US Prescription Opioid Epidemic Escalating

Megan Brooks

October 15, 2015

New surveillance data suggest there has been a slight decline in the proportion of US adults reporting the nonmedical use of prescription opioids, but an increase in prescription opioid use disorders (OUDs), frequency of use, and related deaths.

The increases in OUDs, frequency of use, and related deaths occurred in the context of increasing heroin use and heroin-related overdose deaths, "supporting a need to address nonmedical use of prescription opioid and heroin abuse in a coordinated and comprehensive manner," the researchers say.

The results "underscore the importance of treatment for substance use disorders," lead investigator Beth Han, MD, PhD, of the Substance Abuse and Mental Health Services Administration (SAMHSA), told Medscape Medical News.

"Most adults with prescription opioid use disorders or other substance use disorders neither receive treatment nor perceive a need for treatment. However, receiving treatment for substance use disorders is particularly critical," she said.

The study was published online October 13 in JAMA.

Evolving Epidemic

The researchers examined the current scope of the opioid epidemic using data from 472,200 adults who responded to the National Surveys on Drug Use and Health for the period 2003-2013. They also examined national vital statistics data on cause of death for the same period.

Self-reported nonmedical use of prescription opioids decreased from 5.4% to 4.9% over the study period. This included a decline in the number of new users of opioids, from 1% in 2003 to 0.6% in 2013, they report.

However, the prevalence of prescription OUDs increased from 0.6% in 2003 to 0.9% in 2013, and the prevalence of high-frequency use (defined as use on 200 days or more during the past year) increased from 0.3% to 0.4%, they say.

"The epidemic has evolved over time. The increases in the prevalence of adults with prescription opioid use disorders and high-frequency use identified in our study are a major public health concern," the authors write.

They also found that the average number of days of nonmedical use of prescription opioids increased from 2.1 in 2003 to 2.6 in 2013. The prevalence of having prescription OUDs among nonmedical users was 12.7% in 2003, 15.7% in 2010, 16.1% in 2011, 17.0% in 2012, and 16.9% in 2013. Overdose deaths involving prescription opioids increased from 4.5 per 100,000 in 2003 to 7.8 per 100,000 in 2013.

Slight Decline in Initiation

"The slight decline in opioid initiation reported by Han et al (approximately 0.4% over 10 years) may represent a hopeful finding," say the authors of a linked editorial.

However, the data also suggest that "more patients are experiencing an inexorable progression from initial opioid use to frequent use, highly frequent use, or an opioid use disorder," note Lewis Nelson, MD, of New York University School of Medicine, New York City, and colleagues.

"If the observed decrease in rates of new opioid users reported by Han et al is sustained, understanding the reasons behind this change is important. These are likely multifactorial and may include the use of prescribing guidelines for chronic pain, rationalizing expectations of physicians and patients for pain control and functional outcome, media attention on the consequences of addiction, and regulatory and legal efforts," Dr Nelson and colleagues say.

"It is encouraging," they add, "that the culture around prescription opioids is starting to change, especially when considering the marketing of a plethora of new opioids for the treatment of chronic pain, none of which has been shown to be safe and effective over the long term."

"SAMHSA supports the implementation of a wide variety of prevention and treatment approaches, including medically assisted treatments," Dr Han said. The agency has developed an Opioid Overdose Prevention Toolkit that provides guidance on reducing the risk for death from opioid-related overdose. "It offers ways that medical providers, people who use opioids nonmedically, and others can recognize the signs of an overdose and effectively reverse it with naloxone," Dr Han said.

The study was jointly sponsored by SAMHSA, the National Institute on Drug Abuse, and the US Food and Drug Administration. One author reported owning stock in General Electric Co, 3M Co, and Pfizer. No other relevant financial relationships have been reported.

JAMA. Published online October 13, 2015. Abstract, Editorial


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