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Epidemiology: Opioid Use and Related Disorders

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Book cover Treating Opioid Addiction

Part of the book series: Current Clinical Psychiatry ((CCPSY))

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Abstract

Although opioid use disorders and overdose have been long-term global health problems, the United States has experienced an unprecedented opioid crisis over the early part of the twenty-first century. In contrast to the relatively stable rates of heroin use in the late 1980s and early 1990s, there were marked increases in pharmaceutical opioid use and related overdoses starting in the mid-to-late 1990s, widely attributed to increased opioid prescribing for chronic pain. Starting in 2010, substantial increases in overdoses attributed to heroin were also observed, followed by exponential increases in overdoses involving illicitly manufactured fentanyl. These shifts have been driven by broad economic and social forces, including changes in pharmaceutical and illicit drug markets. Opioid use and its complications have had public health consequences across demographic groups and geographic regions. Of all medical complications, overdose is the most serious and fatal. Overdose has been associated with increasing opioid dose and potency, and loss of tolerance. Further, “opioid” overdoses are frequently related to polysubstance use, polypharmacy, and underlying psychiatric and medical comorbidities. Overdose can be effectively prevented with opioid agonist treatment and reversed with naloxone. Together, these epidemiologic findings have driven clinical and policy initiatives to reduce prescribing of opioid pain relievers, expand access to pharmacotherapy for opioid use disorder, and increase the availability of the overdose reversal agent naloxone.

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Notes

  1. 1.

    Specific questions related to use of Vicodin™ and OxyContin™ were added to the Monitoring the Future survey in 2002 as the prevalence levels of these drugs were thought to account for an upturn in use of the general class of narcotics other than heroin [21].

Abbreviations

CDC:

Centers for Disease Control and Prevention

CHIP:

Children’s Health Insurance Program

DSM:

Diagnostic and Statistical Manual of Mental Disorders

ER:

Extended-release

ICD:

International Classification of Diseases

LA:

Long-acting

MME:

Morphine milligram equivalents

MTF:

Monitoring the Future

NSDUH:

National Survey on Drug Use and Health

YRBS:

Youth Risk Behavior Survey

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Acknowledgments

Drs. Binswanger and Glanz were supported by grant 1R56DA044302. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

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  1. Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA

    Ingrid A. Binswanger, Jason M. Glanz & Morgan A. Ford

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Correspondence to Ingrid A. Binswanger .

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  1. Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine, Harvard Medical School, Boston, MA, USA

    John F. Kelly

  2. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Sarah E. Wakeman

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Binswanger, I.A., Glanz, J.M., Ford, M.A. (2019). Epidemiology: Opioid Use and Related Disorders. In: Kelly, J., Wakeman, S. (eds) Treating Opioid Addiction. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-16257-3_2

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