Update on quantification of opioid dependence and abuse prevalence in the United States of America (2019 and 2020).

Objectives: To quantify the prevalence of opioid drug dependence and abuse in the United States between 2019 and 2020, as well as to identify which opioid molecules are associated with a higher level of dependence and abuse.

Design: National Survey on Drug Use and Health data for 2019 and 2020 was extracted. The variables related to painkillers were studied; the most important ones were selected, and several variable crosses were made. After the data were extracted, they were analyzed with Microsoft Excel® using PivotTables to calculate the relative prevalence and percentages of patients with abuse and dependence.

Results: A total of 1.2 million people were dependent on opioid pain relievers (OPRs) in 2020 versus 1.4 million people in 2018. In 2020, the last OPR used by people with dependence were hydrocodone (27 percent) and oxycodone (21 percent). In the same year, 63 percent of the people with a dependence on OPR had used it without their own prescription to relieve pain (vs 67 percent in 2017). In 2020, 2.5 million people used an OPR without a medical prescription; the main reason (42 percent) was to relieve pain (similar to 2018), followed by wanting to feel good (19 percent vs 16 percent in 2018) and to relax or relieve tension (16 percent). In 2020, 2.2 million people used an OPR differently than prescribed by the doctor; 31 percent of them had also used an OPR without a prescription; and 17 percent were dependent on an OPR in the same year. The most relevant types of abuse were the increase in frequency of use (1.4 million people), increase in the duration of treatment (1.2 million people), and increase in the quantity or dose (1.6 million people).

Conclusions: Abuse and dependence on OPRs during 2019-2020 (affecting 1.24 million people, 0.4 percent of the population over 12 years old) showed an average annual decrease of 3 percent compared to the 2017-2018 period. Similarly, the number of people using OPR without having their own prescription decreased from 5.8 million in 2019 to 4.7 million in 2020. The primary reason people use these medications without a prescription remains the relief of physical pain. The use of OPRs without having an own prescription remains a concern, as 60 percent of the people with dependence have used an OPR without their own prescription. The other major concern is the monitoring of OPR prescriptions. In 2020, over 2.2 million people used the OPRs differently than prescribed, and 28 percent of people with dependence in that year have used an OPR differently than prescribed. Oxycodone and hydrocodone continue to be the molecules more associated with abuse. Dependence associated with oxycodone is directly correlated with its use without prescription.