Prescription Opioids

Prescription opioids are medications that doctors prescribe to treat moderate to severe pain. They work by binding to opioid receptors in the brain and spinal cord, reducing the perception of pain. These drugs are legal when prescribed by a healthcare professional, but they carry a risk of addiction and dependence due to their powerful pain-relieving and euphoric effects.

1 in 4 Patients

According to the Centers for Disease Control and Prevention, approximately one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. This highlights a significant challenge in managing long-term opioid therapy and underscores the need for careful monitoring and support for individuals receiving these medications​​.

Most frequently prescribed opioids

Hydrocodone
Oxycodone
Tramadol
Codeine
Morphine
Fentanyl
Hydromorphone

Opioid Prescriptions by Year

The table below shows a year-by-year account of the number of opioid prescriptions as well as the dispensing rate per 100 people. After a steady increase in the overall national opioid dispensing rate starting in 2006, the total number of prescriptions dispensed peaked in 2012 at more than 255 million and a dispensing rate of 81.3 prescriptions per 100 persons.

Year	Number Of Opioid Prescriptions	Dispensing Rate Per 100 Persons
2006	215,917,663	72.4
2007	228,543,773	75.9
2008	237,860,213	78.2
2009	243,738,090	79.5
2010	251,088,904	81.2
2011	252,167,963	80.9
2012	255,207,954	81.3
2013	247,090,443	78.1
2014	240,993,021	75.6
2015	226,819,924	70.6
2016	214,881,622	66.5
2017	191,909,384	59.0
2018	168,158,611	51.4
2019	153,260,450	46.7
2020	142,816,781	43.3

Analysis

The overall national opioid dispensing rate declined from 2012 to 2020, and in 2020, the dispensing rate had fallen to the lowest in the 15 years, for which we have data at 43.3 prescriptions per 100 persons (total of more than 142 million opioid prescriptions).

Graphs

Overdoses

Opioid prescribing by physicians and other health professionals has decreased for the 13th consecutive year, down nearly 50% since 2012. However, overdoses and deaths related to illicitly manufactured substances like fentanyl and xylazine continue to increase. In 2022, more than 107,000 people died from drug-related overdoses in the United States, with the epidemic increasingly impacting young people, Black and Brown people, and pregnant individuals. The dispensing of naloxone, a medication used to reverse opioid overdoses, has increased more than 200% since 2018, and buprenorphine, used for treating opioid use disorder, has nearly doubled in community pharmacies in the past 10 years​.

From 1999 to 2021, nearly 280,000 people in the United States died from overdoses involving prescription opioids. In 2021, 45 people died each day from a prescription opioid overdose, totaling nearly 17,000 deaths. Prescription opioids were involved in nearly 21% of all opioid overdose deaths in 2021​.

Graph- 1999 – 2018 Opioid Overdose Deaths per year

Statistics

Despite a decrease in the rate of opioid prescriptions, the number of prescription overdoses has not declined proportionally. Up to 92% of opioid abusers use prescription opioids at least once a year. Prescription opioid abuse incurs an annual cost of $78.5 billion, including healthcare, legal programs, and lost productivity.

• Prescription opioids are implicated in 32% of opioid overdose deaths. Pharmacies fill 153 million opioid prescriptions annually, equating to enough prescriptions for 46.7% of Americans. This rate is 9.1% lower than the previous year​​.

Dangers of Combining Opioids and Benzodiazepines

Combining opioids with benzodiazepines presents significant health risks due to their synergistic effects on the central nervous system. Both opioids and benzodiazepines are central nervous system depressants, meaning they slow down brain activity. When taken together, their combined effect can dangerously enhance this slowing, leading to severe respiratory depression. This is one of the most critical risks, as it can result in decreased oxygen to the brain, potentially causing coma or fatal respiratory failure. The risk is particularly acute for individuals with underlying respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD). Moreover, this combination significantly impairs cognitive and motor functions, increasing the risk of accidents, falls, especially in the elderly, and impaired ability to perform tasks that require alertness, such as driving.

Dependency

Those who use prescription opioids are at risk of dependency and addiction. According to a Pubmed study, the lifetime prevalence of any prescription opioid-use disorder in this cohort was 41.3%, with 28.1% for mild symptoms, 9.7% for moderate symptoms, and 3.5% for severe symptoms. It’s important to note that this study focused on opioid use disorder, which encompasses both dependence and addiction as per the DSM-5 criteria, rather than solely on physical dependence​​.

The research suggests that the prevalence of opioid use disorder, which includes dependence, among long-term opioid users is significantly high.

Possible Side Effects

Taking prescription opioids can lead to some serious side effects, including:

• Building a tolerance
• Physical dependency, leading to withdrawal symptoms
• Heightened sensitivity to pain
• Constipation
• Experiences of nausea, dry mouth, and vomiting
• Feelings of fatigue and dizziness
• Mental confusion
• Onset of depression
• Reduced testosterone levels
• Skin itching
• Excessive sweating

References

1. https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
2. https://pubmed.ncbi.nlm.nih.gov/26316838/
3. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases
4. Centers for Disease Control and Prevention. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26);563-568.
5. Ossiander EM. Using textual cause-of-death data to study drug poisoning deaths. Am J Epidemiol 2014 Apr 1;179(7):884-94.
6. Banta-Green CJ, Merrill JO, Doyle SR, Boudreau DM, Calsyn DA. Opioid use behaviors, mental health and pain—development of a typology of chronic pain patients. Drug Alcohol Depend 2009;104:34–42.
7. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82.
8. Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain 2007;8:573–82.
9. https://drugabusestatistics.org/opioid-epidemic/#:~:text=Opioid%20Subcategories%20%20%0ANatural%20opioids,58%E2%80%A0fentanyl%E3%80%91
10. https://medicalxpress.com/news/2023-11-opioid-rx-overdoses-deaths-ama.html

Other resources

Help For Families with an Opioid Problem.

The Coffee Connection – Understanding and Relating to Addiction.