% female). Correlates included substance use (eg, opioid misuse), mental (eg, suicidal ideation) and physical health variables (e.g., inpatient hospitalization). Design-based, weighted cross-tabulations and logistic regression analyses were used, including analyses of age cohort-motive interactions for each correlate. Results: Prescription tranquilizer/sedative misuse motives varied by age group, with the highest rates of self-treatment only motives (ie, sleep and/or relax) in those 65 and older (82.7%), and the highest rates of any recreational motives in adolescents (12–17 years; 67.5%). Any tranquilizer/sedative misuse was associated with elevated odds of substance use, mental health, and physical health correlates, but recreational misuse was associated with the highest odds. Age-based interactions suggested stronger relationships between tranquilizer/sedative misuse and mental health in adults 50 and older. Conclusions: Any tranquilizer/sedative misuse signals a need for substance use and mental health screening, with intervention needs most acute in those with any recreational motives. Older adult tranquilizer/sedative misuse may be more driven by undertreated insomnia and anxiety/psychopathology than in younger groups.
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