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Prescription opioid use disorders increase in last decade despite decreased nonmedical use

From 2003 to 2013, the percentage of nonmedical use of prescription opioids decreased while the prevalence of prescription opioid use disorders, frequency of use and related mortality increased, according to study findings in JAMA.

“After alcohol intoxication, opioids are the most common cause of poisoning in patients presenting to North American emergency departments. Most opioids misused by patients originate from prescription medication. Most patients who overdose on prescription opioids are taking their medications differently than prescribed or are using opioids prescribed to someone else,” Lewis S. Nelson, MD, of Ronald O. Perelman Department of Emergency Medicine at New York University, and colleagues wrote in an editorial. “These two main types of nonmedical opioid use represent a major cause of morbidity and mortality.”

To assess national trends in nonmedical prescription opioid use and use disorder, Beth Han, MD, PhD, MPH, of Substance Abuse and Mental Health Services Administration, Rockville, Maryland, and colleagues analyzed data for 472,200 individuals aged 18 to 64 years who participated in the 2003 to 2013 National Surveys on Drug Use and Health. Mortality was derived from 2003 to 2013 National Vital Statistics System’s Multiple Cause of Death Files.

The prevalence of nonmedical use of prescription opioids decreased from 5.4% (95% CI, 5.08-5.7) in 2003 to 4.9% (95% CI, 4.58-5.22) in 2013 while the prevalence of prescription opioid use disorder increased from 0.6% (95% CI, 0.54-0.76) in 2003 to 0.9% (95% CI, 0.75-1.01) in 2013.

The 12-month prevalence of high-frequency use, defined as 200 days or more, increased from 0.3% (95% CI, 0.19-0.35) in 2003 to 0.4% (95% CI, 0.31-0.48) in 2013.

Drug overdose death rates involving prescription opioids increased from 4.5 per 100,000 (95% CI, 4.42-4.61) in 2003 to 7.8 per 100,000 (95% CI, 7.64-7.89) in 2013.

Prevalence of prescription opioid use disorders among nonmedical users increased from 12.7% in 2003 to 15.7% in 2010, 16.1% in 2011, 17% in 2012 and 16.9% in 2013, according to adjusted modeling.

“The chronic, relapsing nature of opioid addiction means most patients are never ‘cured,’ and the best outcome is long-term recovery. The lifelong implications of this disease far outweigh the limited benefits of opioids in the treatment of chronic pain, and in many cases the risks inherent in the treatment of acute pain with opioids,” Nelson and colleagues wrote in response to the study findings. “The encouraging finding of declining opioid initiation rates should be tempered by the increasing rates of nonmedical opioid use disorders and the limited utilization of treatment programs. Although multifaceted approaches are needed to successfully address the opioid epidemic, an important step is to start at the beginning and keep opioid-naive patients opioid naive.” – by Amanda Oldt

Disclosure: The study was jointly sponsored by SAMHSA, the National Institute on Drug Abuse, and the U.S. FDA. Han reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.