Trends and Predictors of Prescription Drug Substance Use Disorders in the United States: The Role of Recovery Capital.

Abstract

To examine trends and predictors of prescription drug substance use disorders (RxSUDs), highlighting risk and protective factors, with a particular focus on patient recovery capital (social factors known to protect against SUDs) for strengthening policy and practice guidelines. This retrospective cross-sectional study used National Survey on Drug Use and Health (NSDUH) data to assess individuals with RxSUDs between 2016 and 2022. RxSUDs include opioid, sedative, hypnotic, anxiolytic, stimulant, or tranquilizer use disorders. Trends were assessed using time-series logistic regression. Demographic, recovery capital, access, and screening characteristics were investigated as RxSUD predictors using cross-sectional multivariate modeling. The sample (survey n = 292,505; weighted n = 250,414,772) was mostly female (52%), White (63%), and aged 35-49 (25%). Time-series analysis (2016-2020) showed no change in RxSUD prevalence (OR = 0.96, 95% CI = 0.91-1.01). Age showed a clinically meaningful association with older adults being less likely to report RxSUDs (OR = 0.43, 95% CI = 0.31-0.59). Recovery capital strengths showed large clinically meaningful odds predicting RxSUD in 6 of 6 variables (OR >2.0). Healthcare provider substance use screening was associated with lower odds of RxSUDs (OR = 0.39, 95% CI = 0.12, 1.27). Recovery capital reduces the odds of an RxSUD, adjusting for demographics, access, and screening variables. In addition, patient access and healthcare provider drug use screening are important factors to consider in clinical assessment and health care policies aimed at reducing RxSUDs. Improving recovery capital requires targeted policies addressing individual and community needs and can have far-reaching outcomes as they can improve constituencies' wellbeing in addition to RxSUD liability.