The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence — An assessment of demographic and substance use trends, United States, 2003–2014

Abstract Background The harms related to nonmedical use of opioid analgesics have impacted the United States for more than a decade. Examining trends in nonmedical use, abuse, and dependence among various demographic and substance using groups can provide critical insight for prevention and treatment activities. Methods Data from the National Survey on Drug Use and Health were used to assess trends in opioid analgesic nonmedical use, abuse, and dependence for 2003–2005, 2006–2008, 2009–2011, and 2012–2014. Multivariable logistic regression was used to identify characteristics associated with opioid analgesic abuse or dependence. Results Rates of past-year opioid analgesic nonmedical use decreased from 48.4 per 1000 persons aged 12 years and older in 2003–2005 to 43.3 in 2012–2014. Declines were seen among most demographic and substance using groups. In contrast, rates of past-year opioid analgesic abuse or dependence increased from 6.0 per 1000 persons in 2003–2005 to 7.5 in 2012–2014; increases were seen among most demographic and substance using groups. In 2012–2014, odds of opioid analgesic abuse or dependence were highest among those with sedative or tranquilizer and heroin abuse or dependence. Conclusions These findings indicate encouraging trends in overall nonmedical use of opioid analgesics which declined among many demographic and substance using groups. However, continued increases in rates of opioid analgesic abuse or dependence highlight the critical importance of maintaining efforts to drive down inappropriate opioid prescribing and expanding efforts to increase the provision of medication assisted treatment and psychosocial services for opioid use disorders and equipping individuals with naloxone to reverse opioid overdose.