Opioid addiction or misuse continues to be a major public health problem in the United States, affecting over 7% of the population (Hughes et al., 2016), despite increasing awareness of the problem. “Misuse” means using prescription opioids in any way other than as prescribed. This includes both a person who takes their prescribed pain medication more often than prescribed, and the person who obtains medications illegally on the street or from a relative.
The reasons people misuse opioids include:
- Getting high
- Self-medicating to treat pain
- Improving their mood (chemical coping)
- Diverting opioids to other people
How Common Is Opioid Misuse?
Data from the National Drug Use and Health survey describes the extent of the opioid misuse problem. Opioids include both heroin and prescription opioids. Misuse of both types of opioids have increased in recent years (USDHHS, 2016).
- Heroin use continues despite the known devastating effects. 828,000 people used heroin in the past year. This is higher than most of 2002-2009 but has not changed much since then (Center for Behavioral Health Statistics and Quality, 2016).
- Many people in the U.S. are misusing pain relievers: 12.5 million people age 12 or older (~5% of this population) misused pain relievers in 2015 (includes any non-medically supervised use), according to the National Survey on Drug Use and Health (Hughes et al., 2016).
A majority of people misusing pain relievers (62.6%) do it for pain relief; that is, they use it to relieve pain, but without medical supervision. That leaves around 6 million people who misuse pain relievers for reasons other than pain relief, which is a 33% increase from 2013 (SAMHSA, 2014).
The overdose death rate from opioids is also steadily increasing. In 2015, over 22,000 deaths involved prescription opioids, an increase of nearly 16% from 2014 (CDC, 2016).
Opioids for Chronic Pain Treatment
The opioid epidemic is complicated by the legitimate need for opioid prescriptions to treat chronic pain. Chronic pain is also prevalent. Around 11.2% of adults in the United States experience chronic pain; pain daily for the past 3 months, and 6.4% have severe pain (NCCIH, 2015).
Only some patients prescribed opioids will become addicted. Becoming addicted after an opioid prescription is more common with chronic pain than with acute pain and with higher doses than with lower doses (Edlund et al., 2014). Among primary care patients on chronic opioid therapy for pain, a CDC review found reports for the rate of developing addiction ranged from 3 to 26% (Dowell, 2016). Opioid use disorder in the context of chronic pain is defined as using more opioids than is needed to treat the pain for purposes other than treating pain (APA, 2013).
Use of opioids is more likely to produce addiction in vulnerable individuals, which includes people having:
- History of substance abuse
- Mental health disorder
- Younger age
- Experienced pre-adolescent sexual abuse
- Family history of substance abuse
(Chou et al., 2009)
The CDC has published guidelines for prescribing opioids, which, if followed, would likely decrease the opioid epidemic (Dowell, 2016).
Opioid Prescribing Rates Correspond to Opioid Addiction Rates
Increases in opioid prescribing correlate with increases in opioid use disorder (SAMHSA, 2014). Survey data shows that treatment for opioid use disorder increased steadily in parallel to sales of opioid pain relievers from 1999 to 2009 (CDC, 2011; Warner, 2014).
A high percentage of individuals in treatment for opioid addiction started taking the drugs during pain treatment (Savage, 2008). For example, a sizable majority (84%) of a group in opioid addiction treatment received a legitimate prescription for opioids for pain at some point (Passik et al., 2006).
Over 289 million prescriptions for opioids are written per year (USDHHS, 2016). The high opioid prescribing rate contributes to the available supply that often gets diverted for misuse.
- Hughes A, Williams MR, Lipari RN, et al. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. SAMHSA. 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm Accessed on: 2016-09-13.
- USDHHS. Facing Addiction in America. The Surgeon General’s Report on Alcohol, Drugs, and Health. Surgeon General Reports. 2016. Available at: https://addiction.surgeongeneral.gov/ Accessed on: 2016-11-17.
- Center for Behavioral Health Statistics and Quality. Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Retrieved from http://www.samhsa.gov/data/. 2016; HHS Publication No. SMA 16-4984, NSDUH Series H-51: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf Accessed on: 2017-07-14.
- Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings . NSDUH Series H-48. 2014; HHS Publication No. (SMA) 14-4863: . Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed on: 2015-03-12.
- CDC. Opioid Data Analysis. Centers for Disease Control and Prevention. 2016. Available at: https://www.cdc.gov/drugoverdose/data/analysis.html Accessed on: 2017-03-27.
- National Center for Complementary and Integrative Health. NIH Analysis Shows Americans are in Pain. National Institutes of Health. 2015. Available at: https://nccih.nih.gov/news/press/08112015?nav=pinAccessed on: 2015-10-02.
- Edlund MJ, Martin BC, Russo JE, et al.. The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain. 2014; 30(7): 557-64. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24281273 Accessed on: 2014-10-07.
- Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm Accessed on: 2016-03-16.
- American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 5th ed. 2013; 5th ed.: . Available at: https://www.amazon.com/Diagnostic-Statistical-Manual-Mental-Disorders/dp/0890425558/ref=sr_1_1?s=books&ie=UTF8&qid=1492003452&sr=1-1&keywords=dsm+5 Accessed on: 2013-10-08.
- Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy for chronic non-cancer pain. J of Pain. 2009; 10(2): 113-130. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19187889. Accessed on: 2013-10-08.
- CDC. Vital Signs: Overdoses of prescription opioid pain relievers – United States, 1999-2008. MMWR. 2011; 60(43): 1487-92. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm Accessed on: 2015-04-27.
- Warner M , Hedegaard H , Chen LH. Trends in drug-poisoning deaths involving opioid analgesics and heroin: United States, 1999-2012. NCHS health e-stats. 2014. Available at: http://www.cdc.gov/nchs/data/hestat/drug_poisoning/drug_poisoning_deaths_1999-2012.pdf Accessed on: 2015-04-27.
- Savage SD, Kirsh KL, Passik, SD. Challenges in using opioids to treat pain in persons with substance use disorders. Addiction Science & Clinical Practice. 2008. Available at: http://archives.drugabuse.gov/pdf/ascp/vol4no2/Challenges.pdf Accessed on: 2011-04-15.
- Passik S. Psychiatric and pain characteristics of prescription drug abusers entering drug rehabilitation. Journal of Pain and Palliative Care Pharmacotherapy. 2006; 20(2): 5-13. Available at: http://informahealthcare.com/doi/abs/10.1080/J354v20n02_03 Accessed on: 2013-10-10.