BOSTON GLOBE/HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH PRESCRIPTION PAINKILLER ABUSE: U.S. ATTITUDES

BOSTON GLOBE/HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH PRESCRIPTION PAINKILLER ABUSE: U.S. ATTITUDES This survey was conducted for the Boston Globe and the Harvard T.H. Chan School of Public Health via telephone by SSRS, an independent research company. Interviews were conducted by telephone (landline and cell phone) from April 15-19, 2015, among a nationally representative sample of 1,033 respondents age 18 or older. The margin of error for total respondents is +/-3.6 percentage points at the 95 confidence level. I. Perceived Seriousness of the Problem and General Concern Q1. How serious do you think the following problems are in the state of [name of state]? How about abuse of (INSERT ITEM)? Do you think that is an extremely serious problem in [name of state], very serious, somewhat serious, not too serious, or not a problem at all? a. Heroin Extremely serious 19 Very serious 26 Somewhat serious 23 Not too serious 13 Not a problem at all 6 Don t know/refused 13 (Asked of random half sample; n=502) c. Alcohol Extremely serious 13 Very serious 28 Somewhat serious 32 Not too serious 17 Not a problem at all 5 Don t know/refused 5 1

(Asked of random half sample; n=531) d. Marijuana Extremely serious 9 Very serious 18 Somewhat serious 22 Not too serious 26 Not a problem at all 21 Don t know/refused 4 e. Strong prescription painkillers, such as Percocet, OxyContin or Vicodin Extremely serious 21 Very serious 30 Somewhat serious 27 Not too serious 10 Not a problem at all 3 Don t know/refused 9 When we ask about prescription painkillers in this poll, we mean strong ones, sometimes called opioids, such as Percocet, OxyContin or Vicodin. (Asked of random half sample; n=518) Q2. Do you believe the problem of prescription painkiller abuse in [name of state] is better, worse, or about the same as it was 5 years ago? Better 9 Worse 39 Same 38 Don t know/refused 14 Q3. How likely do you think it is that a person taking a strong prescription painkiller will become addicted to it? Very likely 44 Somewhat likely 36 Somewhat unlikely 12 Very unlikely 5 Don t know/refused 3 2

(Asked of random half sample; n=515) Q4. 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 50 Less likely 3 Doesn t make much of a difference 40 Don t know/refused 7 Q4a.To the best of your knowledge, is there a treatment for prescription painkiller addiction that is effective for a long period of time, or isn t there such a treatment? Yes, there is a treatment 45 No, there is not a treatment 28 Don t know 27 3

II. Personal Experience Many people take prescription painkillers for health problems they have. Q5. During the past 2 years, have you taken any strong prescription painkillers, such as Percocet, OxyContin, or Vicodin, prescribed by a doctor for you to use for more than a few days, or not? Yes 21 No 79 Refused -- (Asked of respondents who took strong prescription painkillers; n=216) Q6. Before or while you were taking these strong prescription painkillers, did you and your doctor talk about the risk of prescription painkiller addiction, or haven t you talked about that? Yes, talked about the risk 61 No, did NOT talk about the risk 39 Don t know/refused -- (Asked of respondents who took strong prescription painkillers; n=216) Q7. When you were taking these strong prescription painkillers, were you concerned that taking them could lead you to become addicted, or weren t you concerned with that? (If CONCERNED ASK:) Were you very concerned, somewhat concerned, or not too concerned? Very concerned 16 Somewhat concerned 10 Not too concerned 7 Not concerned 67 Don t know/refused -- 4

(Asked of respondents who took strong prescription painkillers; n=216) Q8. Some people save strong prescription painkillers after the prescribed length of time in case they or a family member need them for another health problem in the future. Have you saved any of these strong prescription painkillers to use later on, or is this something you haven t done? Yes, have saved strong prescription painkillers to use later on 17 No, have not done this 83 Don t know/refused * (Asked of respondents who took strong prescription painkillers; n=216) Q9. Some people have reported that they believe other people have used or taken some of their prescription painkillers. In the past 2 years, have you known or suspected that someone else was using, taking, or selling your strong prescription painkillers, or haven t you thought this? Yes 12 No 88 Don t know/refused -- 5

