Opioid use disorder affects more than 2 million people in the U.S. and contributes to the public health crisis of opioid addiction and overdoses. While previous studies have focused on how prevalent prescription opioid use is, researchers from Mayo Clinic and the National Center for Complementary and Integrative Health looked into who is choosing to use prescription opioids for the first time. They found that, in a nationwide survey conducted in 2019 and 2020, about 4 out of every 100 people had started using prescription opioids, which was more than they expected.

"One of the things that we noticed is that people are still utilizing opioids as an early resort or first line treatment, before trying non-opioid treatments first, which goes against best practice guidelines in healthcare," says anesthesiologist Ryan D'Souza, M.D., lead author of the study, which was published in the Journal of Pain. "This is a wake-up call to how high the incidence rate among new users continues to be."

The researchers analyzed data from the National Health Interview Survey, which collected information from the same 10,415 interview participants in 2019 and 2020. The researchers specifically looked at the 395 adults who reported not using prescription opioids in 2019 but reported using them in 2020.

Ineffective pain management was one of the highest factors given for new prescription opioid use. In addition, study participants with less than a high school education were 80% more likely to report they had begun using prescription opioids than college graduates. Those who reported having problems paying bills were 2.3 times more likely to have begun using opioids than those without such problems.

Other trends among new prescription opioid users surveyed in this study included those who had:

• Three or more visits to the emergency department in one year.
• Four or more painful conditions.
• Two or more disabilities.
• Problems sleeping most days or every day.
• Asthma in the last 12 months.
• Been diagnosed with depression or anxiety.
• Lived in the U.S. Midwest, South or West.

To identify these key predictors, the researchers looked at five variables based on the Andersen socio-behavioral model of healthcare utilization framework: health need measures; personal health behaviors; predisposing factors such as sex, age and race; enabling factors including socioeconomic status; and the external environment, such as region and urban versus rural areas.

Identifying the factors associated with someone's decision to start using prescription opioids in a nationally representative population can help inform targeted outreach strategies to optimize pain management plans, write the researchers.

"When a pain physician, or even a primary care doctor, sees these patients in clinic, having this awareness can help us personalize treatment. For example, when we know which patients are at particularly high risk for opioid use, we can do everything we can to tailor their treatment plan to incorporate a non-opioid multimodal analgesic plan," says Dr. D'Souza.

Additionally, the researchers compared opioid incident rates to the rates of other medications for chronic health issues including cholesterol-lowering drugs, diabetic medications and statin medications. They were surprised to see the rates of new opioid use approaching the levels of these more common prescription medications.

Next steps

The next steps in this research are to analyze data that spans five to 10 years or more to gain a better understanding of the long-term trajectory of these patients. Another facet to explore is how they are accessing prescription opioids. The researchers also hope to put these findings to use in the clinical setting.

Review the study for a complete list of authors, disclosures and funding.

Take part in National Prescription Drug Take Back Day by visiting locations with safe, free and convenient means to dispose of unnecessary medicines stored in the home that can be susceptible to abuse and theft. Drop-off events will take place Oct. 26 from 10 a.m. to 2 p.m. in communities across the nation. You also can find a year-round drop-off location by visiting the DEA National Prescription Drug Take Back Day website.

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