Topline & Methodology The Washington Post/Kaiser Family Foundation Survey of Long-Term Prescription Painkiller Users and Their Household Members December 2016 June 2015 This Washington Post/Kaiser Family Foundation poll was conducted by telephone October 3 – November 9, 2016, among a random national sample of 809 adults age 18 and older who they themselves, or a household member have taken strong prescription painkillers for a period of two months or more at some time in the past two years other than to treat pain from cancer or terminal illness. The results from the full survey have a margin of sampling error of plus or minus 4 percentage points. Sampling, data collection and tabulation by SSRS of Media, Pa. See Methodology appendix on page 29 for full details. SCREENER QUESTIONS S3. I have a question about strong prescription painkillers, sometimes called opioids, including drugs such as morphine, Percocet, OxyContin, and Vicodin. In the past TWO years, have you or someone in your household taken a strong prescription painkiller, or not? Please include painkillers that you or a household member took with or without a doctor’s prescription. [IF YES: Was that you, or someone else in your household?] [If no, terminate] S4. (Ask if respondent or someone in household has taken a strong prescription painkiller in past two years) Did (you/that person) take the prescription painkillers for a period of TWO months or more, or less than two months? [If less than 2 months, terminate] S5. (Ask if respondent or someone in household has taken a strong prescription painkiller in past two years and for a period of two months or more) Did (you/that person) take the prescription painkillers to treat pain from cancer or a terminal illness, or was it for some other reason? [If related to treatment for cancer/terminal illness, terminate] OPIOID USER All Personally Using (User) 72 Household member of user (HH member) 28 Note: Those personally using were asked the questions directly about their use, whereas household members were asked about the user in most cases, as indicated in the questions. 1 MAIN QUESTIONNAIRE Q1. (Items a-d of half sample) First, for each health issue I name, please tell me how serious a problem you think it is in this country. The first is [INSERT ITEM]. Is that very serious, somewhat serious, not too serious, or not at all serious? How about [NEXT ITEM]? (Randomize items) ------ Serious -------- Not serious NET Very Somewhat NET Not too a. Obesity, that is, people being seriously overweight All 95 61 34 4 3 User 95 64 31 4 3 U.S. Adults* 92 63 29 7 5 -Not at all No Unwtd opin. N 1 1 2 1 1 1 405 312 599 b. Cancer All 97 User 97 U.S. Adults* 99 86 87 82 11 10 16 2 2 1 2 2 1 1 * - 1 1 * 405 312 599 c. Heart disease All 94 User 94 U.S. Adults* 95 72 75 70 22 19 25 4 4 4 3 3 3 1 1 1 2 2 1 404 310 603 d. Diabetes All 96 User 96 U.S. Adults* 95 69 74 68 27 23 27 3 2 4 2 2 3 * * * 2 2 1 404 310 603 e. Alcohol abuse All 93 User 94 HH member 88 U.S. Adults* 89 62 67 51 52 30 27 38 37 6 5 9 11 5 4 7 8 2 1 2 2 1 * 3 * 809 622 187 1202 f. Abuse of strong prescription painkillers, sometimes called opioids, such as Percocet, OxyContin or Vicodin All 87 63 23 11 7 4 3 809 User 84 62 23 12 7 5 3 622 HH member 92 67 25 7 4 3 1 187 U.S. Adults* 92 66 26 6 4 2 2 1202 g. Heroin abuse All 89 User 89 HH member 88 U.S. Adults* 93 72 74 69 72 16 15 19 20 4 4 5 6 2 2 3 4 2 2 2 2 7 7 8 1 809 622 187 1202 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) 2 To all: As I mentioned, when I say strong prescription painkillers I’m referring to drugs sometimes called opioids, including drugs such as morphine, Percocet, OxyContin, and Vicodin. Let me remind you that this is a completely confidential interview and that there are no right or wrong answers. If household member interview: We’re interested in how prescription painkiller use affects both the people taking the medications and other people in their household. Some of these questions will be about your household member’s personal experience, and you may or may not have enough information to answer them. If you don’t know the answer to a question, just let me know and we’ll move on to the next one. Q2. (Ask if household member interview) Who is the person in your household that has taken the prescription painkillers for a period of TWO months or more? Is it your spouse, child, parent, or some other person? HH member Spouse 43 Child 9 Parent 25 Some other person 21 No opinion * Unwgt N 187 Q2a. (Ask if household member interview) Is that person male or female? HH member Male 46 Female 54 Other (Vol.) - No opinion 1 Unwgt N 187 Q2b/2c. (Ask if household member interview) What is that person’s age? HH member <18(Vol.) 1 18-29 15 30-49 31 50-64 30 65+ 23 No opinion * Unwgt N 187 Q3. Are (you/they) currently taking any of these strong prescription painkillers, or are (you/they) no longer taking them? All User HH member Currently taking 54 55 53 No longer taking 44 45 43 No opinion 1 * 3 NOTE: Current opioid users were asked the questions in the present tense, indicated where applicable in the first part of the parenthetical text within the question. Former opioid users were asked the questions in the past tense and read the language in the second half of the parentheses. For the next set of questions, I’ll be asking about the most recent time (you/they) have taken these strong prescription painkillers for a period of 2 months or more, even if (you’ve/they’ve) taken them at other times in the past. Q4. How long (have [you/they] been taking)/(did [you/they] take) these painkillers? All User HH member 6 months or less 28 28 28 More than 6 mths. but less than 1 yr. 8 7 