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The percentage of the nonmedical use of prescription opioids decreased among U.S. adults over the last decade, but the prevalence of opioid use disorders, the frequency of opioid abuse, and related mortality all increased, according to a report published online Oct. 13 in JAMA.
These findings, from an analysis of two large nationally representative data sets, paint a picture that is complex and more nuanced than that suggested by some recent reports. For example, a study of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System found that the abuse and diversion of prescription opioids plateaued or decreased in recent years. “The nationally representative results in our study may be especially important in providing an accurate picture of the current status of the epidemic,” said Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Md., and her associates.
The nonmedical use of prescription opioids is an acknowledged epidemic, but that epidemic’s changing pattern over time needed to be updated. The investigators assessed the changes in use during the most recent decade for which data are available (2003-2013) using annual surveys conducted by SAMHSA and cause of death files from the National Vital Statistics System.
Based on responses from 472,200 people aged 18-64 years, the 1-year prevalence of nonmedical use of prescription opioids decreased from 5.4% to 4.9% during the study period. However, the 1-year prevalence of use disorders rose from 0.6% to 0.9%, the 1-year prevalence of high-frequency use (200 days or more per year) increased from 0.3% to 0.4%, and the rate of opioid-related deaths increased from 4.5 per 100,000 to 7.8 per 100,000. In addition, the mean number of days of opioid abuse increased from 2.1 to 2.6 per year in the general population and from 40.0 to 54.2 days per year among acknowledged opioid users, the investigators said (JAMA. 2015 Oct 13;314[14]:1468-1478. doi:10.1001/jama.2015.11859).
Compared with white users of prescription opioids, both black and Hispanic users had a lower prevalence of use disorders. The prevalence of use disorders was higher among less-educated than more-educated adults, among those with no health insurance or Medicaid as opposed to private health insurance, and among smokers than nonsmokers, Dr. Han and her associates added.
Previous research has shown that most adults who abuse prescription opioids neither receive treatment nor perceive that they need treatment. Clinicians can help by using prescription-drug monitoring programs to identify inappropriate receipt of prescription opioids, then offering treatments, which are highly effective, for patients who need them, the investigators noted.
The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the Food and Drug Administration sponsored the study. Dr. Han reported having no relevant disclosures; an associate reported owning stock in General Electric, 3M Company, and Pfizer.
The slight decline (approximately 0.4% over 10 years) in opioid initiation reported by Han et al. may be encouraging, but their other findings suggest that more patients are experiencing an inexorable progression from initial opioid use to frequent use to highly frequent use to a use disorder.
The source of most opioid abuse is often a seemingly legitimate prescription, and the key to addressing the opioid-abuse epidemic is to keep opioid-naive patients opioid naive. It is still unclear why clinicians continue to prescribe opioids, despite recommendations to the contrary and the fact that these agents provide little or no long-term benefit for most types of chronic pain.
Lewis S. Nelson, M.D., is in the Ronald O. Perelman department of emergency medicine at New York University. He and his associates made these remarks in an editorial accompanying Dr. Han’s report (JAMA. 2015 Oct 13;314[14]:1453-1454. doi:10.1001/jama.2015.12397).
The slight decline (approximately 0.4% over 10 years) in opioid initiation reported by Han et al. may be encouraging, but their other findings suggest that more patients are experiencing an inexorable progression from initial opioid use to frequent use to highly frequent use to a use disorder.
The source of most opioid abuse is often a seemingly legitimate prescription, and the key to addressing the opioid-abuse epidemic is to keep opioid-naive patients opioid naive. It is still unclear why clinicians continue to prescribe opioids, despite recommendations to the contrary and the fact that these agents provide little or no long-term benefit for most types of chronic pain.
Lewis S. Nelson, M.D., is in the Ronald O. Perelman department of emergency medicine at New York University. He and his associates made these remarks in an editorial accompanying Dr. Han’s report (JAMA. 2015 Oct 13;314[14]:1453-1454. doi:10.1001/jama.2015.12397).
The slight decline (approximately 0.4% over 10 years) in opioid initiation reported by Han et al. may be encouraging, but their other findings suggest that more patients are experiencing an inexorable progression from initial opioid use to frequent use to highly frequent use to a use disorder.
The source of most opioid abuse is often a seemingly legitimate prescription, and the key to addressing the opioid-abuse epidemic is to keep opioid-naive patients opioid naive. It is still unclear why clinicians continue to prescribe opioids, despite recommendations to the contrary and the fact that these agents provide little or no long-term benefit for most types of chronic pain.
Lewis S. Nelson, M.D., is in the Ronald O. Perelman department of emergency medicine at New York University. He and his associates made these remarks in an editorial accompanying Dr. Han’s report (JAMA. 2015 Oct 13;314[14]:1453-1454. doi:10.1001/jama.2015.12397).
The percentage of the nonmedical use of prescription opioids decreased among U.S. adults over the last decade, but the prevalence of opioid use disorders, the frequency of opioid abuse, and related mortality all increased, according to a report published online Oct. 13 in JAMA.
