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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. National Survey on Drug Use and Health (NSDUH) data suggests that in 2015, 37.8% of U.S. adults used prescription opioids, 4.7% reported opioid misuse, and 0.8% reported an opioid use disorder.

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2. The most common (63.4%) reason given for opioid misuse was relief from physical pain.

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Evidence Rating Level: 4 (Below Average)

Study Rundown:

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In the United States, deaths from prescription opioid overdoses have increased over 4-fold between 1999 and 2015. In 2015, the Substance Abuse and Mental Health Services Administration (SAMHSA) conducted the NSDUH, which consisted of in-person household interview surveys. Samples were chosen to be representative of the U.S. as a whole. According to weighted survey estimates of 2015 data, 91.8 million (37.8%) of adults used prescription opioids, 11.5 million (4.7%) reported opioid misuse, and 1.9 million (0.8%) reported an opioid use disorder. The most common (63.4%) reason given for misuse was relief from physical pain. This study suggests that decreasing unnecessary prescriptions may help reduce the number of opioids available for possible misuse and that pain management access should be improved.

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A strength of the study includes the completion of over 51 000 survey interviews. A limitation of the study includes exclusion of active-duty military, incarcerated adults, and homeless persons not residing in a shelter. Other limitations include the inability to form temporal or causal relationships due to the cross-sectional nature of the survey, susceptibility of survey data to biases of recall and social desirability, and possible nonresponse bias.

In-Depth [survey]:

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For this interview study, 72 600 adults aged ≥18 years were eligible for NSDUH, with 51 200 completing the survey. Data representative of the U.S. regarding use, misuse, and use disorders of prescription opioids was collected via audio computer-assisted self-interviewing for sensitive questions and via computer-assisted personal interviewing for less sensitive questions. According to weighted survey estimates of 2015 data, 37.8% (95% CI, 37.14% to 38.52%) of adults used prescription opioids, 4.7% (CI, 4.49% to 4.97%) reported opioid misuse, and 0.8% (CI, 0.69% to 0.89%) reported an opioid use disorder. Among adults using prescription opioids, the prevalence within 12 months of misusing opioids or having an opioid use disorder was 12.5% (CI, 11.88% to 13.14%) and 2.1% (CI, 1.84% to 2.34%), respectively. Participants who reported misuse or use disorders most commonly lacked insurance, were low income, were unemployed, or had behavioral health problems. This suggests that monetary hardships and behavioral health problems may be associated with misuse risk. Among adults misusing opioids, 59.9% (CI, 57.26% to 62.56%) had no prescription for the opioids, and 40.8% (CI, 38.30% to 43.24%) obtained the drugs from relatives or friends. This suggests that opioids may be dispensed in amounts that the intended patients do not fully consume. Following prescribing guidelines may help to minimize the number of opioids available for potential misuse.

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