10% of those who use opioids account for the vast majority of use

One-tenth of all people who use opioids account for three-fourths of all opioid use in the United States, a research report found.

Researchers used a commercial database of pharmacy claims for more than 20 million privately insured adults without cancer who were continuously enrolled for at least one calendar year between 2001 and 2013 and filled at least one prescription for an opioid. They specifically looked at prescriptions for common orally administered opioids: hydrocodone (except as part of a cold/cough formulation), hydromorphone, methadone, morphine, oxymorphone, and oxycodone. Results were published Sept. 12 by Annals of Internal Medicine.

In 2013, the top 5% of those who used opioids accounted for 59% of all morphine equivalents and the top 10% accounted for 76%, the study found. In 2001, the top 5% accounted for 55% of all morphine equivalents and the top 10% accounted for 69%, suggesting that opioid use became concentrated among fewer people over the study period (P<0.001 for both differences). The top 10% of those who used opioids were older (average age, 47 vs. 41 years) and more likely to be men (46% vs. 44%; P<0.001 for both comparisons). Among the top 10%, 35% remained in this group during their time in the cohort. Overall, 0.4% of all patients were prescribed an average daily dose of more than 90 morphine equivalents, the limit recommended by the CDC.

There are about 100 million people who use prescription opioids in the U.S., so extrapolating from the study results suggests that 10 million people account for most U.S. opioid use, the authors noted. Efforts to reduce prescription opioid abuse should focus on those in the top group instead of a population-based approach, they said.

“Further research efforts aimed at characterizing this population, analyzing the incidence of opioid-related adverse events, and identifying approaches to reduce opioid use could be most effective in reducing total population-level use, especially because adverse events are most common at the highest morphine equivalents,” the authors wrote.

A separate study, published online Aug. 28 by JAMA Internal Medicine, found that evidence-based treatment for opioid and alcohol use disorders can be effectively integrated into primary care using a collaborative care intervention and can result in improved patient outcomes. Collaborative care was a system-level intervention to increase the delivery of a six-session psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders.

At six months, the proportion of participants with opioid or alcohol use disorders who received any addiction treatment was higher in the collaborative care group compared with usual care (73 patients [39.0%] vs. 32 patients [16.8%]; logistic model adjusted odds ratio, 3.97 [95% CI, 2.32 to 6.79]; P<0.001). In addition, a higher proportion of collaborative care participants reported abstinence from opioids or alcohol at six months (32.8% vs. 22.3%).