11 3 At least 1 year but less than 2 years 12 13 9 2 years or more 51 52 50 No opin. 1 * 2 Q5. Which of the following comes closest to the reason (you/they) BEGAN taking painkillers? Was it for …? (IF SURGERY AFTER AN ACCIDENT, CODED AS ACCIDENT/INJURY) Pain after surgery Pain after an accident or injury Chronic pain Recreational use Some other reason No opinion All 25 27 42 3 2 * User 25 25 44 3 2 - HH member 23 32 35 5 3 2 Q6. (Ask if not currently taking Rx painkillers) People stop taking these painkillers for a variety of reasons. For each of the following, please tell me if this is a major reason, a minor reason, or not a reason (you/they) stopped taking these painkillers? Was it because (INSERT ITEM)? (RANDOMIZE ITEMS) Reason Major Minor (NET) reason reason a. (Your/their) prescription ended All 31 18 13 User 34 20 14 Not a reason No opin. Unwgt N 68 65 1 1 322 253 39 37 3 3 322 253 c. (You/they) were worried about becoming addicted to them All 49 35 14 51 1 User 50 36 13 50 1 322 253 d. (You/they) didn’t like the side-effects All 45 31 13 User 45 33 12 322 253 b. (You/they) no longer needed them for pain All 59 42 16 User 60 45 15 54 55 1 * Q7. Overall, would you say (your/their) quality of life (is/was) better or worse than if (you/they) had not taken these medications, or (is/was) it about the same? Better Worse About the same No opinion All 56 18 24 3 User 57 16 25 2 HH member 52 22 21 4 4 Q8. Do you think (your/their) use of strong prescription painkillers (has had/had) a positive or negative impact on (your/their) (INSERT), or has it had no impact at all? Is that very or just somewhat? (Randomize items) ------ Positive -----NET Very Somewhat a. Finances All 7 User 8 HH mem. 4 5 6 2 --NET Negative Somewhat ---Very No impact Not emp/ ret/dis (Vol.) No op. 2 3 2 22 17 37 9 5 17 14 11 20 69 74 58 - 1 1 1 b. Personal relationships All 15 9 6 User 15 10 5 HH mem. 14 7 7 21 16 34 9 6 17 13 11 17 63 68 50 - 1 1 2 c. (Your/Their) ability to do (your/their) job All 24 16 7 18 6 User 23 18 5 14 6 HH mem. 24 12 12 27 6 12 9 20 45 48 38 12 14 8 1 * 3 d. Physical health All 40 24 User 42 26 HH mem. 36 18 16 16 18 25 20 39 12 9 18 14 11 22 33 37 23 - 1 1 2 e. Mental health All 21 12 User 21 12 HH mem. 20 9 9 9 11 25 19 39 13 9 22 12 10 17 52 57 38 - 2 2 3 Q9. Overall, how well would you say these prescription painkillers (reduce/reduced) (your/their) pain? Very well, somewhat well, not too well, not well at all? All User HH member --- Very/somewhat well --NET Very Somewhat 88 49 39 92 53 40 79 40 39 5 --- Not too/not at all -NET Not too Not at all 10 7 3 8 6 2 17 12 5 No opin. 2 * 5 Q10. For each of the following, please tell me if this is a major reason, a minor reason, or not a reason (you/they) (take/took) these painkillers? (ROTATE a-b, d; ALWAYS ASK c LAST) Reason (NET) Major reason a. To relieve physical pain All 97 90 User 98 92 HH member 94 84 Minor reason Not a reason No opin. 7 6 10 3 2 6 * * * b. To deal with day to day stress All 24 15 User 22 14 HH member 28 17 9 8 11 76 78 71 1 1 1 c. For fun or to get high All 34 User 34 HH member 33 19 20 16 15 14 17 65 66 65 1 1 2 d. To relax or relieve tension All 15 11 User 12 10 HH member 21 15 4 3 6 85 88 79 * * Q11. Did a doctor or medical professional initially prescribe (you/them) the painkillers, or did (you/they) get them some other way? All User HH member From a doctor/medical professional 96 97 93 Some other way 4 3 7 No opinion - Q12. (Ask if initially got painkiller Rx from doctor/medical professional) (Has/Did) (your/their) doctor (prescribed/prescribe) or (told/tell) (you /them) to increase or decrease the dose (since/after) (you/they) started taking these painkillers, or (has/did) the dose (stayed/stay) the same? Increase All User HH member 23 22 24 Decrease 16 16 16 Stayed the same 54 58 44 Q11/Q12. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor increased dose 22 Doctor decreased dose 15 Dose stayed the same 52 Both (Vol.) 4 No opinion 4 Got prescription painkillers some other way 4 No opinion - Both (Vol.) 4 3 6 No opinion 4 1 11 User 6 Unwtd. N 782 610 172 HH member 97 21 15 56 3 1 93 22 15 41 6 10 3 - 7 - Q12a. (Ask if initially got painkiller Rx from a doctor/medical professional) (Has/Did) (your/their) doctor (prescribed/prescribe) or (told/tell) (you/them) to take the drug more often or less often (since/after) (you/they) started taking these painkillers, or (have/did) (your/their) doctor’s instructions (stayed/stay) the same? More often All 10 User 10 HH member 10 Less often 15 13 20 Stayed the same 69 74 55 Both (Vol.) 2 3 2 Q11/Q12a. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor prescribed drug more often 10 Doctor prescribed drug less often 14 Frequency stayed the same 66 Both (Vol.) 2 No opinion 4 Got prescription painkillers some other way 4 No opinion - No opinion 4 1 13 User 7 Unwtd. N 782 610 172 HH member 97 93 10 9 12 71 2 1 18 51 2 12 3 - 7 - Q13. (Ask if initially got painkiller Rx from a doctor/medical professional) When (your/their) doctor first prescribed these medications, did (your/their) doctor talk to (you/them) about (INSERT), or not? (Randomize items) Yes No a. The possibility of addiction or dependence All 67 28 User 67 33 HH member 67 17 b. A plan for getting off of the medication All 31 User 34 HH member 24 No opinion 60 63 51 Unwtd. N 5 1 16 782 610 172 9 3 25 782 610 172 c. Other ways to manage (your/their) pain besides these painkillers All 63 32 5 User 64 34 2 HH member 59 27 14 782 610 172 d. Avoiding alcohol or certain medications while taking these painkillers All 80 15 5 782 User 81 18 2 610 HH member 80 8 12 172 e. Possible side-effects associated with these painkillers All 73 23 User 73 26 HH member 72 14 5 1 13 782 610 172 f. Keeping (your/their) medications in a safe place so they’re not misused by others All 69 26 6 782 User 70 28 1 610 HH member 65 18 17 172 Q11/Q13a. