Nearly 92 million adults in the United States used prescription opioids in 2015 — and while the vast majority of those individuals used the medications according to their prescriptions, some groups are particularly vulnerable to opioid use disorders, a new study finds.
The new report, published Monday in Annals of Internal Medicine, analyzed federal health data from more than 72,000 non-institutionalized, civilian adults in the U.S. The authors found that nearly 38 percent of those individuals used opioids in 2015. They then extrapolated their findings to the U.S. population as a whole.
The findings fill in a critical gap in information about the prevalence of prescription painkiller use and abuse in the U.S. Deaths from opioids have been rising dramatically for years, and there are now nearly 100 deaths a day from opioid overdoses.
Here’s a look at what the report found:
An estimated 11.5 million adults misused opioids in 2015. Misuse is a sweeping category that includes taking opioids without a prescription, taking them for a reason other than the condition for which they’re prescribed, or taking them at higher doses, more often, or for a longer period of time than prescribed.
Another 1.9 million adults had an opioid use disorder tied to prescription drugs in 2015. Opioid use disorder is diagnosed using a specific set of criteria. Among them: The use of opioids interferes with personal obligations at work, home, or school, and the user suffers withdrawal when stopping.
The new numbers don’t include opioid use disorders related solely to heroin use.
The prevalence of prescription opioid misuse and use disorders was higher among adults who’ve had suicidal thoughts and major depression. Adults who used prescription opioids and also had a major depressive episode had nearly twice the rate of prescription opioid misuse than those who hadn’t had a major depressive episode.
The most common motivation for misusing prescription opioids was to relieve physical pain. Two out of every three adults who misused prescription opioids in 2015 said they did so to deal with pain. The study’s authors said that drives home the point that “pain is a poorly addressed clinical and public health problem.”
Their conclusion: We need better prevention and treatment of the underlying disorders driving pain to reduce the rate of opioid misuse. Cutting down on access to opioids without offering alternative pain treatments won’t cut it, the authors argued.
“[That] could lead people to seek prescription opioids outside the health system or to use non-prescription opioids, such as heroin or illicitly made fentanyl,” they wrote.
Another 11 percent said they misused opioids to relax, and an additional 11 percent of adults reported doing so to get high.
The report also found that 60 percent of adults who misuse opioids don’t have their own prescription for the drugs. More than 40 percent of those who misuse painkillers say that the last time they misused opioids, a friend or relative gave them the medication for free.
The study’s authors said that suggests that in many cases, opioids are being prescribed in greater amounts than needed or for conditions the medications won’t really help to treat. That’s leading to a surplus of opioids that can be diverted to others.
Unemployed, uninsured, and low-income adults had a higher prevalence of both prescription opioid misuse and use disorders. Roughly 12 percent of adults who used prescription opioids and had an annual family income under $50,000 misused the medication, compared to 9 percent of those whose family income was $75,000 a year or higher.
Two key limitations to the study: It didn’t include homeless individuals who live outside of shelters, nor did it include incarcerated adults. But past research has shown homeless adults and those in the criminal justice system have a higher prevalence of substance use disorders than the rest of the population — which means the new report might underestimate the prevalence of opioid use disorders among disadvantaged adults.
Hispanic adults who took prescription opioids had the highest prevalence of misuse at 14 percent, compared to 9 percent of black adults and 10 percent of white adults who used prescription opioids. But interestingly, opioid use disorder was somewhat similarly prevalent across the racial and ethnic groups included in the study. Of those who took prescription opioids, 2.1 percent of Hispanic and white adults had an opioid use disorder, compared to 1.9 percent of black and non-Hispanic adults.
Men were more likely than women to misuse prescription opioids — 13 percent of men who took prescription painkillers in 2015 misused them, compared to just under 9 percent of women. Men were also twice as likely to have an opioid use disorder.
Unfortunately for the credibility of this piece and possibly of the original study on which it reports, we have no explanation for how “misuse or prescription opioid” was defined (what were behavioral criteria?). We can’t see here what “use” comprised (for how long at what doses?) Likewise, it is unclear whether the outcomes were based solely on self-reports when surveyed. Self-reports of “abuse” are notoriously subject to under-reporting, and we have no visibility into whether those reporting had ever abused street opioids either before or during their prescriptions.
Another serious issue is that addiction specialists generally agree that opioid abuse most often begins in adolescents, not adults. And it does not often begin with prescribed medications in this young population. Kids abuse meds stolen from their families or diverted from other people to the street.
Also missing from the discussion is any distinction between addiction and dependency. Opioid Use Disorder as defined in the DSM-5 is focused primarily on use that continues despite being clearly disruptive of life. Withdrawal symptoms may occur in patients withdrawn from prescription opioids, without implying addiction. The two are separate medical entities.
Before we wax too enthusiastic about whatever this study purportedly teaches us, somebody needs to look at the details buried behind a paywall in the Annals of Internal Medicine. There are many potential sources of error or misinterpretation.
Do your homework, Megan!
Thanks for your comment
Having been through and found sobriety for my own issues several years ago, I think the study sounds like people who have no personal knowledge of addiction trying to find the answers. Pain is not a public health problem. Pain is a normal response to injury. The so called 5th vital sign is a tragedy of medicine. So long as Americans want the benefits of medicine but not at the price of pain, we will continue to have high rates of addiction. Also, people lie a lot (mostly to themselves) that they only take the meds to fight pain. Far more are getting high off it than report, but b/c of the stigma will seldom give an honest response.
The rollovers on the stacked bar graphs are broken. It’s very hard to read the numbers for the pink or green categories.
Re: depression, the problem is opiates are an absolutely fantastic anti-depressant for many, many people suffering from MD and BP. How do you tell somebody escaping from their own personal hell for possibly the first time in years to stop? Especially when they may have already cycled through a dozen or more ineffective medications? These powers of opiates need to be harnessed in a safe, practical matter, both to curb this epidemic and offer relief to people crippled by their own neurobiology.
As the report says most addicts are dual diagnosis. 95% of rehabs are NOT set up to handle underlying psych issues thus most junkies come out back at square one; when the first psych crisis hits the needle goes back in the arm. You can pay $60,000 to get that dual therapy at a place like Silver Hill or Austen Riggs, or maybe find a nice place with horse therapy or luxury spas like the Malibu digs where the celebs go to get clean (and how successful they’ve been).
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