ASSOCIATIONS BETWEEN PROBLEM GAMBLING AND PRESCRIPTION

DRUG MISUSE IN ALBERTA 

Cheryl Currie, Don Schopflocher, Cam WildUniversity of Alberta

AGRI ConferenceBanff AB, April 9, 2010

Outline

Prescription drug misuse in context Study background Prevalence and predictors of PDM Associations between PDM and gambling

Currie, Schopflocher, Wild. Prevalence and correlates of prescription drug misuse in Alberta [under review]

Prescription Drug Misuse in Context Recent increases in the production and use of

psychoactive prescription drugs in North America

Growing concerns about prescription drug misuse

USA – 15 million people misused prescriptions in 2008

2nd most abused category of psychoactive drugs after cannabis

Prescription Drug Misuse in Context

Most abused prescriptions are those most potent and most available on the licit market

Canada is the world’s top per capita consumer of several high-potency opioids (hydromorphone)

3rd heaviest consumers of psychoactive prescriptions in the world

Yet to date, little epidemiological information is available about the misuse of psychoactive prescription drugs in this country, despite calls for action

Alberta Addiction Survey - 2002

Research Questions

1. What was the prevalence of 12-month PDM among adults in Alberta in 2002?

2. What socio-demographic variables and addictive behaviours are associated with PDM?

Methods

Telephone survey of 3,511 adults in Alberta Survey length – 15 minutes Collected in 2002 Response rate was 57.4% Data weighted - Alberta 2001 census data

Methods

4 prescription drug misuse questions based on the following definition:

- Use in larger amounts than prescribed, for a longer period than prescribed, or use on your own without a physician’s prescription.

In the past 12 months, did you misuse:

1. prescription pain killers (e.g., Demerol, Codeine)

2. prescription sedatives (e.g., Seconal, Halcion)

3. prescription tranquilizers (e.g., Librium, Valium)

4. prescription amphetamines (e.g., Preludin, Ritalin)

Results

Prevalence of past year PDM was 8.2%

Prescription pain relievers – 4.9% Sedatives/tranquilizers – 3.2% Stimulants – 0.8%

Disabled status was the strongest overall predictor of past-year prescription drug misuse – Disabled adults were 4x more likely to misuse prescriptions than other adults.

Adult students also at greater risk.

Addictive Behaviour

Alcohol Alcohol use ≥ Monthly binge drinking Alcohol dependent

Illicit drugs Cannabis use Cocaine/crack user Hallucinogen user

Smoking Casual smoker Daily smoker

Gambling Current gambler At-risk gambler Problem gambler

Prevalence

83.0%14.4% 3.2%

12.1% 1.7% 1.9%

5.8%21.7%

64.9%

6.2% 4.7%

Addictive Behaviour

Alcohol

Alcohol use

Binge drinker

Alcohol dependent

Illicit drugs

Cannabis user

Cocaine/crack user

Hallucinogen user

Smoking

Casual smoker

Daily smoker

Gambling

At-risk gambler

Problem gambler

Adjusted OR (95% CI)

1.8 (1.2 - 2.9)

ns

2.2 (1.3 - 3.7)

2.0 (1.4 - 2.9)

2.7 (1.4 - 5.2)

1.9 (1.1 - 3.6)

ns

ns

1.5 (0.9 - 2.4)

2.9 (1.9 - 4.5)

Prescription drug misuse by gambling status

0%

10%

20%

30%

Prescription drug misuse by gambling category

• Stimulants• Sedatives/

tranquilizers• Pain killers

At-Risk & Problem Gamblers (n = 381)

12-Month PDM Prevalence

Overall 16.3% Gender

Males 16.4%Females 16.1%

Age – yrs18 – 24 24.4%*25+ 14.3%

Marital statusNever married 20.3%Married 12.7%Divorced/widowed 14.6%

*p = .03

At-Risk & Problem Gamblers (n = 381)

12-Month PDM Prevalence

Occupational status

Employed full/part time 15.5%

Student 20.0%

Disabled 36.4%

Education Some high school 11.1% High school diploma 17.4% Some university 22.2% University degree 14.4%

Why?

Problem gamblers may be misusing prescriptions to: Cope with gambling losses Deal with gambling urges Stay awake while gambling

Reverse may be true Individuals may engage in both PDM and

gambling to escape other life stressors Confounding by unmeasured factors

Limitations

Small sample size – further research is needed

Cross sectional study – temporal sequence unknown

No information on motives for PDM among gamblers or prescription drug use

Full CPGI not used – types of gambling favoured by PDMs unknown

Conclusions

Prescription drug misuse was an important public health concern in Alberta in 2002

At that time, Canada was 4th highest per-capita consumer of prescription narcotics in the world

2009, Canada 3rd highest per-capita user

There is an urgent need for an ongoing assessment of this evolving phenomenon

Conclusions

This study was the first to examine associations between problem gambling and PDM in a population-based sample.

The prevalence of PDM among problem gamblers was 21.5%.

Further research is needed to shed more light on motives for PDM among problem gamblers.