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about possibility of addiction or dependence 64 Doctor did not talk about possibility of addiction or dependence 27 No opinion 5 Got prescription painkiller some other way 4 No opinion - 8 User HH member 97 93 65 62 32 1 16 15 3 - 7 - Q11/Q13b. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about a plan for getting off of the medication 30 Doctor did not talk about a plan for getting off of the medication 57 No opinion 8 Got prescription painkiller some other way 4 No opinion Q11/Q13c. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about other ways to manage pain 60 Doctor did not talk about other ways to manage pain 31 No opinion 5 Got prescription painkiller some other way 4 No opinion Q11/Q13d. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about avoiding alcohol or certain meds 77 Doctor did not talk about avoiding alcohol or certain meds 15 No opinion 4 Got prescription painkiller some other way 4 No opinion Q11/Q13e. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about possible side effects 70 Doctor did not talk about possible side effects 22 No opinion 4 Got prescription painkiller some other way 4 No opinion - 9 User HH member 97 93 33 22 61 3 48 23 3 - 7 - User HH member 97 93 62 55 33 2 26 13 3 - 7 - User HH member 97 93 78 74 17 2 7 11 3 - 7 - User HH member 97 93 70 67 25 1 13 13 3 - 7 - Q11/Q13f. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor talked about keeping medications in a safe place 66 Doctor did not talk about keeping medications in a safe place 25 No opinion 5 Got prescription painkiller some other way 4 No opinion - User HH member 97 93 68 61 28 1 17 15 3 - 7 - Q14. (Ask if initially got painkiller Rx from a doctor/medical professional) Do you think (your/their) doctor provided enough information on the risk of addiction and other side effects associated with prescription painkillers, or do you think (your/their) doctor did not provide enough information? All User HH member Enough information 76 78 70 Not enough information 21 20 23 Q11/Q14. Combo Table based on total All Initially got prescription painkiller from doctor 96 Doctor provided enough information 72 Doctor did not provide enough information 20 No opinion 4 Got prescription painkiller some other way 4 No opinion - 10 No opinion 4 2 8 Unwtd N 782 610 172 User HH member 97 93 75 65 19 2 21 7 3 - 7 - Q15. Since (you/they) began taking these painkillers most recently, (have/did) (you/they) ever (had/have) trouble (INSERT), or not? How about (INSERT ITEM)? Yes, had No, did not Not applicable (Vol.) trouble have trouble a. Getting a doctor to refill (your/their) prescription All 17 79 3 User 16 81 3 HH member 19 75 3 No opinion 1 * 4 b. Getting a pharmacy to refill (your/their) prescription All 19 77 3 User 16 82 2 HH member 28 66 5 1 * 2 c. Getting insurance to pay for (your/their) painkillers All 13 82 3 User 12 85 3 HH member 17 74 5 2 1 4 d. Being able to afford (your/their) painkillers All 21 76 User 18 81 HH member 30 64 1 3 2 1 3 Q15a/b/c/d Summary Table -- Yes to any All 44 User 41 HH member 52 Q16. (Ask if had trouble getting a doctor to refill Rx) Did (you/they) switch to a different doctor to try to keep taking these painkillers? Yes, (you/they) switched to a different doctor All 30 No, (you/they) did not switch to a different doctor 67 11 No opinion 2 Unwtd N 118 Q17. (Ask if had trouble getting a doctor to refill Rx and switched to a different doctor) When (you/they) switched doctors, were (you/they) able to get a prescription to keep taking these painkillers, or not? Q15a/Q16/Q17 Combo table based on total All Had trouble getting a doctor to refill Rx 17 Switched to a different doctor as a result 5 Was able to get Rx to keep taking painkillers 3 Was not able to get Rx to keep taking painkillers 2 No opinion * Did not switch to a different doctor as a result 11 No opinion * Did not have trouble getting a doctor to refill Rx 79 Not applicable 3 No opinion 1 User HH member 16 19 5 6 3 4 2 * 2 - 11 - 11 1 81 3 * 75 3 4 Q18. (Since [you/they] have been taking these painkillers have [you/they] ever taken)/(While [you/they] were taking these painkillers did [you/they] ever take), painkillers that were not prescribed specifically for (you/them) by (your/their) own doctor, such as medications obtained from a friend or family member, or some other way? Yes, taken painkillers not prescribed to (you/them) All User HH member 18 17 22 No, have not taken painkillers that were not prescribed to (you/them) 81 83 76 No opinion 1 * 2 Q19. In general would you say (your/their) health is excellent, very good, good, only fair, or poor? All User HH member ----Excellent/very good/good NET Excellent Very good 54 5 16 57 7 19 44 2 9 ----Good 32 31 34 ---Only fair/poor NET Fair Poor 46 27 19 42 25 17 55 32 24 No opinion * * * Q20. And would you say (your/their) mental health is excellent, very good, good, only fair, or poor? All User HH member ----Excellent/very good/good NET Excellent Very good 69 19 19 72 22 22 61 9 13 ----Good 31 28 39 12 ---Only fair/poor NET Fair Poor 31 21 10 28 20 8 38 24 14 No opinion * * * Q21. Does any disability, handicap, or chronic disease keep (you/them) from participating fully in work, school, housework, or other activities? All User HH member Yes 70 70 71 No 29 30 28 No opinion * * 1 Q22. Currently, (are you yourself/is your household member taking the strong painkillers) employed full-time, part-time, or not at