Examining Correlates and Motives for Prescription Opioid Misuse Using the National Survey on Drug Use and Health: Do Older and Younger Adults Differ?

Background and Purpose: Prescription opioid misuse is a significant health and social problem affecting Americans across the life course, yet research has disproportionately focused on younger adults and often overlooked this issue among older adults. Older adults face unique risks in relation to prescription opioid misuse when compared to younger adults, including a heightened risk of harms related to drug interactions and polypharmacy, complications due to multimorbidity, opioid-related falls, and a higher risk of opioid-related mortality. The purpose of this research is: (1) To compare correlates of prescription opioid misuse among younger and older adults; and (2) To examine whether older age is associated with pain relief as a motive for misuse.

Methods: Using the combined 2021, 2022, and 2023 National Survey on Drug Use and Health, chi-square and multivariable logistic regression analyses were conducted to examine correlates of opioid misuse among adults aged 18-49 (n=107,755) and 50+ (n=31,706). Additional analyses were conducted to examine whether older age is associated with pain relief as a motive for misuse (n=4,303).

Results: The prevalence of past-year prescription opioid misuse was 3.7% among adults aged 18-49 and 2.6% among adults aged 50+. Correlates of prescription opioid misuse among both age cohorts included having a very low household income (<$19,999 per year; 18-49: OR=1.44 [95% CI: 1.20-1.73]; 50+: OR=1.82 [95% CI: 1.20-2.76]), poor self-rated health (18-49: OR=1.47 [95% CI: 1.26, 1.72]; 50+: OR=1.58 [95% CI: 1.18, 2.13]), a history of depression (18-49: OR=1.37 [95% CI: 1.22, 1.54]; 50+: OR=2.34 [95% CI: 1.75, 3.13]), and having a past-year alcohol use disorder (18-49: OR=2.24 [95% CI: 1.93, 2.60]; 50+: OR=2.43 [95% CI: 1.66, 3.56]) or cannabis use disorder (18-49: OR=2.61 [95% CI: 2.22, 3.05]; 50+: OR=3.58 [95% CI: 2.23, 5.66]). Being divorced (OR=1.49 [95% CI: 1.22, 1.83]) and lower levels of education (OR=1.54 [95% CI: 1.28, 1.84]) were associated with misuse among younger adults, but not older adults. Older age was associated with pain relief as a motive for misuse at the bivariate level (p<0.001), but was no longer significant in the multivariable analysis. In the multivariable analysis, those with a past-year alcohol use disorder (OR=0.50 [95% CI: 0.38, 0.64]) or cannabis use disorder (OR=0.65 [95% CI: 0.51, 0.82]) were less likely to report pain relief as a motive for misuse.

Conclusions and Implications: Findings from this research provide important knowledge on correlates of opioid misuse, how they may vary by age, and factors associated pain relief as a motive for misuse. By identifying those who have a heightened likelihood of misuse, as well as those who are more likely to misuse opioids because they are seeking pain relief, the findings of this study can help inform targeted screening and treatment for opioid misuse, and also help to inform the importance of prioritizing pain management when supporting people with prescription opioid misuse.