Opioid Use Disorder __________________________________________________________________________
to 25 years of age [19]. In 2016, an estimated 11.8 million people in the United States 12 years of age or older reported past-year use of heroin and 3.6 million reported past-month use [12]. According to the National Survey on Drug Use and Health, there were 26,000 new heroin users older than 12 years of age in 2021 [12]. Most new users were female. In 2021, an estimated 829,000 persons received treatment for heroin abuse [12]. It is important to note that this survey underestimates heroin use, possibly to a substantial extent, as obtaining accu- rate statistics on illicit drug use is difficult [12]. According to the Monitoring the Future survey, NIDA’s nationwide annual survey of drug use among the nation’s 8th-, 10th-, and 12th-graders, heroin use declined slightly from 2017 to 2020 [20]. In 2023, the level of annual use was 0.4% or less in each grade [20]. Lifetime heroin use (at least one use in an individual’s lifetime) declined significantly in 2023, bringing prevalence to 2.4%, which is the second-lowest recorded by NIDA [20]. Past 12-month use also significantly declined in 2023, to 1% [20]. The survey also monitors the use of diverted opioids and shows past year oxycodone use rates significantly declined in grades 10 and 12 and was 0.8% lower in all grades [20]. Nonmedical use of prescription opioids has caused increasing concern among law enforcement officials and regulatory, pain relief advocacy, and drug abuse organizations [21]. Between 1992 and 2003, the U.S. population increased 14%, while persons abusing opioid analgesics increased 94% and first- time nonmedical opioid analgesic users 12 to 17 years of age increased 542% [21]. The prevalence of past-year nonmedical oxycodone use increased from 8.9% in 2019 to 12.8% in 2021 [12]. During 2021 in the United States, an estimated 71.7 million (12.2%) individuals misused prescription pain relievers; 1.8 million (20.9%) initiated misuse of prescription pain relievers; and almost 1.9 million (0.7%) had a substance use disorder involving prescription pain relievers [12]. ED visits involving treatment from prescription opioids were estimated to be 239,000 in 2021 [12]. Among high school seniors, use of hydrocodone/acetamino- phen (Vicodin) was less than 1% across grades 10, 11, and 12 in 2023. Levels of use significantly declined to record lows in 2023 for 12th- and 10th-grade students. The low levels in 2023 are the result of a marked declined from peaks before 2010 of 3% in 8th grade, 8% in 10th grade, and 11% in 12th grade [20]. More than 40 million prescriptions were written for acetaminophen/hydrocodone in 2020, making it the twelfth most prescribed drug in the United States [22]. At least 35.5 million Americans have ever used a hydrocodone product illicitly [12]. In 2014, the DEA reclassified hydrocodone- containing products from Schedule III to Schedule II of the Controlled Substances Act. Following the rescheduling, pre- scriptions dropped from 120 million in 2014 to 5.5 million in 2018 [23; 24].
Some studies estimate that as many as 20% of individuals in the United States have used a prescription opioid for non- medical purposes at least once during their lifetime [25; 26]. In 2019, 9.1 million young adults had used an prescription pain reliever for nonmedical purposes in the past year. This number dropped to 8.2 million in 2021 [12]. The greatest misuse was among individuals 26 to 49 years of age, and the incidence was similar between men and women [12]. Among persons 12 years of age or older, treatment admissions for prescribed opioid abuse have more than doubled between 2000 and 2010. In 2019, 731,000 people received past-year substance use treatment for prescription pain relievers. This number increased slightly to 746,000 in 2021 [12]. The number of new nonmedical users of the four major classes of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) increased between 1991 and 2019; the largest increase occurred with pain relievers. In 1990, there were 628,000 initiates compared with 1.8 million in 2021 [12]. As of 2021, it is conservatively estimated that 5 million individuals have a substance use disorder related to prescription pain medication [12]. The number of primary treatment admissions for pain medication use disorder was 746,000 in 2021 [12]. In 2021, 1.8 million individuals reported using prescription pain relievers nonmedically for the first time within the last year—nearly 4,930 per day [12]. Approximately 87.1 million individuals 12 years of age or older were past-year users of prescription pain relievers in 2019 [12]. DEMOGRAPHICS OF ILLICIT OPIOID USERS Male-to-female ratios for lifetime heroin-only users and lifetime heroin and oxycodone users show that use is higher for men than for women [12]. In 2021, 65.3% of admissions to sub- stance use treatment services (for all substances) were male and 34.6% were female [27]. Male opioid users are more likely to also use other illicit drugs; female opioid users are more likely to also abuse other prescription drugs [28]. There is a high incidence of mood/anxiety disorders among opioid users, and this incidence is significantly greater among women than men. In 2021, the percentages of past-year nonmedical use of pain relievers among the predominant racial and ethnic groups were [12]: • White: 3.0% • Hispanic or Latino: 3.1% • Native Hawaiian or Pacific Islander: Not reported • American Indian/Alaska Native: 4.4% • Black or African American: 3.5% • Asian: 2.2% As of 2021, individuals 18 to 25 years of age have the highest percentage of past year (3.1%) and past month (0.9%) illicit pain medication use [12].
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MDRI2026
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