“It is becoming less reliant on opioids, and physicians are prescribing much more responsibly,” said Wasan, who is co-director of the Center for Innovation in Pain Care at the University of Pittsburgh.
Between 2015 and 2018, nearly 11 percent of American adults aged 20 and over used at least one prescription opioid like oxycodone or a nonopioid like Celebrex, investigators found.
Breaking that down, they found that nearly 6 percent of American adults used one or more prescription opioid painkillers, while 5 percent used a nonopioid prescription pain medication to quell their aches and pains.
“Physicians should look first at nonopioid drugs to manage pain and then if nonopioid medications don’t work, think about opioids,” said researcher Dr. Qiuping Gu, an epidemiologist at the CDC’s National Center for Health Statistics (NCHS).
For the study, Gu and colleagues used data from the U.S. National Health and Nutrition Examination Survey.
- More women than men used prescription opioids in the past 30 days, and use increased with age.
- Use of any prescription pain medication was highest among whites (nearly 12 percent), compared to Blacks (about 10 percent) and Hispanics (8.5 percent). Use was lowest among Asians (4.5 percent).
- Between 2009 and 2010 and between 2017 and 2018, there was no significant change in the use of prescription opioids, while the use of prescription nonopioids rose.
Despite a leveling off of prescription opioids, which is good news given the nation’s addiction epidemic, their use remains a concern.
“When taking into account that 21 percent to 29 percent of patients prescribed opioids for chronic pain may misuse them, and 8 percent to 12 percent of these patients may develop opioid use disorder, the survey data showing greater than 1 of 20 U.S. adults using opioids for pain continues to be problematic,” said Dr. Yili Huang, director of the Pain Management Center at Northwell Health Phelps Hospital in Sleepy Hollow, N.Y.
“This stresses a need for continued pain management education as well as increased access to safe and effective pain care,” said Huang.
Wasan said other studies looking at doctors’ prescribing practices have found fewer opioids prescribed for chronic pain.
But he also said he expects the number of Americans taking a prescription painkiller to increase as the population ages.
And Wasan voiced concern that some patients may not get the pain relief they deserve because doctors are more reluctant to prescribe opioids and insurance companies have become reluctant to approve them.
“Unfortunately, a lot of that has been made worse by insurance companies that have become very restrictive on opioid prescribing,” he noted. “Even if opioids are appropriate to prescribe, you can’t prescribe because of all the barriers involved that insurance companies introduce,” Wasan said. “That is one of the big drivers for many patients receiving inadequate pain care.”
Wasan added that insurance companies don’t, as a rule, cover pain management, which includes not only medications but physical and psychological therapy.
“In managing chronic pain, there needs to be use of multimodal approaches, so that you can avoid opioids and so you can also get the most improvement in pain and function,” he said.