Long-Term Opioid Use in the U.S.: Trends, Risks, and the Need for Better Care
A recent study published in JAMA highlights an important shift in opioid prescribing across the United States. While long-term opioid use has declined over the past decade, millions of people are still relying on these medications—raising ongoing concerns about overdose risk, dependence, and the need for safer pain management strategies.
Millions Still on Long-Term Opioid Therapy
In 2023, approximately 4.2 million Americans were engaged in long-term opioid therapy, according to research led by University of Michigan. These treatment episodes typically involve opioid use for 90 days or longer, often for chronic pain management.
Although this marks a 24% decrease from about 5.6 million patients in 2015, the numbers remain significant. In fact, long-term users still represented 11.5% of all patients receiving opioid prescriptions in 2023.
Researchers used data from IQVIA, which captures the vast majority of U.S. retail pharmacy prescriptions, to analyze trends over time and better understand how long-term opioid use is evolving.
Who Is Receiving Long-Term Opioid Treatment?
The study revealed a noticeable shift in patient demographics:
- The average age increased from 52.5 in 2015 to 60.5 in 2023
- Medicare coverage became more common, rising from 38.8% to 48.7%
This suggests that long-term opioid therapy is increasingly concentrated among older adults, many of whom may be managing chronic or complex health conditions.
At the same time, prescribing practices appear to be improving. The average daily opioid dose—measured in morphine milligram equivalents—declined over the study period, indicating a move toward more cautious prescribing.
Changes in Co-Prescribing Patterns
The study also examined how opioids are prescribed alongside other controlled substances:
- Benzodiazepine co-prescribing dropped from 43.8% to 33.5%
- Gabapentinoid co-prescribing increased from 47% to 58.7%
- Stimulant co-prescribing rose slightly from 5.9% to 6.7%
These shifts may reflect evolving clinical practices aimed at reducing high-risk drug combinations—particularly since mixing opioids with sedatives like benzodiazepines significantly increases overdose risk.
Why This Matters
Despite progress, long-term opioid use remains widespread. Nearly 1 in 9 patients receiving opioid prescriptions in 2023 were still chronic users.
This is especially important in the context of today’s drug landscape, where substances like FYL and XYL may be present in the supply—often without a user’s knowledge—dramatically increasing overdose risk.
Because of this, experts emphasize:
- Safer prescribing practices
- Close patient monitoring
- Access to evidence-based pain treatments
- Widespread availability of Naloxone for overdose reversal
Even patients using prescription opioids as directed can face risks, making education and preparedness critical.
Gaps in the Data
While the study provides valuable insights, it also has limitations. The analysis was based on prescription data and could not determine:
- Why opioids were prescribed
- Whether patients actually took the medications
- Underlying health conditions or provider decision-making
Even so, the findings clearly show that long-term opioid therapy continues to play a major role in U.S. healthcare—and that more work is needed to ensure it is managed safely.
The Path Forward
As opioid prescribing continues to evolve, the focus must shift toward balanced, patient-centered care. This includes:
- Expanding access to non-opioid pain treatments
- Improving clinical guidelines
- Increasing education around overdose prevention
- Ensuring Naloxone is widely available and understood
The decline in long-term opioid use is a positive sign—but with millions still affected, the need for safer, more effective pain management solutions remains urgent.
Source: Michigan Public Health News Center