New US Data on Opioid Use

Deborah Brauser

March 03, 2015

New data on the use of opioids in the United States has been released by the US Centers for Disease Control and Prevention (CDC).

Investigators from the CDC's National Center for Health Statistics (NCHS) report that previous-month use of prescription opioid analgesics significantly increased for adults older than 19 years ― from 5% in the period 1999-2002 to 6.9% in 2003-2006; but use by this group from 2007-2012 remained stable at 6.9%.

Still, along with results from the third National Health and Nutrition Examination Survey, the current findings "indicate that the use of opioid analgesics among US adults has more than doubled since 1988 to 1994, when 3.4% used opioid analgesics," write Steven M. Frenk, PhD, and colleagues.

Use of opioids stronger than morphine also increased dramatically, from 17% of the participants in 1999-2002 to 37% in 2011-2012.

In addition, during 2007-2012, significantly more women used opioids than men, and more non-Hispanic white adults used the substance in comparison with Hispanics. Also, the number of adults older than 39 who used opioids was significantly higher than their younger peers.

The report was posted on the CDC's website on February 25.

Increased Sales, Deaths

Previous CDC reports have shown that opioid-related deaths per 100,000 more than tripled between 1999 and 2012, and sales in kilograms per 10,000 quadrupled between 1999 and 2010.

For the current report, the investigators examined updated estimates and trends. They identified opioid analgesics "using the Multum ingredient category codes 60 (narcotic analgesics) and 191 (narcotic analgesic combinations)."

Also included were nine medications with the ingredient code 59 (miscellaneous analgesics); buprenorphine and opium were excluded.

In addition, products were categorized on the basis of how strong they were in relation to morphine.

"Weaker-than-morphine" substances included codeine, dihydrocodeine, meperidine, and pentazocine; "morphine equivalent" substances included hydrocodone and tapentadol; and "stronger-than- morphine" substances included fentanyl, oxycodone, and methadone.

From 1999-2002, 5% of adults 20 years of age or older reported using at least one prescription opioid analgesic within the past 30 days. This number increased to 6.9% in 2003-2006, dropped slightly to 6.7% during 2007-2010, and then increased back to 6.9% during 2011-2012.

In 2011-2012, 43% of the users said they took a morphine–equivalent strength opioid. During the same period, 37% said they used an opioid that was stronger than morphine.

The number of participants who used only a weaker-than-morphine opioid during the previous month fell during 1999-2002 to 2011-2012 (42.4% vs 20%, respectively).

Results specifically from 2007-2012 showed that 8.1% of those between the ages of 40 and 59 years and 7.9% of those 60 years of age and older had used opioids in the past 30 days vs 4.7% of the participants between the ages of 20 and 39 years.

Plus, 7.2% of the women vs 6.3% of the men reported past-month use, as did 7.5% of non-Hispanic whites and 6.5% of non-Hispanic blacks vs 4.9% of Hispanics.

Moving Target?

The overall results line up with recent research. As reported by Medscape Medical News, a study published in January of this year in the New England Journal of Medicine examined 2002-2013 data from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System.

It showed that rates of opioid diversion, opioid abuse, and opioid-related deaths increased significantly from 2002-2010 before flattening or decreasing from 2011-2013.

"There's been so many efforts in the United States to curb prescription opioid abuse that eventually something's going to work," lead author Richard Dart, MD, PhD, director of the Rocky Mountain Poison and Drug Center, in Denver, Colorado, said at the time.

However, commenter Petros Levounis, MD, vice-chair of the American Psychiatric Association's Council on Addiction Psychiatry, cautioned in the same story that more work is still needed, especially because heroin use has increased.

"It's a moving target," said Dr Levounis.

The current report is available for download on the CDC website.

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