all? Q23. Are (you/they): Full-time Part-time Not employed Retired A homemaker or stay at home parent A student Temporarily unemployed On disability & can’t work Other (Vol.) No opinion No opinion All 23 9 67 19 6 2 6 30 2 * 1 User 23 8 69 20 7 2 6 33 1 1 * HH member 25 11 61 16 4 2 6 25 7 4 Q24. (Are you, yourself/Is your household member taking the strong prescription), now covered by any form of health insurance or health plan or do (you/they) not have health insurance at this time? (IF NECESSARY: A health plan would include any private insurance plan through (your/their) employer or a plan that (you/they) purchased (yourself/themselves), as well as a government program like Medicare or [Medicaid/Medi-CAL])? All User HH member Covered by health insurance 89 90 87 Not covered by health insurance 9 10 8 No opinion 2 1 5 Q24a. (Ask if covered by health insurance) Which of the following is (your/their) MAIN source of health insurance coverage? Is it a plan through (your/their) employer, a plan through (your/their) spouse’s employer, a plan (you/they) purchased (yourself/themselves) either from an insurance company or a state or federal marketplace, are (you/they) covered by Medicare or (Medicaid/[INSERT STATE-SPECIFIC MEDICAID NAME]), or do (you/they) get your health insurance from somewhere else? All User HH member Plan through (your/their) employer 20 20 20 Plan through (your/their) spouse’s employer 12 11 14 Plan (you/they) purchased (yourself/themselves) 8 8 8 Medicare 34 35 31 Medicaid 17 19 11 Through the military/VA/Tricare 2 2 3 Somewhere else 3 2 4 Plan through (your/their) parents/mother/father (Vol.) 2 2 2 No opinion 2 * 7 13 Q24/Q24a Combo Table based on total Covered by health insurance Plan through employer Plan through spouse’s employer Plan purchased yourself Medicare Medicaid Through the military/VA/Tricare Somewhere else Plan through parents/mother/father (Vol.) No opinion Not covered by insurance No opinion Q25. All 89 18 10 7 30 15 2 2 2 2 9 2 User 90 18 10 7 32 17 2 2 2 * 10 1 HH member 87 18 12 7 27 10 2 4 1 6 8 5 How many different prescription drugs do (you/they) take? All 36 15 11 10 24 9 8 7 30 10 1-3(NET) 1 2 3 4-6 (NET) 4 5 6 7 or more No opinion User 35 14 11 9 25 9 8 8 32 9 HH member 41 17 11 12 24 9 9 6 23 13 Q26. While taking prescription painkillers, (are/were) (you/they) taking any other prescription medications for anxiety or depression, or sleep problems, or not? All User HH member Yes 50 52 45 No 50 48 53 No opinion 1 2 Q27. Do (you/they) have a prescription for Narcan or Naloxone in your home, a drug that can prevent people from dying if they are experiencing an overdose of a prescription painkiller, or not? All User HH member Yes, have a Rx 3 4 2 No, do not have a Rx 93 95 89 No opinion 4 1 9 14 Q28. (Have/Did) (you/they) (tried/try) to manage (your/their) pain with any other pain medications, such as Aleve, Tylenol, or ibuprofen or Motrin, or not? All User HH member Yes 80 84 69 No 19 16 29 No opinion 1 * 2 Q29. (Ask if tried to manage pain with non-narcotic painkillers) Was this before or after (you/they) started taking these strong prescription painkillers? Before All User HH member 41 41 41 After 27 26 29 Started at the same time (Vol.) 4 4 3 Both before and after (Vol.) 28 29 24 No opin. 1 1 3 Unwtd N 649 522 127 Q28/Q29. Combo Table based on total Tried to manage pain with non-narcotic painkillers Before starting to take Rx painkillers After starting to take Rx painkillers Started at the same time (Vol.) Both before and after (Vol.) No opinion Did not try to manage pain with non-narcotic painkillers No opinion All User HH member 80 33 21 3 22 1 84 35 22 3 24 1 69 28 20 2 16 2 19 1 16 * 29 2 Q30. (Have/Did) (you/they) (tried/tried) to manage (your/their) pain with other types of treatments such as physical therapy, acupuncture, or meditation, or not? All User HH member Yes, have tried 68 69 64 No, have not tried 32 31 36 No opinion * * 1 Q31. (Ask if tried to manage pain with alternative treatments) Was this before or after (you/they) started taking these strong prescription painkillers? Before All User HH member 30 32 24 After 39 35 50 Started at the same time (Vol.) 8 8 9 15 Both before and after (Vol.) 23 25 16 No opin. * * 1 Unwtd N 584 467 117 Q30/Q31. Combo Table based on total Tried to manage pain with alternative treatments Before starting to take Rx painkillers After starting to take Rx painkillers Started at the same time (Vol.) Both before and after (Vol.) No opinion Did not try to manage pain with alternative treatments No opinion All User HH member 68 20 26 6 15 * 69 22 24 6 17 * 64 15 32 6 10 * 32 * 31 * 36 1 Q32. (Ask if tried to manage pain with either non-narcotic medications or other treatments) How effective, if at all, were the other ways (you/they) tried to manage (your/their) pain? Were they very effective, somewhat effective, not too effective or not at all effective? --NET All 43 User 41 HH member 48 Effective ---Very Somewhat 12 31 13 28 8 40 --NET 55 57 49 Not Effective Not too Not 22 23 21 --at all 33 35 28 No Unwtd opin. N 1 737 1 583 3 154 Q28/Q30/Q32. Combo Table based on total Tried to manage pain with other approaches Effective Very effective Somewhat effective Not effective Not too effective Not at all effective No opinion Did not try to manage pain with other approaches/No opinion All 91 39 11 28 50 20 30 1 9 User 94 39 12 26 54 21 33 1 HH member 83 40 7 33 40 17 23 2 6 Q33. Have (you/they) wanted to try other treatments, therapy or surgeries reducing (your/their) pain, but found that you could not afford the cost? All User HH member Yes 29 31 25 No 67 66 70 No opinion 3 3 6 16 17 On a different topic… Q34. How concerned, if