III. Rx Painkiller Abuse Problems among People You Know Q10. During the past 5 years, have you known anyone who has abused prescription painkillers, or not? Yes 39 No 61 (Asked of respondents who knew someone who has abused prescription painkillers; n=387) Q11. Do you believe that person s abuse of prescription painkillers led to their using heroin or other illegal drugs, or don t you believe it did? Yes 43 No 51 Don t know/refused 6 Q12. Did that person s abuse of prescription painkillers have a harmful effect on (INSERT ITEM), or not? Did it have a harmful effect on (next item), or not? (IF HARMFUL EFFECT ASK:) Did it have a major or minor harmful effect? (Asked of respondents who knew someone who has abused prescription painkillers; n=387) a. Their family life MAJOR harmful effect 67 MINOR harmful effect 15 NO harmful effect 14 Don t know/refused 4 6

(Asked of respondents who knew someone who has abused prescription painkillers; n=387) b. Their work life MAJOR harmful effect 58 MINOR harmful effect 15 NO harmful effect 23 Don t know/refused 4 (Asked of respondents who knew someone who has abused prescription painkillers; n=387) c. Their school life MAJOR harmful effect 37 MINOR harmful effect 6 NO harmful effect 46 Don t know/refused 11 (Asked of respondents who knew someone who has abused prescription painkillers; n=387) d. Their health MAJOR harmful effect 55 MINOR harmful effect 26 NO harmful effect 15 Don t know/refused 4 (Asked of respondents who knew someone who has abused prescription painkillers; n=387) Q13. Did it lead to their dying, or didn t this happen? Yes 21 No 77 Don t know/refused 2 7

IV. Regulation and Treatment Q14. The [name of state] state and federal governments currently regulate the prescribing and availability of strong prescription painkillers. Do you believe these regulations make it too easy or too hard for people to get strong prescription painkillers, or do you think they are about right? Too easy 29 Too hard 11 About right 51 Don t know/refused 9 Q15. There is a drug called Narcan or Naloxone that can prevent people from dying if they are experiencing an overdose of a prescription painkiller or heroin. Right now, adults in some states can buy this drug from pharmacists at many chain or retail pharmacies. Some other states restrict adults ability to buy this drug because they think it might encourage use of illegal drugs. Do you favor or oppose letting adults buy this drug from pharmacists at chain or retail pharmacies? Favor 42 Oppose 47 Don t know/refused 11 Q16. Many health insurance plans in [name of state] provide only limited coverage for drug treatment programs for people addicted to prescription painkillers or heroin. Some have suggested that the state government require private health insurers to provide more extensive coverage for these treatment programs. This might add to the cost of health insurance premiums for insured people. Do you favor or oppose the state government requiring private health insurers to provide more extensive coverage for these treatment programs? Favor 48 Oppose 46 Don t know 6 8

V. Causes of Rx Painkiller Abuse Q17. For each of the following, please tell me whether or not you think it is a major cause, a minor cause, or not a cause of abuse of strong prescription painkillers in [name of state]? How about (INSERT ITEM)? (IF NECESSARY: Is that a major cause, a minor cause, or not a cause of abuse of strong prescription painkillers in [name of state]) a. It is too easy to buy prescription painkillers illegally. MAJOR cause 55 MINOR cause 24 Not a cause 11 Don t know/refused 10 b. It is too easy to get prescription painkillers from people who have saved some from their old prescription. MAJOR cause 45 MINOR cause 35 Not a cause 13 Don t know/refused 7 c. Painkillers are prescribed too often, or in doses greater than what is needed MAJOR cause 45 MINOR cause 32 Not a cause 17 Don t know/refused 6 9

