The National Survey on Drug Use and Health (NSDUH) for 2015 shows that the most commonly reported reason that people misuse prescription pain relievers is to relieve physical pain: 62.6 percent of respondents gave that as the main reason for using prescription analgesics without a prescription. While noting that pain relief “is the reason pain relievers are prescribed,” the NSDUH added that “use without a prescription of one’s own or use at a higher dosage or more often than prescribed still constituted misuse.”

Other commonly reported reasons for the last misuse among people who misused pain relievers in the past year were to feel good or get high (12.1 percent) and to relax or relieve tension (10.8 percent). Less common reasons among past-year misusers of pain relievers included to help with sleep (4.4 percent), to help with feelings or emotion (3.3 percent), to experiment or see what the drug was like (2.5 percent), because they were “hooked” or needed to have the drug (2.3 percent) and to increase or decrease the effects of other drugs (0.9 percent).

Prior to 2015, the NSDUH used “nonmedical use” of prescription drugs to describe taking them when only for the feeling that they caused. However, there was a problem with this concept, because it didn’t include the possibility that people were using medications for the legitimate use based on the intended effects, such as pain relief — even if the person didn’t have a prescription. “A further concern was whether the term ‘nonmedical use’ appropriately describes use of prescription drugs that individuals took to treat a condition for which the medications are typically prescribed (e.g., nonprescription use of opioid pain relievers to relieve physical pain) but were prescribed for someone else,” the NSDUH stated.

“Misuse as a category includes using more than a physician prescribed or more often than the physician prescribed,” said Kim Johnson, Ph.D., director of SAMHSA’s Center for Substance Abuse Treatment, in response to questions about the survey. “We know that the response to opioids varies and that some types of pain do not respond well to opioid pain relievers. We also know that continued use of opioids leads to the development of tolerance and the need for more medication to address the same level of pain. Patients and physicians need to work together to better address pain, particularly chronic pain, to avoid misuse converting to abuse and addiction.”

So the NSDUH no longer uses the term “nonmedical use” and instead uses the term “misuse.” People who take pain relievers to relieve pain are actually engaging in medical use, although it is still called “misuse” if they aren’t taking it pursuant to a prescription.

The NSDUH was released Sept. 8 (see ADAW, Sept. 19). Stay tuned for further analyses of the survey.