In the JournalsPerspective

One in eight adult opioid users in the US reported misuse, abuse

In 2015, more than 12% of the 91.8 million adults in the United States using prescription opioids reported misusing them or noted they had a use disorder. These findings highlight a need for medical-based interventions and stricter adherence to opioid-prescribing guidelines to reduce the opioid crisis, according to survey results published in Annals of Internal Medicine.

“The United States is experiencing an epidemic of prescription opioid misuse, with prescription opioid overdose deaths more than quadrupling between 1999 and 2015 ... However, an examination of the prevalence of prescription opioid use, misuse, and use disorders and motivations for misuse in the U.S. adult population has been lacking,” Beth Han, MD, PhD, MPH, from the Substance Abuse and Mental Health Services Administration, and colleagues wrote.

Han and colleagues conducted the 2015 National Survey on Drug Use and Health to determine the prevalence of prescription opioid use, misuse and use disorders, and motivations for misuse among adults from the United States. They selected 72,600 eligible civilian, noninstitutionalized adults and 51,200 completed the survey. The survey was interview-style and was performed face-to-face.

Weighted results from the survey indicated an estimated 37.8% of U.S. adults used prescription opioids (n = 91.8 million) and 4.7% misused these drugs (n = 11.5 million) and 0.8% had a use disorder (n = 1.9 million). Misuse was reported by 12.5% of adults who used prescription opioids. Of these adults, prescription opioid use disorder was reported by 16.7%. Approximately 63% of patients reported “to relieve physical pain” as their main motivation, making it the most common reason for misuse. Adults who were uninsured, were unemployed, had low income or had behavioral health problems most frequently reported misuse and use disorders. Nearly 60% of adults with misuse used opioids without a prescription, with 40.8% acquiring prescription opioids from friends or relatives for free and 13.8% acquiring them from drug dealers or strangers.

According to the researchers, the widespread social availability of prescription opioids may indicate that these are frequently prescribed in amounts that patients do not fully consume.

“Our findings highlight the importance of interventions targeting medication sharing, selling, and diversion and underscore the need to follow prescribing guidelines to minimize environmental availability of opioids due to excessively large numbers of leftover medications,” Han and colleagues concluded.

“Actions should be taken to expand safe, evidence-based pain treatment and decrease excessive prescribing that may leave unused opioids available for potential misuse,” they added.

In a related editorial, Karen E. Lasser, MD, MPH, from the Boston Medical Center and Boston University School of Medicine and School of Public Health, wrote that the findings by Han and colleagues are “striking.” The types of interventions that the researchers suggested can reduce the opioid crisis can be implemented into medical practices, she added.

“[Our] broken system of primary care contributes to the problem,” she wrote. “Talk to any busy full-time primary care physician, and it becomes evident that writing an opioid prescription is much easier than exploring other options for addressing chronic pain in the course of a 15-minute visit. The same stressful work conditions likely also make it difficult for primary care providers to appropriately monitor patients who take opioids in the long term with urine drug tests and pill counts to assess for opioid diversion or other substance use.

“A potential solution to the problem of the overburdened primary care physician is to distribute some of the work to other members of the health care team,” according to Lasser. – by Alaina Tedesco

Disclosures: Han reports no relevant financial disclosures. Please see full study for complete list of all other authors’ financial disclosures. Lasser reported grants from NIH/NIDA.

 

In 2015, more than 12% of the 91.8 million adults in the United States using prescription opioids reported misusing them or noted they had a use disorder. These findings highlight a need for medical-based interventions and stricter adherence to opioid-prescribing guidelines to reduce the opioid crisis, according to survey results published in Annals of Internal Medicine.

“The United States is experiencing an epidemic of prescription opioid misuse, with prescription opioid overdose deaths more than quadrupling between 1999 and 2015 ... However, an examination of the prevalence of prescription opioid use, misuse, and use disorders and motivations for misuse in the U.S. adult population has been lacking,” Beth Han, MD, PhD, MPH, from the Substance Abuse and Mental Health Services Administration, and colleagues wrote.

Han and colleagues conducted the 2015 National Survey on Drug Use and Health to determine the prevalence of prescription opioid use, misuse and use disorders, and motivations for misuse among adults from the United States. They selected 72,600 eligible civilian, noninstitutionalized adults and 51,200 completed the survey. The survey was interview-style and was performed face-to-face.

Weighted results from the survey indicated an estimated 37.8% of U.S. adults used prescription opioids (n = 91.8 million) and 4.7% misused these drugs (n = 11.5 million) and 0.8% had a use disorder (n = 1.9 million). Misuse was reported by 12.5% of adults who used prescription opioids. Of these adults, prescription opioid use disorder was reported by 16.7%. Approximately 63% of patients reported “to relieve physical pain” as their main motivation, making it the most common reason for misuse. Adults who were uninsured, were unemployed, had low income or had behavioral health problems most frequently reported misuse and use disorders. Nearly 60% of adults with misuse used opioids without a prescription, with 40.8% acquiring prescription opioids from friends or relatives for free and 13.8% acquiring them from drug dealers or strangers.

According to the researchers, the widespread social availability of prescription opioids may indicate that these are frequently prescribed in amounts that patients do not fully consume.

“Our findings highlight the importance of interventions targeting medication sharing, selling, and diversion and underscore the need to follow prescribing guidelines to minimize environmental availability of opioids due to excessively large numbers of leftover medications,” Han and colleagues concluded.

“Actions should be taken to expand safe, evidence-based pain treatment and decrease excessive prescribing that may leave unused opioids available for potential misuse,” they added.

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In a related editorial, Karen E. Lasser, MD, MPH, from the Boston Medical Center and Boston University School of Medicine and School of Public Health, wrote that the findings by Han and colleagues are “striking.” The types of interventions that the researchers suggested can reduce the opioid crisis can be implemented into medical practices, she added.

“[Our] broken system of primary care contributes to the problem,” she wrote. “Talk to any busy full-time primary care physician, and it becomes evident that writing an opioid prescription is much easier than exploring other options for addressing chronic pain in the course of a 15-minute visit. The same stressful work conditions likely also make it difficult for primary care providers to appropriately monitor patients who take opioids in the long term with urine drug tests and pill counts to assess for opioid diversion or other substance use.

“A potential solution to the problem of the overburdened primary care physician is to distribute some of the work to other members of the health care team,” according to Lasser. – by Alaina Tedesco

Disclosures: Han reports no relevant financial disclosures. Please see full study for complete list of all other authors’ financial disclosures. Lasser reported grants from NIH/NIDA.

 

    Perspective

    In Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health, Han and colleagues provide a meticulously done survey which represents well the diverse population of the United States. The results will not surprise readers who have been following published data on the opioid epidemic — opioid prescriptions are obtained by a large percentage of Americans and improper use and addiction are all too common. These data likely are significant underestimates of misuse and abuse as they are collected face to face and rely on self report. Among the uninsured, the problem behaviors were far more prevalent which presents many challenges including prevention by first finding effective and safer choices for acute and chronic pain management and for those with addiction, obtaining affordable, evidence-based treatment.

    Consistent with prior surveys, a high percentage of misused medications were obtained from family and friends. These data should serve as a clear message to prescribers of opioid analgesics regarding the importance of using safe strategies around opioid prescribing including proper patient education, pain management agreements, random pill counts, urine drug testing and use of the prescription drug monitoring program in their state. Prescribers must be thoughtful about quantity and cannot assume that unused medication will be safely disposed. 

    • Larry Greenblatt, MD
    • professor of medicine, Duke University co-chair, opioid safety committee, Duke Health