More than one-third of U.S. adults used prescription opioids in 2015 and about 5 percent misused the treatment or had an opioid use disorder, according to report by the National Institute on Drug Abuse (NIDA) published Monday in the Annals of Internal Medicine.
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For the report, NIDA researchers analyzed federal health data on 51,200 non-institutionalized, civilian adults in the United States from the 2015 National Survey on Drug Use and Health (NSDUH). The researchers extrapolated the survey's findings to all non-institutionalized, civilian adults in the United States.
The researchers did not account for homeless individuals living outside of shelters or incarcerated adults—who, according to previous research, report a higher prevalence of substance use disorders, STAT News reports.
Report findings
The researchers estimated that, in 2015, about:
- 37.8 percent of U.S. adults—or 91.8 million—used prescription opioids;
- 4.7 percent of U.S. adults—or 11.5 million—misused prescription opioids; and
- 0.8 percent of U.S. adults—or 1.9 million—had an opioid misuse disorder.
Opioid misuse is a broad term that includes using prescription opioids:
- At higher frequencies and doses than prescribed;
- For non-prescribed reasons, and for longer durations than prescribed; or
- Without a prescription.
Meanwhile, opioid use disorders are formal diagnoses based on a set of criteria, which includes an interference with personal obligations and withdrawal symptoms.
According to the report, prescription opioid misuse and use disorders were more common among individuals who:
- Had behavioral health conditions, such as suicidal thoughts or major depression;
- Had low annual household incomes; and
- Were unemployed or uninsured.
The report stated that the primary reason U.S. adults said they misused prescription opioids was to relieve physical pain—with about 63 percent of NSDUH respondents citing physical pain as their reason for misuse. Other reasons U.S. adults said they misused prescription opioids included to relax and to get high.
A majority of U.S. adults—about 60 percent of NSDUH respondents—who misused prescription opioids did not have a prescription for the drug, according to the report. The researchers found that about 41 percent of NSDUH respondents who misused prescription opioids said the last time they misused the drugs they obtained them at no-cost from friends or relatives.
Discussion
The researchers wrote that the findings suggest "pain is a poorly addressed clinical and public health problem" that requires better prevention and treatment options to reduce opioid misuse.
The researchers wrote that simply limiting access to opioids without providing an alternative pain treatment would not decrease the rate of opioid misuse, because it "could lead people to seek prescription opioids outside the health system or to use non-prescription opioids, such as heroin or illicitly made fentanyl."
Karen Lasser of Boston Medical Center and the Boston University School of Medicine in an accompanying editorial wrote that individuals should be aware of the risks associated with opioids.
Lasser said, "Part of the problem has to do with the broken state of primary care," which, because of shortages, results in patients having limited access to a primary care provider. She said Boston Medical Center "developed a website called MyTopCare.org that has a portal for patients, prescribers, and pharmacists" to receive information on opioids. However, Lasser said the problem functions on multiple levels, noting that there should be "a stepped approach to managing pain" and "opioids should be a last resort" (Seaman, Reuters, 7/31; Thielking, STAT News, 7/31; Compton et al., Annals of Internal Medicine, 8/1).
Reduce opioid misuse and abuse with our new report
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.