at all, (are/were) you about side-effects (they may experience) from the prescription painkillers? Very concerned, somewhat concerned, not too concerned or not at all concerned? --NET 54 49 67 All User HH member Concerned ---Very Somewhat 30 24 27 23 40 27 --NET 45 50 33 Not concerned --Not too Not at all 17 28 19 31 12 21 No opin. * 1 * Q35. (As far as you know,) Have (you/they) ever experienced any of the following side effects as a result of taking prescription painkillers? (RANDOMIZE ITEMS) Yes, have experienced No, have not experienced No opinion a. Constipation All User HH member 54 55 50 42 44 38 4 1 12 b. Breathing problems All User HH member 16 15 19 81 84 73 3 1 7 48 49 45 3 1 6 c. Indigestion, dry mouth, or nausea All 50 User 50 HH member 48 Q36. (Ask if have experienced specified side effects) Have (you/they) taken medication to treat any side effects caused by the prescription painkillers (you/they) (are/were) taking, or not? All User HH member Yes, have taken medication 31 29 36 No, have not taken medication 66 70 53 No opinion 4 1 11 Unwtd N 590 451 139 Q35a,b,c/Q36. Combo Table based on total Experienced constipation, breathing problems, or dry mouth, indigestion, or nausea Yes, have taken medication No, have not taken medication No opinion Have not experienced side effects/No opinion 17 All User HH member 71 22 47 3 29 72 21 50 1 28 70 25 37 8 30 Now, thinking about the use of prescription painkillers more generally, Q37. Which comes closer to your view on using prescription painkillers for more than a week to treat pain:(ROTATE OPTIONS) The risk of addiction outweighs the benefit of pain relief All 30 User 25 HH member 43 U.S. Adults* 47 The benefits of pain relief outweigh the risk of addiction 63 68 50 44 No opinion 6 6 6 9 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) Q38. How easy or difficult do you think it is for people to get access to prescription painkillers that were NOT prescribed to them? Very easy, somewhat easy, somewhat difficult, or very difficult? All User HH member U.S. Adults* --NET 63 60 71 71 Easy Very 38 36 44 37 ---Somewhat 25 24 27 33 --NET 26 27 22 27 Difficult Somewhat 14 14 15 17 --Very 12 14 7 10 No opinion 11 13 7 3 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) Q39. How easy or difficult do you think it is for people who need prescription painkillers for medical purposes to get access to them? Very easy, somewhat easy, somewhat difficult, or very difficult? All User HH member U.S. Adults* --NET 39 36 45 62 Easy Very 19 16 26 28 ---Somewhat 20 20 19 34 --NET 57 59 52 35 Difficult Somewhat 31 30 34 24 --Very 26 29 18 12 No opinion 5 5 3 3 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) Q40. Next I’d like to ask you about (your/their) use of alcohol and other drugs, and I just want to remind you that your answers are completely anonymous. Do (you/they) drink alcohol, or not? All User HH member Yes 39 38 42 No 61 62 57 No opinion * 1 18 Q41. (Ask if drink alcohol) About how many drinks in an average week? All User <1 19 24 1 23 23 2 11 12 3 11 8 4 6 4 More than 4 28 29 Q40/41. Combo Table based on total All Drinks alcohol 39 <1 8 1 9 2 4 3 4 4 2 5+ 11 No opinion 1 Does not drink alcohol 61 No opinion * No opinion 3 * User 38 9 9 5 3 1 11 * 62 - Unwtd N 308 236 HH member 42 3 9 3 8 5 10 4 57 1 Q42. (Ask if drinks alcohol) While taking prescription painkillers, did (you/they) ever drink alcohol, or not? All User Yes 54 47 No 45 53 No opinion 1 - Unwtd N 308 236 Q40/Q42. Combo Table based on total Drink alcohol Ever drinks with Rx painkillers Does not drink with Rx painkillers No opinion Does not drink alcohol No opinion All 39 21 18 * 61 * User 38 18 20 62 - HH member 42 30 11 1 57 1 And thinking again about (your/their) use of prescription painkillers Q43. Has a friend or family member ever suggested (you/they) stop taking these painkillers, or not? All User HH member Yes 31 26 43 No 69 74 54 Yes I have (Vol.) (if HH member) * 1 19 No opinion 1 2 Q44. How concerned, if at all, (are/were) you about (them) becoming addicted to these painkillers? Very, somewhat, not too, not at all? All User HH member --NET 36 33 42 Concerned ---Very Somewhat 22 14 19 14 30 12 --NET 63 66 57 Not concerned --Not too Not at all 15 48 14 52 18 39 No opin. 1 1 1 Q45. Do you think (you/they) (are/were) physically dependent on these painkillers, that is, (you/they) would find them very hard to quit, or not? (INTERVIEWER NOTE: if respondent says they would be hard to quit because of pain, code as yes, dependent) All User HH member Yes, dependent 37 31 51 No, not dependent 62 68 47 No opinion 1 1 2 Q46. Do you think (you/they) (are/were) addicted to these painkillers, or not? All User HH member Yes, addicted 28 23 40 No, not addicted 71 76 59 No opinion 1 1 1 Q45/Q46. Combo Table based on total All User HH member Yes, addicted or dependent 39 34 54 No, not addicted/dependent/No opinion 61 66 46 Q47. (Ask if addicted) Did (you/they) seek help or treatment for addiction, or not? All User Yes, (you/they) sought treatment 36 37 No, (you/they) did not No seek treatment opinion 62 2 61 1 Unwtd N 209 130 Q48. (Ask if addicted and did not seek treatment for addiction) Have (you/they) considered seeking help or treatment for addiction, or not? All Yes, have considered 17 No, have not considered 81 20 No opinion 1 Unwtd N 135 Q46/Q47/Q48. Combo Table based on total All Addicted to Rx painkillers 28 Sought treatment 10 Did not seek treatment 17 Yes, have considered seeking help/treatment 3 No, have not considered seeking help/treatment 14 No opinion * No opinion * Not addicted to Rx painkillers 71 No opinion 1 User 23 9 14 HH member 40 14 25 2 5 12 * 76 1 20 1 