OBJECTIVES: To estimate the frequency, distribution, and correlates of nonprescription use of pain relievers by middle‐aged and elderly persons in the United States.

DESIGN: Cross‐sectional data analysis of a national community survey.

SETTING: The 2005 and 2006 National Surveys on Drug Use and Health.

PARTICIPANTS: Ten thousand nine hundred fifty‐three respondents aged 50 and older (6,717 aged 50–64 and 4,236 aged ≥65).

MEASUREMENTS: Social and demographic variables, detailed assessment of nonprescription use (and abuse) of prescription pain relievers (e.g., acetaminophen with codeine, morphine), substance use, major depression, self‐reported medical illnesses, and self‐rated health.

RESULTS: A small proportion of the sample (1.4%) reported nonprescription use of prescription pain relievers during the previous year. Combinations of acetaminophen and hydrocodone or propoxyphene were the most commonly used drugs. Use was associated with younger age (odds ratio (OR)=2.39, 95% confidence interval (CI)=1.31–4.36), American Indian and Alaska native (OR=8.78, 95% CI=2.50–30.85), and use of marijuana (OR=7.07, 95% CI=3.99–12.53). Fewer than 10% of nonprescription users were abusing these medications or dependent upon them.

CONCLUSION: In a representative sample of middle‐aged and older adults, nonprescription use of prescription pain relievers is relatively uncommon, but the much higher use by middle‐aged adults suggests that, as this cohort ages, the problem may increase in elderly people.