Study Finds U.S. Opioid Use Remains Unchanged

As lawmakers, clinicians, law-enforcement officials, and community leaders seek solutions to the opioid crisis, new research offers discouraging results.
Researchers report in BMJ that opioid use has been largely unchanged in recent years, despite ongoing efforts to reduce the use of opioid pain medications.
Study Population
The study included all commercially insured or Medicare beneficiaries who had medical and pharmacy coverage at any point in 2007 through 2016. The data included 48 million unique beneficiaries, in a wide range of age groups.
For measurement purposes, the researchers translated the milligram of each drug into milligram morphine equivalents (MME). Among their goals, the researchers aimed to determine the average daily opioid dose in MME.
Study Found Disturbing Trends in Opioid Use
Scientists report that opioid prescriptions for commercially insured patients have stayed around 14 percent for the past 10 years. In the same period, the quarterly prescription rate for aged Medicare beneficiaries rose from 11 percent to 14 percent.
Highest use of opioids were among disabled Medicare beneficiaries aged 45-54 years. Of these, 45 percent used prescription opioids from the fourth quarter of 2011 to the fourth quarter of 2013.
Despite the risk of opioid dependency associated with long-term use, most opioids prescribed were for this purpose. Among disabled Medicare beneficiaries, 14 percent of opioid episodes were classified as being for long-term use. This 14 percent accounted for 89 percent of the total opioids dispensed.
During the 10 years included in the study, the average daily observed dose among those disabled Medicare beneficiaries who were prescribed opioids never dropped below 50 MME. While this group is more likely to have significant pain and have an increased tolerance for opioids, it also presents real dangers. At this dose, the chances of overdose are two to four times higher compared to daily doses under 20 MME, the study authors write.
This coincides with reports by the CDC that the United States saw a 30-percent increase in hospital emergency department visits for opioid overdoses from July 2016 through September 2017.
What Can Be Done to Reduce Opioid Overuse
The new study’s researchers point out a need for evidence-based approaches that can make opioid use safer and improve patients’ pain management and abilities to function.
Based on their findings, the study authors suggest that both doctors and patients seriously consider whether long-term opioid use really helps improve the patient’s ability to function and their quality of life. If not, they should consider other treatments that can either supplement or replace the use of opioids.
The CDC supports medication-assisted treatment for patients with opioid use disorder (OUD), and expanded availability of naloxone to counteract overdose. As drugmakers come under fire for their alleged role in the opioid crisis, many companies are working to bring new, non-opioid drugs to market.
Opioids should be prescribed only when benefits outweigh risks, and after considering a patient’s overall needs, drug history, and level of risk. Providers may recommend alternative approaches to help patients experiencing severe pain, such as physical therapy. Providers also should be aware of behavioral health, addiction treatment, and social services that are available to those patients with OUD.