1 59 1 Q49. Did (you/they) ever give any of (your/their) painkillers to a family member or friend, or not? Yes, have given painkillers to family or friend All 15 User 14 HH member 19 No, have not given painkillers No to family or friend opinion 83 1 86 78 4 Q50. Some people have reported that they believe other people have used or taken some of their prescription painkillers. Have you ever known or suspected that someone else was using, taking, or selling (your/their) strong prescription painkillers, or have you not thought this? All User HH member Yes, have known/suspected 22 20 28 No, have not thought this 77 80 68 No opinion 1 * 4 Now, more generally, Q51. How closely have you been following news about the prescription painkiller addiction epidemic in the U.S.? Did you follow this story very closely, fairly closely, not too closely, or not at all closely? All User HH member U.S. Adults* --NET 56 55 56 57 Closely ---Very Fairly 26 29 26 29 27 30 24 33 --NET 44 45 44 43 Not closely Not too Not 21 19 24 25 --at all 24 25 19 18 No opin. * * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) 21 Q52. How much, if any, do you blame each of the following for the prescription painkiller addiction epidemic? Do you blame (INSERT) a lot, some, not too much, or not at all? (RANDOMIZE ITEMS) --NET a. The government All 42 User 40 HH member 49 U.S. Adults* 44 A lot/some -A lot Some 21 18 28 16 21 21 21 29 b. Doctors who prescribe painkillers All 57 27 31 User 54 23 31 HH member 66 36 31 U.S. Adults (n=599)* 69 29 41 c. Law enforcement All 16 User 17 HH member 14 U.S. Adults (n=599)* 28 55 58 48 54 12 11 15 23 43 47 34 30 3 3 3 2 41 44 31 11 10 15 29 34 16 2 2 3 30 16 14 1 10 11 8 81 80 84 13 10 20 68 70 64 2 3 2 8 20 71 22 49 1 31 31 31 35 35 33 12 12 12 23 24 21 3 3 1 38 31 18 13 1 30 27 39 21 20 26 46 51 34 8 8 10 38 43 24 2 2 1 35 25 38 15 24 1 10 10 12 83 85 80 15 13 20 69 72 61 1 1 1 20 70 29 41 2 10 9 14 22 19 29 66 71 55 16 16 18 50 55 37 2 2 2 10 33 55 27 28 2 f. Pharmacies and pharmacists All 16 6 User 15 5 HH member 19 7 U.S. Adults (n=603)* 28 8 g. Hospitals All 32 User 27 HH member 44 U.S. Adults (n=603)* 43 No opin. 7 7 6 d. People who use painkillers All 63 31 User 61 30 HH member 65 35 U.S. Adults (n=599)* 68 29 e. Drug companies All 52 User 47 HH member 65 U.S. Adults (n=603)* 60 -- Not too much/not at allNET Not too Not at all * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) 22 Q53. (Ask items a-d if half sample A; Ask items e-i if half sample B) For each of the following, please tell me how effective, if at all, you think it would be in reducing the abuse of prescription painkillers. First/Next, would (INSERT) be very effective, somewhat effective, not too effective, or not at all effective in reducing the abuse of prescription painkillers? (RANDOMIZE ITEMS) --Effective -----NET Very Somewhat NET a. Public education and awareness programs All 73 33 40 25 User 72 33 38 26 U.S. Adults* 86 46 39 14 Not Effective --Not too Not at all No Unwtd opin. N 12 11 13 15 2 2 405 312 8 6 1 599 10 11 4 3 405 312 4 1 599 4 5 405 312 2 599 b. Increasing access to addiction treatment programs All 80 42 38 16 6 User 80 43 36 17 6 U.S. Adults* 85 47 39 14 9 c. Monitoring doctors’ prescription painkiller prescribing habits All 71 37 34 26 10 15 User 69 38 32 26 9 17 U.S. Adults* 83 44 39 15 8 7 d. Increasing pain management training for medical students and doctors All 83 47 36 14 5 9 3 User 82 50 32 15 4 11 3 U.S. Adults* 89 55 34 10 6 5 1 405 312 599 e. Encouraging people who were prescribed painkillers to dispose of any extras once they no longer medically need them All 71 46 24 26 8 19 3 404 User 73 49 24 24 6 17 3 310 U.S. Adults* 68 38 30 31 12 19 1 603 f. Putting warning labels on prescription drug bottles that explain addiction All 51 25 26 47 15 33 User 50 27 23 48 15 33 U.S. Adults* 52 24 28 48 18 30 g. Increasing research about pain and pain management All 85 51 33 13 4 User 81 50 31 15 5 U.S. Adults* 85 46 39 14 7 h. Reducing the social stigma around addiction All 55 25 30 38 12 User 54 23 31 39 11 U.S. Adults* 62 29 33 34 14 23 the risk of 2 2 404 310 1 603 8 11 3 3 404 310 7 2 603 26 28 7 6 404 310 20 4 603 i. Government limits on the amount of drugs that can be produced All 47 22 24 49 13 36 User 47 24 23 48 13 35 U.S. Adults* 47 19 29 51 21 30 4 5 404 310 2 603 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) Q54. How concerned are you that efforts to decrease the number of people abusing prescription painkillers will make it MORE difficult for (you/them) to get prescription painkillers (if [you/they] needed them again)? Are you very concerned, somewhat concerned, not too concerned or not at all concerned? --NET 68 67 70 All User HH member Concerned ---Very Somewhat 40 28 44 23 28 42 --NET 32 32 30 Not concerned --Not too Not at all 15 17 13 19 19 11 No opin. 1 1 - Q55. Do you think prescription painkiller abuse makes a person more likely or less likely to use heroin or other illegal drugs, or do you think it doesn’t make much of a difference? More likely All User HH member U.S. Adults* 50 46 61 58 Less likely Doesn’t make much of a difference 40 43 31 36 4 4 2 2 No opinion 6 7 5 4 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) Q56. Which do you think is more addictive, (prescription painkillers) or (heroin), or do you think they are about equally addictive? (ROTATE ITEMS IN PARENTHESES) Rx painkillers All 4 User 3 HH member 6 U.S. Adults* 6 Heroin 43 45 37 29 Equally addictive 42 40 49 60 No opinion 11 12 7 6 * Kaiser Family Foundation, Kaiser Health Tracking Poll (conducted November 1521, 2016) 24 Next, I have just a few questions we will use to describe the people