An epidemic of opioid misuse

According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs.3 From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription, with 15,000 of these deaths in 2015.

Prescription opioids used to treat moderate to severe pain include oxycodone/OxyContin, hydrocodone (Vicodin), morphine, and methadone.  Fentanyl is a synthetic opioid pain reliever, more powerful than other opioids used for severe pain, typically in advanced cancer. Heroin is an illegal opioid.

Opioid addiction and deaths continue to rise

Opioid use and related deaths are on the rise in the US. Over the past 15 years, deaths related to opioids have quadrupled totaling nearly 170,000.  Contributing to the problem is the misuse of prescription opioids- highly addictive and deadly when misused- quadrupling during the same time period and responsible for almost half the opioid deaths.

For more information on community and outpatient opioid misuse, visit our section on risks in community and outpatient setting.)

One opioid prescription can trigger dependence/addiction

Even one opioid prescription can trigger long term dependence/use and addiction. More than 259 million prescriptions were written for opioids in 2012, according to CDC, which is more than enough to give every American adult their own bottle of pills. In 2015, more than 2 million Americans abused or were dependent on opioids.

The risk of chronic opioid use was found to increase with each additional day of opioid medication use starting with the third day, with sharpest increase in chronic use after the fifth and thirty-first day, a second prescription or refill, and an initial 10 or 30 day supply (CDC 2017).

Why are opioids so addicting?

Opioids create artificial “endorphins” in the brain and nervous system to produce pleasurable effects and relieve pain.  Within the first few days on opioids, the body gradually stops making its own endorphins naturally.   Often when opioids are stopped abruptly without tapering people can suffer withdrawal symptoms, including worsening pain, nausea, anxiety, depression, restlessness, suicidal thoughts and other debilitating effects. Staying on the opioids, even after the pain is gone, is the only way to feel good and avoid these symptoms. 

Alarming rise in opioid in-patient use and emergency department visits

Opioid-related hospitalizations reflect this alarming rise in opioid use. Over the last ten years, opioid-related inpatient stays increased by 64 percent and opioid-related emergency department visits increased 99 percent (AHRQ 2017).   Opioids were also responsible for half of the more than 1.2 million emergency department visits in the U.S. involving the nonmedical use of pharmaceuticals, the top two being  hydrocodone and oxycodone.

Premier research found that opioids were used in more than half of hospital admissions of non-surgical patients at 286 U.S. hospitals. Among pediatric inpatients, Premier research identified two specific opioids (fentanyl and morphine) that were found to be among the top 10 most administered medications. 

Opioid adverse effects are common among inpatients

Adverse effects from opioids can occur in patients in any setting receiving any opioid drug, including fentanyl, hydrocodone, oxycodone, hydromorphone, morphine and methadone.  Adverse effects include nausea, vomiting, constipation, falls, hypotension, hallucinations, delirium, aspiration pneumonia, respiratory depression and even death.

In the inpatient setting, opioids are among the drugs most frequently associated with adverse reactions. In one large study, opioids were responsible for 16 percent of drug-related adverse effects. A study of post-surgical patients found that almost 14 percent of those who received opioids experienced an adverse event. The study also found that the risk of death while hospitalized was more than three times higher among the patients who experienced an adverse effect associated with opioids compared with patients who did not. (For more information, visit our section on hospitals-inpatients safer opioid use for additional information.)

Premier research found that inpatients who experienced an opioid-related adverse event had greater costs, long length of stay and more readmissions.

Opioid misuse in community and outpatient settings

In the community or outpatient setting opioid misuse has become a significant health threat in the US.   Although all age groups are involved, the Medicare population has among the fastest growing rates of opioid use disorders (physical/psychological dependence or addiction), currently at more than 6 of every 1,000 beneficiaries. For Medicaid beneficiaries, the prevalence of diagnosed opioid use disorder is even higher, at 8.7 per 1,000, a figure estimated to be over 10 times higher than in populations who receive coverage under private insurance companies.

A 2017 study in JAMA-Surgery found that 6 percent of 36,177 patients without opioid use in past year who were prescribed opioids for surgical procedures, including minor outpatient procedures, were still on opioids 3 months later, long after most should have recovered.  There was no difference in long term opioid use between those who had minor outpatient vs major surgical procedures. Extrapolated to just the 50 million outpatient procedures each year, this represents up to 3 million that may become newly dependent on opioids.

For more information, visit our section on risks in community and outpatient setting.

Opioid drug diversion

The epidemic of addiction to opioids is the major driver of drug diversion and can occur at any point along the supply chain.  Drug diversion in healthcare facilities (employee stealing for their own use) results in care delivered by impaired provider, denial of essential pain therapy, and outbreaks from hepatitis C virus or bacterial pathogens when tampering with injectable opioids involving hundreds of patients, according to the CDC.   For more information visit our section on Drug Diversion.