HSPH/Boston Globe Prescription Painkiller April 15 - April 19, 2015 Study #O1007 TABLE 005 I. Perceived Seriousness of the Problem and General Concern 1e. How about abuse of *** Strong prescription painkillers, such as Percocet, OxyContin or Vicodin?? *** Do you think that is an extremely serious problem in Massachusetts/(STATE), very serious, somewhat serious, not too serious, or not a problem at all? Base: Total Respondents Race/eth Gender Age Household Income Education ***************** Metro Status Region *********** ************************ ********************** ***************** White Black ***************** *********************** Fe- $25- $50- HS or Some Coll. Non- Non- Hisp- Sub- Nort North Total Male male 18-29 30-49 50-64 65+ <25K 49.9K 74.9K $75K+ Less Coll. Post Hisp Hisp anic Urban urban Rural East Cntrl South West ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== Total Unweighted 1033 522 511 176 259 287 308 266 228 122 229 420 271 338 679 130 115 320 452 251 190 196 423 224 100 51 49 17 25 28 30 26 22 12 22 41 26 33 66 13 11 31 44 24 18 19 41 22 Total Weighted 1033 500 533 222 351 266 192 270 225 125 234 434 293 302 664 118 154 342 469 210 187 220 385 241 -------------- 100 48 52 21 34 26 19 26 22 12 23 42 28 29 64 11 15 33 45 20 18 21 37 23 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) (O) (P) (Q) (R) (S) (T) (U) (V) Extremely/Very 527 246 281 94 189 148 94 131 123 66 121 224 152 149 360 64 63 169 235 118 110 121 189 106 Serious (Net) 100 47 53 18 36 28 18 25 23 13 23 43 29 28 68 12 12 32 45 22 21 23 36 20 ============== 51 49 53 43 54 56 49 48 54 53 52 52 52 50 54 54 41 49 50 56 59 55 49 44 D D Q Extremely serious 216 95 121 35 93 52 36 54 51 23 48 88 62 66 140 25 26 69 95 47 37 54 78 47 100 44 56 16 43 24 17 25 24 11 22 41 29 30 65 12 12 32 44 22 17 25 36 22 21 19 23 16 26 20 19 20 23 19 20 20 21 22 21 21 17 20 20 23 20 25 20 19 D Very serious 311 151 160 59 96 96 58 77 71 43 74 136 91 84 219 39 37 101 140 71 73 67 111 60 100 49 51 19 31 31 19 25 23 14 24 44 29 27 71 13 12 32 45 23 23 22 36 19 30 30 30 27 27 36 30 28 32 34 31 31 31 28 33 33 24 29 30 34 39 31 29 25 Somewhat/Not Too/Not 423 211 212 113 135 104 70 119 83 54 101 163 122 135 268 44 68 141 201 78 65 77 163 119 At All (Net) 100 50 50 27 32 25 17 28 20 13 24 39 29 32 63 10 16 33 48 18 15 18 38 28 ==================== 41 42 40 51 38 39 36 44 37 43 43 38 42 45 40 37 44 41 43 37 35 35 42 49 EFG Somewhat serious 282 118 164 72 96 72 42 78 51 35 71 104 81 97 183 31 47 94 135 52 42 50 110 81 100 42 58 25 34 25 15 28 18 12 25 37 29 34 65 11 17 33 48 19 15 18 39 29 27 24 31 32 27 27 22 29 23 28 30 24 28 32 28 26 30 27 29 25 22 23 29 34 B G L --------------------------------- (sig=.05) (all_pairs) columns tested BC, DE, DF, DG, EF, EG, FG, HI, HJ, HK, IJ, IK, JK, LM, LN, MN, OP, OQ, PQ, RS, RT, ST, UV

HSPH/Boston Globe Prescription Painkiller April 15 - April 19, 2015 Study #O1007 TABLE 005 (continued) I. Perceived Seriousness of the Problem and General Concern 1e. How about abuse of *** Strong prescription painkillers, such as Percocet, OxyContin or Vicodin?? *** Do you think that is an extremely serious problem in Massachusetts/(STATE), very serious, somewhat serious, not too serious, or not a problem at all? Base: Total Respondents Race/eth Gender Age Household Income Education ***************** Metro Status Region *********** ************************ ********************** ***************** White Black ***************** *********************** Fe- $25- $50- HS or Some Coll. Non- Non- Hisp- Sub- Nort North Total Male male 18-29 30-49 50-64 65+ <25K 49.9K 74.9K $75K+ Less Coll. Post Hisp Hisp anic Urban urban Rural East Cntrl South West ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== Not too serious 108 70 38 32 31 23 23 28 23 17 26 40 33 34 75 7 12 36 53 18 19 25 35 29 100 65 35 29 29 21 21 26 21 16 24 37 30 32 70 7 11 33 49 17 18 23 32 27 10 14 7 14 9 9 12 10 10 14 11 9 11 11 11 6 8 11 11 9 10 11 9 12 C Not a problem at 32 23 10 10 7 10 6 13 9 2 4 19 8 4 10 6 9 11 13 7 4 2 18 8 all 100 71 29 31 22 30 17 41 28 5 13 60 25 13 30 18 28 35 41 23 14 7 55 25 3 5 2 4 2 4 3 5 4 1 2 4 3 1 1 5 6 3 3 4 2 1 5 3 C N O O Don't know 79 40 39 13 28 12 27 18 20 5 11 44 17 17 36 10 21 29 31 14 11 22 31 15 100 51 49 16 35 15 34 23 25 7 13 56 21 22 45 12 27 37 39 18 14 27 39 19 8 8 7 6 8 4 14 7 9 4 5 10 6 6 5 8 14 9 7 7 6 10 8 6 DEF O Refused 3 3 0 1-1 1 2 0-1 2 2-0 0 1 2 1-0 - 2 1 100 87 13 33 42 25 46 13 42 46 54 13 13 42 67 33 13 54 33 * 1 * * 1 * 1 * 1 * 1 * * 1 1 * * * * --------------------------------- (sig=.05) (all_pairs) columns tested BC, DE, DF, DG, EF, EG, FG, HI, HJ, HK, IJ, IK, JK, LM, LN, MN, OP, OQ, PQ, RS, RT, ST, UV Note: Percentage less than 0.5 printed as *.

