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).

 

Overdose
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.

 

References

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