Clinical Edge

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Prevalence of Rx Opioid Use, Misuse & Disorders

Ann Intern Med; ePub 2017 Aug 1; Han, et al

Publish date:

Among the more than one-third of US civilian, noninstitutionalized adults who reported prescription opioid use in 2015, more than one-third also reported misuse and use disorders. This according to results from the 2015 National Survey on Drug Use and Health (NSDUH) that estimated the prevalence of prescription opioid use, misuse, and use disorders and motivations for misuse among US adults. 72,600 eligible civilian, noninstitutionalized adults were selected and 51,200 completed the survey. Highlights included:

  • In 2015, 91.8 million (38%) US civilian, noninstitutionalized adults used prescription opioids; 11.5 million (4.7%) misused them; and 1.9 million (0.8%) had a use disorder, according to weighted survey estimates.
  • 12.5% of these adults reported misuse and of these, 16.7% reported a prescription opioid use disorder.
  • Among adults with misuse, 60% reported using opioids without a prescription, and nearly 41% obtained prescription opioids for free from friends or relatives.
  • The most commonly reported motivation for misuse was to relieve physical pain (63.4%).

Citation:

Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. [Published online ahead of print August 1, 2017]. Ann Intern Med. doi:10.7326/M17-0865.

Commentary:

Opioid abuse, diversion, and misuse have become a national crisis, with prescription opioid overdose deaths having more than quadrupled from 1999 to 2015. Recently, President Donald Trump declared the opioid crisis a national emergency, which could lead to federal dollars being used through the Disaster Relief Fund to fight the crisis. This study found that the motivation for over 60% of opioid misuse is pain relief, demonstrating how challenging finding a solution to this problem will be. As we try to address the crisis in our individual practices, the following 2 findings from a previous paper may inform our practice:1

  • The likelihood of chronic use goes up when the initial prescription for opioids exceeds either 5 days or 1 month of therapy.
  • A refill for a second prescription for opioid treatment during an episode of pain approximately doubles the risk for use 1 year later, such that 1 in 7 persons who receive a refill of an opioid prescription for an acute problem remain on opioids a year later.

CDC guidelines for prescribing opioids recommend prescribing opioids for the shortest duration of time possible, with a recommendation to limit opioid prescriptions for acute pain to 3-7 days.2 —Neil Skolnik, MD

  1. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid us —United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269. doi:10.15585/mmwr.mm6610a1.
  2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(No. RR-1). doi:10.15585/mmwr.rr6501e1.

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