Pharmacoepidemiology
National Trends and Correlates of National Trends in Psychoactive Prescription Medication Misuse, 2021–2023 Oluwapelumi Odubunmi* Oluwapelumi Odubunmi Odubunmi Odubunmi Odubunmi University of Nevada, Reno
Background: Surveillance of prescription drug misuse in the United States has primarily focused on opioids, despite widespread prescribing and misuse potential of other psychoactive medications such as stimulants, benzodiazepines, and sedatives. Whether misuse of these medications shifted in the post-COVID period, and whether patterns align more closely with behavioral risk or healthcare access mechanisms, remains unclear.
Methods: We analyzed pooled 2021–2023 National Survey on Drug Use and Health (NSDUH) data (N=173,808). Past-year misuse of prescription stimulants, benzodiazepines, sedatives, and pain relievers was defined as nonmedical use. Survey-weighted prevalence estimates and multivariable survey logistic regression models assessed associations with time (continuous year), age (12–17, 18–25, ≥26), sex, race/ethnicity, and insurance status, accounting for survey design.
Results: Prevalence of misuse was 1.41% for stimulants, 1.46% for benzodiazepines, 0.33% for sedatives, and 3.02% for pain relievers. From 2021–2023, stimulant misuse declined modestly (OR=0.82; 95% CI: 0.67–1.02) and benzodiazepine misuse trended downward (OR=0.69; 95% CI: 0.47–1.01), while sedative (OR=1.14; 95% CI: 0.67–1.96) and pain reliever misuse (OR=0.99; 95% CI: 0.86–1.14) remained stable. Misuse was strongly patterned by age, with substantially lower odds among adolescents and young adults compared with older adults (p<0.01 across outcomes). Variations by race/ethnicity and insurance status were observed, suggesting access-driven rather than purely behavioral mechanisms.
Conclusions: Misuse of psychoactive prescription medications remained stable in the United States during 2021–2023, despite heightened attention to mental health and medication use in the post-COVID period. Age and insurance gradients indicate that misuse may reflect prescribing opportunity and healthcare access. Integrating non-opioid psychoactive medications into pharmacoepidemiologic surveillance frameworks may improve prevention, equity monitoring, and behavioral health policy assessment.