who took part in our survey… RSEX. Are you male or female? Female 52 53 50 Other (Vol.) - No opinion - Gender of Opioid User Male Female All 46 53 User 47 53 HH member 46 54 Other (Vol.) - No opinion * 1 All User HH member Male 48 47 50 Q57. What is your age? Q58. Could you please tell me if you are between the ages of? All User HH member 18-29 15 11 25 30-49 32 32 33 Age of Opioid User <18 18-29 All * 12 User 11 HH member 1 15 50-64 36 39 28 65+ 18 19 14 30-49 32 32 31 50-64 36 39 30 No opinion * * 65+ 20 19 23 No opinion * * Q59. Are you? Single, that is never married Single, living with a partner Married Separated Widowed Divorced No opinion All 23 10 38 5 9 15 * User 23 8 36 6 9 18 - HH member 23 14 44 3 7 7 1 Q60. Are you, yourself, of Hispanic or Latino background, such as Mexican, Puerto Rican, Cuban, or some other Spanish background? All User HH member Yes 11 11 9 No 88 87 89 No opinion 2 2 2 Q60a. (Ask if Hispanic) Were you born in the United States, the island of Puerto Rico, or in another country? 25 Q61. Do you consider yourself white, black or African American, Asian, Native American, Pacific Islander, mixed race or some other race? All User HH member White 73 72 75 Black or African American 11 11 9 Asian/Chinese/Japanese 1 1 Native American/American Indian/Alaska Native 3 4 * Native Hawaiian and Other Pacific Islander * * Mixed 6 5 10 Other 4 4 3 No opinion 3 3 4 Race Summary Table based on total All 70 10 11 8 1 3 * 4 * 2 White non-Hispanic Black non-Hispanic Hispanic Other (NET) Asian Native American Native Hawaiian Mixed Other No opinion User 68 11 11 8 1 4 * 3 * 3 HH member 74 7 9 8 * 7 * 1 Q62. What is the last grade of school you completed? HS grad or less (NET) Less than high school graduate High school graduate Some college (NET) Some college Technical school/Other College grad + (NET) Graduated college Graduate school or more No opinion All 48 17 32 31 29 2 21 14 6 * User 51 18 33 31 29 2 18 13 5 * HH member 41 12 29 30 28 2 28 18 10 1 Q63. In politics today, do you consider yourself a (Republican), a (Democrat), an Independent, or what? All User HH members Republican 25 24 26 Democrat 30 32 26 Independent 32 32 32 26 Other/None 8 7 9 No opinion 6 5 7 INCOME. Which of the following CATEGORIES best describes your total annual household income before taxes, from all sources? Q64. Could you tell me if your total annual household income is less than $50,000, $50,000 but less than $100,000, or over $100,000? All User HH member Less than $50K (NET) 61 65 48 Under 20 thousand dollars 22 27 9 20 to under 35 thousand 24 24 26 35 to under 50 thousand 13 14 13 <$50K unspecified 1 1 * $50K-$99.9K (NET) 25 21 37 50 to under 75 thousand 16 14 20 75 to under 100 thousand 10 7 17 $50-$99.9K unspecified * * * $100K or more 11 10 12 No opinion 3 3 3 L-1 (Ask if landline sample) Now thinking about your telephone use. . . Does anyone in your household including yourself, have a working cell phone? All Yes 78 No 22 No opinion - Unwtd N 266 C1 (Ask if cell phone sample) Now thinking about your telephone use, is there at least one telephone INSIDE your home that is currently working and is not a cell phone? All Yes 38 No 62 No opinion * Unwtd N 543 L1/C1. Combo table based on total All Landline only 5 Both LL and Cell 48 Cell phone only 46 No opinion * C3. (Ask if cell phone sample or HH has a cell phone) How many different cell phone numbers do you personally answer calls on? All None 8 1 79 2 9 3 2 4 or more 2 No opinion 1 Unwtd N 776 C3a. (Ask if landline sample or HH has a landline phone) How many telephone numbers does your household have that I could have reached you on? Not extensions, but different telephone numbers, not counting cell phones? All None 6 1 80 2 9 3 2 4 or more 2 27 No opinion 1 Unwtd N 526 Region All User HH member Northeast 17 16 21 Midwest 21 21 21 South 36 38 31 West 25 25 27 Metro Status All User HH member Urban 25 25 25 Suburban 51 50 51 Rural 22 22 21 Unknown 2 2 2 *** END *** 28 METHODOLOGICAL DETAILS The Washington Post/Kaiser Family Foundation Survey Project is a partnership combining survey research and reporting to better inform the public. The Post-Kaiser Survey of Long-Term Prescription Painkiller Users and Their Household Members, the 30th in this series was conducted by telephone October 3 - November 9, 2016, among a representative random national sample of 809 adults age 18 and over who they themselves, or a household member, have taken strong prescription painkillers for a period of two months or more1 at some time in the past two years, other than to treat pain from cancer or terminal illness. Interviews were administered in English and Spanish, combining random samples of both landline (n=266) and cellular telephones (n=543). Sampling, data collection, weighting and tabulation were managed by SSRS in close collaboration with The Washington Post and Kaiser Family Foundation researchers. The SSRS Omnibus survey (detailed below) estimates that about seven percent of adults in the U.S. have either themselves used strong prescription painkillers in the past two years for two months or more, other than to treat pain from cancer or terminal illness (five percent), or have a household member that has (two percent). Due to the low-incidence of this study population, the sampling was designed to increase efficiency in reaching this group by using the following sample sources: 1. Cell and Landline Phone Random Digit Dialing (RDD) (n=354): The dual frame landline and cellular phone sample was generated by Marketing Systems Group (MSG) using RDD procedures. Interviewers calling landline phone numbers asked to speak with an adult currently at home on a random rotation. Interviews calling cellular phones interviewed the person answering the phone after verifying eligibility. 