US Prescription Opioid Abuse Was Declining Before Pandemic

By Rob Goodier

October 14, 2020

NEW YORK (Reuters Health) - Prescription opioid abuse in the United States declined dramatically from 2009 to 2018, raw data indicate. Weighted data also showed a statistically significant decline, although less dramatic, according to findings presented virtually at the annual meeting of the American Society of Anesthesiologists October 3.

"First glance at these data seems to indicate that new initiates of opioid abuse from prescription pain medication is now similar to pre-epidemic levels, and to continue that, we need to continue educating the public, and perhaps focus on youth or other susceptible populations," study leader Mario Moric, a biostatistician at Rush University Medical Center in Chicago, told Reuters Health by email.

Moric and colleagues analyzed prescribed pain medicine abuse data from 2002 through 2018 from the National Survey on Drug Use and Health. They broke their research period into two parts, 2002-2014 and 2015-2018, to accommodate a 2015 redesign in the survey that yielded different results.

The new survey may be more sensitive to opioid abuse, suggesting that the older version underestimated the effect, the researchers write in their presentation.

"The good news is that under either parameterization a decline was seen," the researchers write.

Abuse rates plateaued at just below 5% from 2002 to 2012, with dips and rises over those years. Then, from 2012 to 2104, there was a steady decline from 4.8% to 3.8%. Data from the new survey show a decline from roughly 4.6% in 2015 to 3.6% in 2018.

Statistically significant declines occurred from 2002 to 2014 and from 2015 to 2018, according to the research.

Moric also presented data from 1978 to 2018 that portray the rise of the opioid abuse epidemic in 1998, and its decline starting in 2009 up until 2018, before the coronavirus pandemic.

Pain medication abuse rates zig-zagged around 6% from 1978 to 1998. From 1998 to 2002, the rate spikes to 16%, a 186% increase. The rate hovers at that point until 2009, which marks the beginning of a decline.

"From 2009 to 2018 the lifetime use decreased 72%, the past year use decreased 90% and the past month use decreased 185%," Moric said.

While the results suggest that public awareness campaigns work, the success story is complicated by the likely increase in opioid abuse during the pandemic.

"We've seen that opioid overdose deaths are increasing this year," said Dr. David Dickerson, Section Chief of Pain Medicine at Northshore University Health System in the Chicago area.

Overdose deaths may be rising because people are isolating themselves in response to the pandemic, Dr. Dickerson, who wasn't involved in the study, said in an audio interview available on the American Society of Anesthesiologists' site.

"The margin for injury changes. The ability to have someone there that can identify that an overdose may be impending is challenged," Dr. Dickerson said.

New trends aside, the research by Dr. Moric and colleagues offers a nice 35,000-foot view of change that is happening, he said. "This type of data allows us to say what are the targets for intervention this year. They might not be the same as they were 10 years ago."

Opioid prescription rates have also been declining, Dr. Dickerson pointed out. Still unclear is whether the quality of pain care has changed as prescription and abuse rates have declined.

While the potential for abuse exists, opioids have a role, said Dr. Asokumar Buvandendran, Executive Vice Chair of the Department of Anesthesiology at Rush University Medical Center, who co-wrote the study.

"Physicians need to understand and evaluate all pain conditions. There is a role for opioids in an acute pain condition but the prescription number should be limited depending on the cause. Similarly, for chronic pain conditions there is role for opioids if used appropriately," Dr. Buvandendran told Reuters Health by email.

SOURCE: Anesthesiology 2020 , presented October 3, 2020.