10% of Opioid Users Receive the Vast Majority of Prescriptions

Deborah Brauser

September 13, 2017

Among adult opioid users living in the United States, just 10% account for the bulk of opioid prescriptions, new research suggests.

The study assessed pharmacy claims for more than 19 million individuals who did not have cancer and who filled at least one prescription for opioids between 2001 and 2013. Each prescription was converted to oral morphine equivalents (MEQs).

In 2013, 76% of all MEQs were from the top 10% of opioid users (ie, the 90th percentile). This is up from 2001, when the top 10% of users accounted for 69% of all MEQs, "suggesting that opioid use became concentrated among fewer users over the study period," note the researchers.

Eric C. Sun, MD, PhD, Stanford University, California, and Anupam B. Jena, MD, PhD, Harvard Medical School, Boston, Massachusetts, write that if 100 million individuals in the US population use opioids, the findings suggest that "10 million persons account for most US opioid use."

Although more research is needed, the investigators add that the results support the argument for focused vs population-wide intervention policies.

The study was published online September 12 in the Annals of Internal Medicine.

Missing Piece

Last year, the Centers for Disease Control and Prevention (CDC) released recommendations regarding the prescribing of opioids for chronic pain.

"In light of this and other public health efforts, an integral piece of epidemiologic information about opioid misuse [has remained] unknown: the distribution of use across the population," write Dr Sun and Dr Jena.

They examined pharmacy claims from the MarketScan database (Truven Health Analytics) for individuals aged 18 to 64 years who were continuously enrolled in a private insurance program for at least one calendar year.

Patients who used methadone were excluded because this agent is often used "to manage addiction instead of pain," the investigators write. Patients with a history of cancer were also excluded from the analysis.

There were 19,530,587 patients in the final study sample, which included 31,156,099 person-year observations.

In 2013, the 99th percentile of opioid users, or the top 1%, accounted for 23% of all MEQs.

The percentage rates were higher for the top 5% and 10% of users and were significantly higher for both groups in 2013 than in 2001.

Table. Comparison by Year of Opioid Distribution Among Percentiles

Patient Group 2001 (% of MEQs) 2013 (% of MEQs) P Value
Top 5% of opioid users 55 59 < .001
Top 10% of opioid users 69 76 < .001


The top 10%, compared with other use groups, were significantly more likely to be men (46% vs 44%, respectively; P < .001) and to be older (47 vs 41 years, P < .001).

Finally, 0.4% of the entire study population were prescribed more than 90 MEQs as an average daily dose. The CDC recommends a limit of 90 MEQs per day.

"Further research efforts aimed at characterizing this population, analyzing the incidence of opioid-related adverse events, and identifying approaches to reduce opioid use could be most effective in reducing total population-level use," write the investigators.

Dr Sun reports receiving grants from the National Institutes of Health (NIH) during the conduct of the study and personal fees from Egalet, Inc, outside the submitted work. Dr Jena reports receiving NIH grants during the conduct of the study and personal fees outside the submitted work from Pfizer, Hill Rom Services, Bristol-Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics.

Ann Intern Med. Published online September 12, 2017. Abstract

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