National Survey Data Provide New Insights on Use of Prescription Opioids in the U.S. Adult Population

An analysis of national survey data on new prescription opioid use suggests that opioids are sometimes being used as a first-line or early resort treatment for pain, contrary to best practices. The study was conducted by researchers from the Mayo Clinic and the National Center for Complementary and Integrative Health and was recently published in The Journal of Pain. 

The authors used data from the 2019–2020 National Health Interview Survey (NHIS) Longitudinal Cohort (NHIS-LC), a nationally representative, population-based study of U.S. adults with a 1-year follow-up. They applied Andersen’s socio-behavioral model of health care utilization, which examines five variable sets that may interact and influence the use of health services: the external environment, predisposing factors, enabling factors, health need measures, and personal health behaviors.

Of 21,161 people who were randomly selected from the 2019 survey respondents, 10,415 participated in a second survey in 2020 and were included in this analysis. Among adults who did not use prescription opioids in 2019, the authors found a 1-year cumulative incidence of 4.1 percent in 2020, with an incidence rate (IR) of 32.6 new cases of prescription opioid use per 1,000 person-years. As suggested by the Andersen model, health status (need) variables were consistent predictors of incident opioid use. Participants that reported having ineffective pain treatment and going to the emergency room of a hospital three or more times over the past year had the highest IR (81.6 and 93.8 cases per 1,000 person-years, respectively).

Other predictors of incident opioid use included reporting four or more painful health conditions in 2019, having two or more disabilities, having asthma in the last 12 months, having problems sleeping most days or every day, and having four or more medical comorbidities. Additionally, participants who had ever received a diagnosis of depression or anxiety had a higher relative risk of incident prescription opioid use.

Most previous studies on prescription opioid use among U.S. adults have focused on the prevalence of use (current use) or were based on data on incidence (new use) from sources not representative of the U.S. adult population, such as insurance claims. This new study is the first to examine nationally representative rates of incident prescription opioid use in the general U.S. adult population and selected subpopulations.

According to the authors, the findings suggest that some risk factors for incident opioid use are comparable to risk factors for opioid use disorder. Additionally, some participants reported using prescription opioids as a first response to treat pain rather than following best practice guidelines that recommend nonpharmacologic options, over-the-counter medications, and nonopioid analgesics as initial treatments for pain. The authors suggest that these data can be used to develop targeted messaging for at-risk populations about appropriate pain management strategies.