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Increases in the Use of Prescription Opioid Analgesics and the Lack of Improvement in Disability Metrics Among Users

Sites, Brian D. MD*†; Beach, Michael L. MD, PhD*†; Davis, Matthew A. MPH§

Regional Anesthesia & Pain Medicine: January/February 2014 - Volume 39 - Issue 1 - p 6–12
doi: 10.1097/AAP.0000000000000022
Original Articles

Background and Objectives: In the United States, use of oral opioid analgesics has been associated with increasing rates of addiction, abuse, and diversion. However, little is known about the recent national use of non-illicit prescription opioid analgesics (those prescribed in a physician-patient relationship), the primary source of these drugs for the general US population. Our primary objective was to examine trends in the use of prescription opioid analgesics in the United States and to identify defining characteristics of patient users of prescribed opioids from 2000 to 2010.

Methods: We used the nationally representative Medical Expenditure Panel Survey to examine trends in prescription oral opioid analgesic use from 2000 to 2010. We used survey design methods to make national estimates of adults (18 years and older) who reported receiving an opioid analgesic prescription (referred to as opioid users) and used logistic regression to examine predictors of opioid analgesic use. Our primary outcome measures were national estimates of total users of prescription opioid analgesics and total number of prescriptions. Our secondary outcome was that of observing changes in the disability and health of the users.

Results: The estimated total number of opioid analgesic prescriptions in the United States increased by 104%, from 43.8 million in 2000 to 89.2 million in 2010. In 2000, an estimated 7.4% (95% confidence interval, 6.9–7.9) of adult Americans were prescription opioid users compared with 11.8% (95% confidence interval, 11.2–12.4) in 2010. On the basis of estimates adjusted for changes in the general population, each year was associated with a 6% increase in the likelihood of receiving an opioid prescription from 2000 to 2010. Despite the apparent increase in use, there were no demonstrable improvements in the age- or sex-adjusted disability and health status measures of opioid users.

Conclusions: The use of prescription opioid analgesics among adult Americans has increased in recent years, and this increase does not seem to be associated with improvements in disability and health status among users. On a public health level, these data suggest that there may be an opportunity to reduce the prescribing of opioid analgesics without worsening of population health metrics.

From the *Departments of Anesthesiology, †Orthopaedic Surgery, ‡Communityand Family Medicine, Community Health Research Program, Hood Center for Children and Families; and §The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.

Accepted for publication September 18, 2013.

Address correspondence to: Brian D. Sites, MD, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756 (e-mail: brian.d.sites@hitchcock.org).

The authors declare no conflict of interest.

The Department of Anesthesiology at Dartmouth Medical School provided protected research time for Drs Brian D. Sites and Michael L. Beach to support this project. Matthew Davis was supported by Award No. 5K01AT006162 by the National Institutes of Health. The views expressed herein do not represent the official view of the National Institutes of Health.

Copyright © 2014 by American Society of Regional Anesthesia and Pain Medicine.