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Institute Report
Prescription Opioid Trends in the United States
Measuring and understanding progress in the opioid crisis
Dec 16, 2020
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About the Report

The opioid epidemic has captivated the country for a decade, although it lost attention this year in the face of the COVID-19 pandemic, which affected the life and healthcare of patients with chronic pain and addiction and so many others. The impact of COVID-19 on use of prescription opioids has been modest, with use largely rebounding to baseline levels since June. Still, another year of double-digit declines in prescription opioid use in 2020 is expected to further reduce use in the United States to levels not seen since the early 2000s. While the human toll of the opioid epidemic is being addressed differently across the country, efforts in managing prescription opioids and in supporting medication-assisted treatment are showing measurable progress in many states. 

Report Summary

This report provides a timely view of levels of, and trends in, opioid prescribing, how those vary by state, and how those variations illustrate progress and remaining risks. Prescription opioid volume is expected to drop for the ninth consecutive year — a decline of 60% from its peak in 2011. Per capita use of prescription opioids is expected to drop back to levels of use seen in the early 2000, with the greatest reductions in prescription opioid use – as measured in morphine milligram equivalents (MME) – seen in higher-risk segments taking more than 90 MMEs (per day. The greatest declines in prescription opioid use are seen in states which previously had the highest per capita use.

There has been further progress in reducing the highest-risk prescriptions and co-prescribing of opioids with anxiety drugs called benzodiazepines, which are linked to a higher risk of overdose and death. However, the decline in use of co-prescribed opioids and benzodiazepines has been lesser in patients over 65 than in younger patients. While combined prescribing of opioids and benzodiazepines is down by 30% since 2016, the number of seniors estimated to be receiving a combination regimen remains substantial at 1.2 million seniors. 

There are sometimes no other alternatives to opioids for pain management, and current drugs for opioid use disorders are themselves narcotics, driving an intense research effort for alternatives, with only limited progress emerging. Treating underlying diseases with symptomatic pain and developing non-opioid therapies is the focus of the current pipeline. Unmet needs in addiction additionally are being addressed with ongoing research on new mechanisms of action and digital therapeutics. 

Key Findings

Total national prescription opioid use has declined to 60% of the peak volume in 2011 after another year of double digit decline expected in 2020
  • Per capita use of prescription opioids is expected to drop back to levels of use seen in the early 2000.
  • Since 2011, total opioid prescriptions have declined by 40%, with declines of 51% and 63% in commercial and cash pay types.

Trends in use of prescription opioids and medication-assisted treatment quickly returned to pre-pandemic levels after initial disruptions 

  • During the COVID-19 pandemic, as many as 44% fewer patients started new opioid therapy while MAT was less impacted. 
  • Total opioid prescribing declined 16% at the peak of shutdowns in late April, with significant variations across key specialties. 
  • Healthcare providers have prescribed longer opioid prescriptions to mitigate COVID-19 disruptions.
  • Trends in use of prescription opioids and medication-assisted treatment quickly returned to pre-pandemic levels after initial disruptions. 

There is a significant cluster of states with both opioid and MAT use above the national average

  • Use of medication-assisted treatment, which was disrupted in 2020 due to COVID-19, remains highly variable across states.
  • In 2019, opioid MME per capita declined in every state compared to 2018, with the national average declining by 15%.
  • The greatest declines in prescription opioid use are seen in states which previously had the highest per capita use.

Co-prescribing benzodiazepines and opioids — consistently identified as increasing the risk of abuse and/or death — has declined in recent years, but still occurs in more than 1 million patients over the age of 65

  • Opioid and benzodiazepine treatments have declined less in patients over 65 than in younger patients.
  • About 1.2 million Americans over the age of 65 are estimated to be receiving a combination regimen and therefore at an increased risk of abuse and/or death.  
  • This number has declined from about 1.7 million in 2016, a lower rate of decline than seen in under 65 year-olds.  
  • A total of about 18 million seniors are using prescription opioids, benzodiazepines, or a combination, representing about 30% of the 59.4 million total Americans receiving these medicines.  
 
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