People with Disabilities Likelier to Misuse Rx Drugs

Compared with adults without disabilities, those with disabilities have higher rates of general drug misuse, but information on their misuse of prescription drugs specifically has been lacking. Now, a new analysis has reported that, overall, adults with disabilities are nearly twice as likely to misuse prescription drugs as those without disabilities.

Reporting in the American Journal of Preventive Medicine, researchers pointed to the critical need to understand abuse in this population.

With the rise in prescription stimulant use over the past several years, the investigators wanted to explore this area using secondary data from the National Survey on Drug Use and Health. “Additionally, the literature in this area has been mixed, with earlier reports suggesting that individuals with disabilities have lower risk, and more recent reports suggesting that they may have greater risk, depending on the type of drug and disability,” Jeannette M. Garcia, PhD, an associate professor in the School of Sport Sciences at West Virginia University in Morgantown, West Virginia, and colleagues told Medscape Medical News.

In 2024, the investigators looked at misuse prevalence by disability status and age group in data on 47,100 individuals from the 2021-2022 National Survey on Drug Use and Health.

The sample was stratified by age group: 18-29 years, 30-49 years, 50-64 years, and 65+ years. Disability status — defined as difficulties with vision, hearing, ambulation, cognition, self-care, or communication — and misuse of prescribed drugs were treated as dichotomous variables.

Adults with disabilities in the 18-29-year-old and 30-49-year-old groups had twice the odds of misusing stimulants, tranquilizers, and pain relievers compared with their unaffected counterparts. Adults with disabilities in the 50-64 years and 65+ years age groups had more than twice the odds of misusing pain relievers compared with those without disabilities. There were no significant differences in stimulant or tranquilizer misuse in the older age groups.

“I was surprised by the magnitude of the difference in misuse rates,” Garcia said. “I hadn’t expected misuse rates to be twice as high in adults with disabilities compared to those without disabilities. This does align with more recent research. However, there’s very little research on stimulant misuse at this point.”

Pain medications were misused by individuals with disabilities across all age groups and disability types, whereas cognitive disabilities were associated with the highest rate of misuse for all prescription drugs, Garcia added. “We weren’t able to capture exact diagnoses, but this group could include those with ADHD, intellectual disabilities, and traumatic brain injury.” 

Given the level of prescription drug misuse in adults with disabilities across all age groups and prescription drug categories, further research should focus on prevention and treatment of misuse in this population, Garcia and coauthors wrote.

They noted that prescription drug misuse, defined as use without a prescription or in a manner not directed by the prescriber, is a significant public health problem in the United States, with approximately 16.9 million adults reporting such misuse each year.

Prescription drugs are often thought to be safer because they are associated with beneficial medical effects, and over the past two decades, misuse has increased, especially of those with drugs addictive qualities and dangerous side effects such as stimulants, opioids, and tranquilizers.

Individuals with disabilities may be more likely to misuse prescription drugs owing to chronic pain, heightened anxiety levels, major depression, and poor physical health. One study found an 18% higher likelihood of prescription opioid use disorder in adults with disabilities who experienced chronic pain compared with those without disabilities.

Commenting on the study but not involved in it, Sharon Reif, PhD, a professor at the Institute for Behavioral Health, Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management at Brandeis University in Waltham, Massachusetts, said recognition of this problem is long overdue. “Ableism and stereotypes abound about people with disabilities, which may lead providers to ignore certain behaviors such as substance use,” she told Medscape Medical News.

“Moreover, healthcare providers generally are not screening for substance use problems in meaningful ways.” Collectively, these points increase the likelihood that misuse of substances will not be recognized and addressed by providers.

The National Institute on Alcohol Abuse and Alcoholism has a helpful provider’s resource that could be applied to other substances as well.

In Garcia’s view, doctors should not assume individuals with disabilities don’t develop prescription misuse issues. “Some information has suggested physicians don’t feel misuse is an issue in this population, and they may be more inclined to prescribe these substances without monitoring for signs of misuse or discussing the negative effects of misuse,” she said.

“But they should be aware of possible signs of misuse. They should also have a discussion with their patients about the adverse health effects of prescription drug misuse and concerns that come with prescribing these medications,” she said.

In addition, drivers of misuse such as chronic pain and anxiety should be considered and other interventions to treat those symptoms developed.

First and foremost, added Reif, the key to reducing self-medication is listening to people with disabilities to see whether their symptoms are sufficiently managed. Second, assess people for common cooccurring conditions. Third, assess for substance misuse and intervene when use reaches risky levels. Fourth, continue to state that drugs should be used only as prescribed.

This study received no specific funding. The authors had no conflicts of interest to report. Reif had no conflicts of interest.

Diana Swift is an independent medical journalist based in Toronto, Ontario, Canada.