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.