Opioid Misuse Still Largely a Prescription-Related Problem

Alicia Ault

September 11, 2017

Marijuana continues to be the most widely used drug in America — with some 37 million users — but prescription and illicit opioid use also continues to be a relatively unabated problem, according to the latest annual National Survey on Drug Use and Health (NSDUH).

The 2016 NSDUH, conducted yearly since 1990 by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that some 7.4 million people — almost 3% of the US population — aged 12 years or older had an illicit drug use disorder.

In addition, about 11.8 million Americans misused opioids in the past year, but the majority, 11.5 million, misused prescription pain relievers. About 948,000 Americans acknowledged past-year heroin use, 228,000 said they'd misused prescription fentanyl, and 641,000 said they were dual abusers of prescription opioids and heroin.

Federal officials attempted to put a positive spin on the numbers, saying that prescription opioid misuse appears to be declining.

"The survey did not show opioid misuse and addiction becoming more common in 2016," said Health and Human Services Secretary Tom Price, MD, in remarks  delivered at the survey's release.

"We do know, however, that the number of opioid and overdose deaths continues to skyrocket," he said, noting that 50,000 died in 2015. "Preliminary data from the CDC [Centers for Disease Control and Prevention] for 2016 suggests that this number rose substantially again last year, likely topping 60,000 — and is on track to continue that heartbreaking trend in 2017," he added.

Hydrocodone Most Commonly Misused

Of those overdose deaths, about 13,219 will be from heroin in 2016, compared with 2089 in 2002, according to preliminary data from the CDC cited by SAMHSA.

The NDSUH asked respondents to name — if they could — the type of opioid they had misused. The most commonly misused medications were hydrocodone products, with almost 7 million of the 11.5 million naming brands such as Vicodin and Lortab. Oxycodone was misused by almost 4 million Americans.

A much smaller number — 0.3% of people aged 12 years or older — misused buprenorphine products or methadone (0.1%).

The figure 228,000 for people who misused prescription fentanyl is likely an underestimate, said SAMHSA, because it may underrepresent people who misused fentanyl that was illicitly manufactured in clandestine laboratories and likely did not include people who unknowingly misused fentanyl, such as when it is added to heroin.

Two thirds of those who said they misused prescription opioids said they did so to relieve physical pain. About a fifth of users said they took the drugs to feel good or get high and to relax or relieve tension.

More than half of those who reported misusing the prescription drugs said they'd obtained the pills from a friend or relative. About one third said they'd gotten their opioid from a prescription or had stolen from a healthcare provider. Only 6% reported that they had purchased an opioid from a drug dealer or stranger.

Treatment Sorely Lacking

SAMHSA found that of the 2.1 million Americans with an opioid use disorder in 2016, only 21% received treatment in 2016. Interestingly, almost 40% of those with heroin use disorders received treatment, compared with just 18% of those with a prescription opioid use disorder.

Overall, in 2016, an estimated 21 million people needed substance use treatment, including 1.1 million adolescents and 5.3 million adults aged 18 to 25 years. But only about 3.8 million people received any substance use treatment — just 1.4%.

The survey also took a close look at mental health issues and found that treatment was lacking for people with serious mental illness.

About 45 million Americans — 18.3% — aged 18 years or older had any mental illness in 2016. Of those, 10.4 million had a serious mental illness.

Deaths from suicide average 100 a day, according to SAMHSA. In 2016, 9.8 million adults aged 18 years or older (4%) reported they had thought seriously about trying to kill themselves. Of those, 2.8 million reported that they had made suicide plans, and 1.3 million made a nonfatal suicide attempt.

Major depression was more readily treated, with two thirds of the 16.2 million adults aged 18 years or older who had the disorder reporting they received treatment.

Serious mental illness has been on the rise, in particular among those aged 18 to 25 and 26 to 49 years, according to the survey. Only about half of those with a serious mental illness received treatment in 2016, similar to the percentage in 2015.

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