The total number of national prescription opioid use has declined by 60% from the peak volume in 2011 after another year of double-digit decline that is expected in 2020, according to the latest report from the IQVIA Institute for Human Data Science, Prescription Opioid Trends in the United States: Measuring and Understanding Progress in the Opioid Crisis.

Decreases in prescription opioid volume over the past 9 years have been driven by changes in clinical use, regulatory, and reimbursement policies, and in progressively more restrictive legislation enacted since 2012, according to the report. Further, the declines have been greatest in the highest doses of prescription opioids, or 90 morphine milligrams equivalents per day, which present the highest risk of opioid use disorder.

“These significant decreases are evidence of the positive impact of the collective efforts to reduce the use of prescription opioids by the medical community, public health authorities, and legislators at the state and federal levels,” said Haiden Huskamp, Henry J. Kaiser Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School, in a press release. “Reducing the overuse and misuse of prescription opioids continues to be an important public health priority both during the [coronavirus disease 2019 (COVID-19)] pandemic and beyond.”

Murray Allen, IQVIA senior vice president, noted that they will continue to monitor the course of the opioid epidemic.

“The burden of the epidemic varies from state to state and is also very dependent on the different strategies and interventions taken by the individual states,” Allen said in a press release. “As an example, the use of medication-assisted treatment, which was disrupted in 2020 due to COVID-19, remains highly variable across states. Continued research efforts are very important to learn from the impact of the different strategies states are undertaking to curb the opioid epidemic.”

The study also highlights the risks of co-prescribing benzodiazepines and opioids in the elderly population. Approximately 1.2 million Americans over 65 years of age are estimated to be receiving a combination regimen and therefore are at an increased risk of abuse and/or death.

The number has declined from approximately 1.7 million in 2016, a lower rate of decline than seen in those under 65 years of age. Approximately 18 million seniors are using prescription opioids, benzodiazepines, or a combination, representing approximately 30% of the 59.4 million total Americans receiving these medications, according to the report.

Some other key highlights of the study include:
  • Another year of double-digit decline in prescription opioid use in 2020 is expected to reduce usage in the United States to levels not seen since the early 2000s, completing a 20-year cycle that peaked in 2011 and has declined steadily since. 
  • Decreases in prescription opioid use over the past 9 years were driven by changes in clinical use, regulatory, and reimbursement policies, and in progressively more restrictive legislation enacted since 2012.
  • The impact of COVID-19 on use of prescription opioids has been modest, with use largely rebounding to baseline levels since June. 
  • Use of medication-assisted treatment was disrupted by the COVID-19 pandemic and its use remains highly variable across individual states.  
  • Co-prescribing benzodiazepines and opioids—consistently identified as increasing the risk of abuse and/or death — has declined in recent years, but still occurs in more than 1 million patients over 65 years of age.

REFERENCE
Prescription opioid use in the US has declined by 60% from 2011 peak, according to new report from the IQVIA institute for human data science. IQVIA [email]. Sent December 14, 2020. Accessed December 17, 2020.