Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Nonmedical Prescription Opioid Use

Will rise in morbidity & mortality continue?

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The prevalence of prescription opioid use disorders, frequency of use, and related mortality increased from 2003 to 2013, according to a study of 472,000 persons aged 18 to 64 years. Study results included:

• Prevalence of nonmedical use of prescription opioids decreased from 5.4% in 2003 to 4.9% in 2013.

• Prevalence of prescription opioid use disorders increased from 0.6% in 2003 to 0.9% in 2013.

• 12-month prevalence of high-frequency use (≥200 days) increased from 0.3% in 2003 to 0.4% in 2013.

• Mortality assessed by drug overdose death rates involving prescription opioids increased from 4.5 per 100,000 in 2003 to 7.8 per 100,000 in 2013.

• Prevalence of having prescription opioid use disorders among nonmedical users increased from 12.7% in 2003 to 16.9% in 2013.

Citation: Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. JAMA. 2015;314(14)1468-1478. doi: 10.1001/jama.2015.11859.

Commentary: Deaths from prescription drugs over the last decade have become the second leading cause of unintentional death in young adults and have exceeded deaths from cocaine and heroin combined.1 Emergency room visits due to opioid use have more than doubled from 2004 to 2011. Deaths from prescription opioids more than tripled from 1999 to 2013.2 It is a struggle to find the correct balance between appropriate and empathic treatment of patients’ chronic pain and not overusing opioid analgesics or contributing to diversion and misuse. Fortunately, as we have become more knowledgeable about the dangers of misuse and diversion of opioids, many offices have developed more careful systems to manage the prescribing of pain medicine, including the use of random urine drug testing, increasing use of adjuvant pain medications, and more frequent visits for patients with chronic pain. —Neil Skolnik, MD

1. Okie S. A flood of opioids, a rising ride of deaths. N Engl J Med 2010; 363(21):1981-1985. doi: 10.1056/NEJMp1011512.

2. Centers for Disease Control and Prevention. National Center for Health Statistics, 2014. Multiple cause-of-death data, 1999–2013. http://wonder.cdc.gov/mcd.html.

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