HSPH/Boston Globe Prescription Painkiller April 15 - April 19, 2015 Study #O1007 TABLE 019 III. Rx Painkiller Abuse Problems Among People You Know 10. During the past 5 years, have you known anyone who has abused prescription painkillers, or not? Base: Total Respondents Race/eth Gender Age Household Income Education ***************** Metro Status Region *********** ************************ ********************** ***************** White Black ***************** *********************** Fe- $25- $50- HS or Some Coll. Non- Non- Hisp- Sub- Nort North Total Male male 18-29 30-49 50-64 65+ <25K 49.9K 74.9K $75K+ Less Coll. Post Hisp Hisp anic Urban urban Rural East Cntrl South West ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== Total Unweighted 1033 522 511 176 259 287 308 266 228 122 229 420 271 338 679 130 115 320 452 251 190 196 423 224 100 51 49 17 25 28 30 26 22 12 22 41 26 33 66 13 11 31 44 24 18 19 41 22 Total Weighted 1033 500 533 222 351 266 192 270 225 125 234 434 293 302 664 118 154 342 469 210 187 220 385 241 -------------- 100 48 52 21 34 26 19 26 22 12 23 42 28 29 64 11 15 33 45 20 18 21 37 23 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) (O) (P) (Q) (R) (S) (T) (U) (V) Yes 400 203 197 88 160 97 54 94 77 55 115 155 114 129 296 29 43 117 186 94 74 87 162 77 100 51 49 22 40 24 14 24 19 14 29 39 29 32 74 7 11 29 47 24 18 22 40 19 39 41 37 40 45 37 28 35 34 44 49 36 39 43 45 24 28 34 40 45 39 40 42 32 G G HI PQ R No 630 295 335 133 192 167 137 173 148 70 119 278 178 172 366 89 111 225 281 115 113 131 222 164 100 47 53 21 30 27 22 28 23 11 19 44 28 27 58 14 18 36 45 18 18 21 35 26 61 59 63 60 55 63 71 64 66 56 51 64 61 57 55 76 72 66 60 55 61 59 58 68 DE K K O O T Don't know 3 2 1 0-1 1 2 1-0 1 1 1 1-1 0 2 1-2 1 0 100 60 40 18 48 34 66 20 14 38 39 23 47 27 9 58 20 58 33 9 * * * * * * 1 * * * * * * * * * * 1 * * --------------------------------- (sig=.05) (all_pairs) columns tested BC, DE, DF, DG, EF, EG, FG, HI, HJ, HK, IJ, IK, JK, LM, LN, MN, OP, OQ, PQ, RS, RT, ST, UV Note: Percentage less than 0.5 printed as *. PAGE 27

