Misuse of Prescription and Illicit Drugs in Middle Adulthood in the Context of the Opioid Epidemic.

Background: The United States' opioid epidemic continues to escalate overdose deaths. Understanding its extent is complicated by concurrent misuse of other prescription or illicit drugs, increasing risk for overdose. Current surveillance using electronic medical records and police data has limitations and frequently fails to distinguish middle-aged adults from other age groups in reporting. Objectives: The purpose of this analysis is to (1) describe characteristics of middle-aged US adults who report misusing prescription and illicit drugs and (2) evaluate if misusing prescription opioids increases risk of misusing other drugs. Methods: We analyzed data from 12,300 adults ages 32-42 from Wave V of the Add Health study collected from 2016 to 2018. Self-reported past 30-day misuse of prescription sedatives, tranquilizers, stimulants, and opioids as well as cocaine, crystal methamphetamine, heroin, and other illicit drugs were analyzed for associations with demographic characteristics in weighted bivariate analysis and multivariable logistic regression. Results: Those misusing prescription opioids were more likely to misuse prescription sedatives, tranquilizers, and stimulants compared to those not misusing prescription opioids. Those misusing prescription opioids were also more likely to misuse heroin, crystal meth, cocaine, and other illicit drugs. Higher levels of education and personal income were protective for prescription opioid misuse, any prescription drug misuse, and any illicit drug misuse. Race/ethnicity was not significantly associated with prescription opioid misuse. Conclusions/Importance: Our analysis shows those misusing prescription opioids are at high risk of misusing other prescription and illicit drugs. Practitioners and researchers should consider concurrent drug misuse when treating and studying opioid misuse disorders.