__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use Nonmedical Use of Prescription Opioids
use prevalence of 1 in 20 adults was comparable to U.S. rates. Although the study found high rates of prescribed opioid analgesic use and nonmedical use, most noteworthy was the conclusion that opioid analgesic prescribed use, nonmedical use, and non- medical use to get high was not associated with the level of prescription opioid dispensing. This finding stands in contrast to the stream of reports over the past decade from the CDC, the DEA, and other governmental agencies in the United States [74]. SAMHSA data do differentiate the underlying basis of misuse. For instance, a person who took or received a prescription opioid from a relative or friend for a headache is recorded as a nonmedical user (abuser); although placed in the same category as someone who stole prescription opioids from a medicine cabinet to get high, the motivations and possible interventions for the respective problems are entirely different. The importance of this distinc- tion is clear in a large 2008 survey of high school seniors, which found that 12.3% had used opioid analgesics for nonmedical reasons at some point [75]. This is similar to a 2012 study of 7,374 high school seniors, which found that 12.9% reported lifetime nonmedical use of prescription opioids [76]. A multi-cohort national study of more than 8,000 high school seniors found that 36.9% of past-year nonmedical users of prescription opioids obtained the medications from their own previous prescrip- tions. Analyses indicated that these users were pri- marily motivated by a desire to relieve physical pain [77]. This should lead to exploration of important public health questions, such as why so many young people suffering from untreated (or mistreated) physical pain resort to self-medication [76; 77]. Opioid Use Disorders in Patients with Pain Receiving Long-Term Opioid Analgesics The literature examining opioid use disorder inci- dence in patients with chronic pain receiving opioid analgesic therapy have reported rates of addiction developing during opioid therapy ranging from 0.03% to 50% [78; 79]. These vast differences are mainly the result of widely varying criteria to define opioid addiction. Many of the studies used diagnos- tic criteria according to the DSM-IV, or the DSM-III in studies that began before 1994. The DSM-III
In 2021, 9.2 million people reported nonmedical use of opioid analgesics (i.e., use without a prescrip- tion or for the non-analgesic effect) and 1.4 million were first-time nonmedical users that year [73]. An estimated 2.6 million people misused oxycodone products (including OxyContin) in the past year (1.2% of the population) [73]. The most frequent ini- tial (past year) drug used was cannabis (52.5 million), followed by nonmedical use of prescription opioids (9.2 million), hallucinogens (7.4 million), nonmedi- cal use of tranquilizers (4.9 million), stimulants (4.9 million), cocaine (4.8 million), methamphetamine (2.5 million), inhalants (2.2 million), and heroin (1.1 million) [73]. Among people 12 years of age or older in 2021, 3.3% (9.2 million) reported opioid misuse in the past year. The percentage was lowest among adolescents 12 to 17 years of age (1.9% or 497,000 people). Percent- ages were similar among young adults 18 to 25 years of age (3.1% or 1.0 million people) and adults 26 years of age or older (3.5% or 7.7 million people) [73]. Rates of Prescription Opioid Abuse and Addiction The vast majority of people who misused opioids in the past year misused prescription pain relievers. Specifically, 8.7 million people 12 years of age or older misused prescription pain relievers in the past year, compared with 1.1 million people who used heroin [73]. In 2021, the majority (8.1 million) of the 8.7 million misusers of prescription pain reliev- ers misused only prescription pain relievers in the past year—they had not used heroin. An estimated 574,000 people misused prescription pain relievers and used heroin in the past year, and 525,000 people used heroin in the past year but had not misused prescription pain relievers [73]. Widespread opioid analgesic prescribing and non- medical use, abuse, and dependence are not unique to the United States. Canadian estimates for 2009 indicated that of the total population, 19.2% used prescription opioid analgesics, including nonmedi- cal use by 4.8%, and that 0.4% used the drugs non- medically to get high. The past-year nonmedical
19
MDMS1526
Powered by FlippingBook