2. Respondents Previously Completing Interviews on the SSRS Omnibus Survey (n=455). Weekly, RDD landline and cellular phone surveys of the general public were used to identify eligible respondents. Individuals who had previously indicated on the SSRS omnibus survey that they fit the eligibility criteria for this study were re-contacted. Regardless of the sample source, all respondents were screened to verify that they have taken a strong prescription painkiller for a period of two months or more in the past two years or have a household member who has, other than to treat pain from cancer or terminal illness. If a respondent indicated that both themselves and a household member qualified, they completed the questionnaire about their own A time period of two months or more was selected to focus on those whose use may be at odds with current government guidelines around prescription painkillers use. 1 29 personal use. The screening questions are identified at the beginning of this document as S3 through S5. A multi-stage weighting design was applied to ensure an accurate representation of the population of long-term strong prescription drug users and their household members. The first stage of weighting involved corrections for sample design, including accounting for nonresponse for the re-contact sample. In the second weighting stage, demographic adjustments were applied to account for systematic nonresponse along known population parameters. No reliable administrative data were available for creating demographic weighting parameters for this group. Therefore, demographic benchmarks were derived by compiling a sample of all respondents interviewed on the SSRS Omnibus survey between August 18, 2016 and November 9, 2016 (N=15,944) and weighting this sample to match the national adult population based on the 2016 U.S. Census Current Population Survey March Supplement parameters for age, gender, education, race/ethnicity, region, phone status, and population density. This sample was then filtered to include respondents qualifying for the current survey (N=1,122), and the weighted demographics of this group were used as post-stratification weighting parameters for the total sample (including age by gender, education, race/ethnicity, region, population density, self or household member prescription painkiller user, and phone status). All sampling error margins and tests of statistical significance have been adjusted to account for the survey’s design effect, which is 1.6 for this survey. The design effect is a factor representing the survey’s deviation from a simple random sample, and takes into account decreases in precision due to sample design and weighting procedures. Sample sizes and margin of sampling errors for key groups are shown below; other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Group Total Interview type Personal user Household interview Among those personally using: Report being addicted or dependent Do not report being addicted or dependent N (unweighted) 809 Margin of sampling error (percentage points) ±4 622 187 ±5 ±9 200 ±9 422 ±6 This questionnaire was administered with the exact questions in the exact order as appears in this document. If a question was asked of a reduced base of the sample, a parenthetical preceding the question identifies the group asked. Current users were asked the questions in the present tense, indicated where applicable in the first part of the parenthetical text within the question. Past users were asked the 30 questions in the past tense and read the language in the second half of the parentheses. In addition, those personally using were asked the questions directly about their use, whereas household members were asked about the user in most cases, as indicated in the questions. Since some of the questions could be sensitive and due to the nature of the survey content, interviewers were given specific instructions on how to cope with respondents who seemed agitated or distressed by the questions, including offering resources to which respondents could turn for support. The Washington Post and the Kaiser Family Foundation each contributed financing for the survey, and representatives of each organization worked together to develop the survey questionnaire and analyze the results. Each organization bears the sole responsibility for the work that appears under its name. The project team from the Kaiser Family Foundation included: Mollyann Brodie, Ph.D., Bianca DiJulio, and Bryan Wu. The project team from The Washington Post included: Scott Clement and Emily Guskin. Both The Washington Post and the Kaiser Family Foundation public opinion and survey research are charter members of the Transparency Initiative of the American Association for Public Opinion Research. Please note: (1) Table percentages may not add to 100 percent due to rounding. (2) Values less than 0.5 percent are indicated by an asterisk (*). (3) “vol.” indicates that a response was volunteered by respondent and not an explicitly offered choice. (4) Data aren’t shown if the number of respondents asked a question (the unweighted N) is less than 100. 31 The Henry J. Kaiser Family Foundation Headquarters 2400 Sand Hill Road Menlo Park, CA 94025 Phone: (650) 854-9400 Fax: (650) 854-4800 Washington Offices and Barbara Jordan Conference Center 1330 G Street, NW Washington, DC 20005 Phone: (202) 347-5270 Fax: (202) 347-5274 www.kff.org This publication (#8942-T) is available on the Kaiser Family Foundation website at www.kff.org. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.