These findings, from an analysis of two large nationally representative data sets, paint a picture that is complex and more nuanced than that suggested by some recent reports. For example, a study of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System found that the abuse and diversion of prescription opioids plateaued or decreased in recent years. “The nationally representative results in our study may be especially important in providing an accurate picture of the current status of the epidemic,” said Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Md., and her associates.
The nonmedical use of prescription opioids is an acknowledged epidemic, but that epidemic’s changing pattern over time needed to be updated. The investigators assessed the changes in use during the most recent decade for which data are available (2003-2013) using annual surveys conducted by SAMHSA and cause of death files from the National Vital Statistics System.
Based on responses from 472,200 people aged 18-64 years, the 1-year prevalence of nonmedical use of prescription opioids decreased from 5.4% to 4.9% during the study period. However, the 1-year prevalence of use disorders rose from 0.6% to 0.9%, the 1-year prevalence of high-frequency use (200 days or more per year) increased from 0.3% to 0.4%, and the rate of opioid-related deaths increased from 4.5 per 100,000 to 7.8 per 100,000. In addition, the mean number of days of opioid abuse increased from 2.1 to 2.6 per year in the general population and from 40.0 to 54.2 days per year among acknowledged opioid users, the investigators said (JAMA. 2015 Oct 13;314[14]:1468-1478. doi:10.1001/jama.2015.11859).
Compared with white users of prescription opioids, both black and Hispanic users had a lower prevalence of use disorders. The prevalence of use disorders was higher among less-educated than more-educated adults, among those with no health insurance or Medicaid as opposed to private health insurance, and among smokers than nonsmokers, Dr. Han and her associates added.
Previous research has shown that most adults who abuse prescription opioids neither receive treatment nor perceive that they need treatment. Clinicians can help by using prescription-drug monitoring programs to identify inappropriate receipt of prescription opioids, then offering treatments, which are highly effective, for patients who need them, the investigators noted.
The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the Food and Drug Administration sponsored the study. Dr. Han reported having no relevant disclosures; an associate reported owning stock in General Electric, 3M Company, and Pfizer.
The percentage of the nonmedical use of prescription opioids decreased among U.S. adults over the last decade, but the prevalence of opioid use disorders, the frequency of opioid abuse, and related mortality all increased, according to a report published online Oct. 13 in JAMA.
These findings, from an analysis of two large nationally representative data sets, paint a picture that is complex and more nuanced than that suggested by some recent reports. For example, a study of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System found that the abuse and diversion of prescription opioids plateaued or decreased in recent years. “The nationally representative results in our study may be especially important in providing an accurate picture of the current status of the epidemic,” said Dr. Beth Han of the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Md., and her associates.
The nonmedical use of prescription opioids is an acknowledged epidemic, but that epidemic’s changing pattern over time needed to be updated. The investigators assessed the changes in use during the most recent decade for which data are available (2003-2013) using annual surveys conducted by SAMHSA and cause of death files from the National Vital Statistics System.
Based on responses from 472,200 people aged 18-64 years, the 1-year prevalence of nonmedical use of prescription opioids decreased from 5.4% to 4.9% during the study period. However, the 1-year prevalence of use disorders rose from 0.6% to 0.9%, the 1-year prevalence of high-frequency use (200 days or more per year) increased from 0.3% to 0.4%, and the rate of opioid-related deaths increased from 4.5 per 100,000 to 7.8 per 100,000. In addition, the mean number of days of opioid abuse increased from 2.1 to 2.6 per year in the general population and from 40.0 to 54.2 days per year among acknowledged opioid users, the investigators said (JAMA. 2015 Oct 13;314[14]:1468-1478. doi:10.1001/jama.2015.11859).
Compared with white users of prescription opioids, both black and Hispanic users had a lower prevalence of use disorders. The prevalence of use disorders was higher among less-educated than more-educated adults, among those with no health insurance or Medicaid as opposed to private health insurance, and among smokers than nonsmokers, Dr. Han and her associates added.
Previous research has shown that most adults who abuse prescription opioids neither receive treatment nor perceive that they need treatment. Clinicians can help by using prescription-drug monitoring programs to identify inappropriate receipt of prescription opioids, then offering treatments, which are highly effective, for patients who need them, the investigators noted.
The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the Food and Drug Administration sponsored the study. Dr. Han reported having no relevant disclosures; an associate reported owning stock in General Electric, 3M Company, and Pfizer.
FROM JAMA
Key clinical point: The percentage of nonmedical use of prescription opioids declined during the last decade, but the prevalence of use disorders, the frequency of abuse, and related mortality all increased.
Major finding: The 1-year prevalence of opioid use disorders rose from 0.6% to 0.9%, that of high-frequency use increased from 0.3% to 0.4%, and that of opioid-related deaths increased from 4.5 per 100,000 to 7.8 per 100,000.
Data source: An analysis of time trends in prescription opioid use, based on two nationally representative data sets involving 472,200 adults.
Disclosures: The Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, and the Food and Drug Administration sponsored the study. Dr. Han reported having no relevant disclosures; an associate reported owning stock in General Electric, 3M Company, and Pfizer.