HSPH/Boston Globe Prescription Painkiller April 15 - April 19, 2015 Study #O1007 TABLE 034 IV. Regulation and Treatment 16. Many health insurance plans in Massachusetts/(STATE) provide only limited coverage for drug treatment programs for people addicted to prescription painkillers or heroin. Some have suggested that the state government require private health insurers to provide more extensive coverage for these treatment programs. This might add to the cost of health insurance premiums for insured people. Do you favor or oppose the state government requiring private health insurers to provide more extensive coverage for these treatment programs? Base: Total Respondents Impt Opioid Problem *********** Opioid Likely Get Some- Problem Addicted Know what/ *********** *********** Taken RX Someone Not Get- Very/ Govt Regs Make Party ID/Lean Painkiller Who Abused Ex- Too/ ting Very/ Some Leads Effective Getting Opioids ***************** 2 Years 5 Years treme Not Bet- Get- Some what To Heroin Treatment **************** Party ID Rep/ Dem/ Ind/ *********** *********** ly At ter ting what Un- *********** *********** Too About Too ***************** Lean Lean Don't Total Yes No Yes No Very All Same Worse Lkly lkly Yes No Yes No Easy Right Hard Rep Dem Ind Rep Dem Lean ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== Total Unweighted 1033 216 815 387 640 519 426 237 204 810 179 252 231 453 280 279 540 104 237 323 425 372 484 177 100 21 79 37 62 50 41 23 20 78 17 24 22 44 27 27 52 10 23 31 41 36 47 17 Total Weighted 1033 215 817 400 630 527 423 240 198 824 171 262 227 467 286 303 530 111 227 301 452 361 480 192 -------------- 100 21 79 39 61 51 41 23 19 80 17 25 22 45 28 29 51 11 22 29 44 35 46 19 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) (O) (P) (Q) (R) (S) (T) (U) (V) (W) (X) Favor 499 121 377 224 272 268 201 126 90 412 75 135 108 253 129 134 263 66 88 167 218 143 260 96 100 24 76 45 55 54 40 25 18 83 15 27 22 51 26 27 53 13 18 33 44 29 52 19 48 56 46 56 43 51 47 52 45 50 44 51 48 54 45 44 50 59 39 55 48 40 54 50 C E O P S S V V Oppose 473 87 386 161 311 241 196 102 102 370 88 121 104 196 149 156 240 41 129 117 205 202 190 80 100 18 82 34 66 51 42 22 22 78 19 26 22 41 32 33 51 9 27 25 43 43 40 17 46 41 47 40 49 46 46 43 52 45 51 46 46 42 52 51 45 37 57 39 45 56 40 42 D N R TU WX Don't know 58 7 51 13 45 16 25 12 6 40 8 5 14 18 8 13 25 5 9 15 29 16 28 14 100 12 88 22 78 28 43 21 10 68 13 9 23 30 13 22 44 8 16 26 49 28 48 25 6 3 6 3 7 3 6 5 3 5 4 2 6 4 3 4 5 4 4 5 6 4 6 7 D L --------------------------------- (sig=.05) (all_pairs) columns tested BC, DE, FG, HI, JK, LM, NO, PQ, PR, QR, ST, SU, TU, VW, VX, WX Note: Percentage less than 0.5 printed as *. PAGE 58

HSPH/Boston Globe Prescription Painkiller April 15 - April 19, 2015 Study #O1007 TABLE 034 (continued) IV. Regulation and Treatment 16. Many health insurance plans in Massachusetts/(STATE) provide only limited coverage for drug treatment programs for people addicted to prescription painkillers or heroin. Some have suggested that the state government require private health insurers to provide more extensive coverage for these treatment programs. This might add to the cost of health insurance premiums for insured people. Do you favor or oppose the state government requiring private health insurers to provide more extensive coverage for these treatment programs? Base: Total Respondents Impt Opioid Problem *********** Opioid Likely Get Some- Problem Addicted Know what/ *********** *********** Taken RX Someone Not Get- Very/ Govt Regs Make Party ID/Lean Painkiller Who Abused Ex- Too/ ting Very/ Some Leads Effective Getting Opioids ***************** 2 Years 5 Years treme Not Bet- Get- Some what To Heroin Treatment **************** Party ID Rep/ Dem/ Ind/ *********** *********** ly At ter ting what Un- *********** *********** Too About Too ***************** Lean Lean Don't Total Yes No Yes No Very All Same Worse Lkly lkly Yes No Yes No Easy Right Hard Rep Dem Ind Rep Dem Lean ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== Refused 3-3 1 2 2 1-1 3 0 1 2 1-1 2-0 2 1 0 2 1 100 100 38 62 47 38 16 85 15 31 53 31 24 53 7 54 23 7 54 38 * * * * * * * * * * 1 * * * * 1 * * * 1 --------------------------------- (sig=.05) (all_pairs) columns tested BC, DE, FG, HI, JK, LM, NO, PQ, PR, QR, ST, SU, TU, VW, VX, WX Note: Percentage less than 0.5 printed as *.