Predictors of the Overestimation of the Prevalence of Prescription Pain Reliever Misuse

Background and Purpose: Estimates from the National Survey on Drug Use and Health (NSDUH, 2016) suggest that 4.3% of persons aged 18 and older misused prescription pain relievers in the past year. However, past work (e.g., McCabe, 2008) suggests that individuals drastically overestimate rates of prescription pain reliever misuse. Further, those who overestimate substance misuse are often more likely to misuse substances themselves (Kilmer et al., 2015; McCabe, 2008). Public perceptions of substance misuse are important as they help to shape what individuals consider to be a problem and what advice is given to those facing substance use related problems related (Resko, 2014). Understanding public perceptions of prescription pain reliever misuse can help inform prevention and treatment efforts. This study compared perceived versus actual rates of prescription pain reliever misuse among a statewide sample of adults.

Methods: A survey on health perceptions was distributed through Facebook advertising to adults living in Michigan in July and August of 2018 (N=630). Participants ranged in age from 18 to 82 and were 84% white, 8% African American and 8% other races (e.g. Asian, Native Hawaiian/Pacific Islander, Native American). Participants were asked to estimate what percentage of adults aged 18-44 used pain medication that was not prescribed to them, in the past year. Accuracy of estimating pain reliever misuse was calculated by subtracting the NSDUH misuse rates from the respondent’s estimation (McCabe, 2008). Participants were also asked if they had engaged in pain reliever misuse and if they personally knew anyone who had misused prescription pain medications. Multiple regression was conducted to examine the relationship between demographic factors, pain reliever misuse, and knowing someone who has misused prescription pain relievers and the accuracy of estimating the prevalence of prescription pain reliever misuse.

Results: The overwhelming majority of the sample (99%) overestimated the prevalence of prescription pain reliever misuse (median estimate = 44%). The overestimation of the prevalence of prescription pain reliever misuse was significantly associated with education (β = -.03, p = .001) and knowing someone who had misused prescription pain relievers (β = .073, p < .001). Although past year prescription pain reliever misuse was not a significant predictor of the overestimation of the prevalence of prescription pain reliever misuse, there was a significant relationship with a past history of prescription pain relievers misuse (> one year ago; β = .043, p = .025).

Conclusions and Implications: Consistent with previous research on college students’ perceptions (e.g. McCabe, 2008; Romberg, 2019), adult overestimation of prescription pain reliever misuse was pervasive. Lifetime misuse of prescription pain relievers and knowing someone who has misused prescription pain relievers were both associated with overestimation of the prevalence of prescription pain reliever misuse. Higher levels of education were associated with less overestimation of the prevalence of prescription pain reliever misuse. These findings demonstrate the potential need for social-norms based education, interventions, and prevention efforts. Further research investigating how misperceptions of the prevalence of pain reliever misuse develops among these high risk groups may be beneficial.