National guidelines note that nonpharmacologic and non-opioid-containing pharmacologic therapies are preferred for managing chronic pain whenever appropriate. “Since the early 2000s, there has been a rise in opioid prescriptions and deaths resulting from these medications in the United States,” explains Craig M. Hales, MD, MPH. “As a result, there has been a greater emphasis on using nonpharmacologic and nonopioid-containing pharmacologic therapies for treating chronic pain.”

In an NCHS Data Brief, Dr. Hales and colleagues conducted a cross-sectional analysis of data from the National Health and Nutrition Examination Survey. According to Dr. Hales, these data are important in the context of the current opioid epidemic. “Data from our study are intended to provide information for policymakers, clinicians, and the public on recent trends in the use of prescription opioids and non-opioid prescription medications,” he says.

Key Findings

According to the study, 10.7% of all U.S. adults aged 20 and older used one or more prescription pain medications in the past 30 days from 2015 to 2018 (Figure). “In addition, we found that 5.7% of U.S. adults used prescription opioids and 5.0% used nonopioid prescription pain medications (without prescription opioids) in the past 30 days during this timeframe,” Dr. Hales says.

Overall, use of these medications increased with age, rising from 5.4% among adults aged 20 to 39 years to 12.7% for people aged 40 to 59 years and 15.1% for those aged 60 and older. Use of one or more prescription opioids was higher in women than men overall (12.6% vs 8.7%, respectively). Prescription pain medication use also increased with age in both women and men. “Of note, our study showed that use of one or more prescription opioids among Hispanic adults was lower than that of non-Hispanic white adults in both men and women,” Dr. Hales says. Prescription pain drug use was higher in women than men for non-Hispanic white adults, non-Hispanic black adults, and Hispanic adults.

Other Important Results

“Another finding from our report was that use of one or more opioid prescription pain medications—either with or without using nonopioid prescription pain drugs—was higher for women than men and increased with age,” says Dr. Hales. Regarding age, rates of using one or more prescription opioids rose from 2.8% for those aged 20 to 39 years to 6.6% for people aged 40 to 59 years to 8.2% for those aged 60 years and older.

“Of all races, the rate of using one or more prescription opioids and nonopioid prescription pain medications (without prescription opioids) was lowest among non-Hispanic Asian adults,” Dr. Hales says. Rates were higher among non-Hispanic white than Hispanic adults but use among both groups did not differ significantly from non-Hispanic black adults.

The study also showed that use of one or more nonopioid prescription pain drugs without prescription opioids was higher among women than men, and again, increased with age. In addition, use of nonopioid prescription pain medications without prescription opioids was lowest among non-Hispanic Asian adults when compared with all other race and Hispanic-origin groups. “Furthermore, our analysis revealed that between 2009–2010 and 2017–2018, there was no significant increase in the use of prescription opioids, but there was an increase in use of nonopioid prescription pain medications (without prescription opioids),” says Dr. Hales.

Critical Implications

Dr. Hales says it is important to continue monitoring use of opioid and nonopioid prescription therapies in the U.S. population, but notes that help is available to ensure appropriate prescribing of these medications in the meantime. “The CDC has published a guideline for prescribing opioids for chronic pain, which is available at www.cdc.gov/drugoverdose/prescribing/guideline,” he says. “This document is available for primary care clinicians to guide their prescribing practices when these therapies are necessary. In addition, it offers guidance on alternative treatment options to improve pain management and patient safety.”

References

Hales CM, Martin CB, Gu Q. Prevalence of prescription pain medication use among adults: United States, 2015-2018. NCHS Data Brief. 2020;369:1-8. Available at: https://www.cdc.gov/nchs/data/databriefs/db369-h.pdf or https://www.cdc.gov/nchs/products/databriefs/db369.htm.

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49.

Miller GF, Guy GP, Zhang K, Mikosz CA, Xu L. Prevalence of nonopioid and opioid prescriptions among commercially insured patients with chronic pain. Pain Med. 2019;20(10):1948-1954.

Chou R, Hartung D, Turner J, et al. Opioid treatments for chronic pain. Rockville (MD): Agency for Healthcare Research and Quality; 2020 Apr. Report No.: 20-EHC011.