Epidemiology: Opioid Use and Related Disorders

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.