Prescription opioids fueled the start of the opioid crisis, but other forces now drive it. Opioid prescriptions have fallen. Yet opioid use disorder and overdose deaths keep rising, as pill mills and illegally made opioids took over the supply. Researchers say ending the crisis takes a fuller grasp of opioid dependence.
Summary: Opioid prescriptions have dropped, yet the opioid crisis goes on. Opioid use disorder (OUD) and deaths from opioid overdose keep rising. So researchers say we need a better grasp of opioid dependence. We must not oversimplify the problem. A rise in opioid prescriptions first fueled the crisis. Later, other forces took over, like pill mills and a bigger supply of illegally made opioids.
The opioid crisis is not new, and it shows no signs of fading. That holds despite the best efforts of regulators and doctors. The worrying part is that overdose deaths keep climbing. That is true even though opioid prescriptions have dropped significantly in the last few years. Also, many people now seem to buy and use prescription opioids that were made illegally.
Researchers think we must understand how complex the opioid crisis is if we want to fight it. Things are not as simple as they look. Doctors who prescribe opioids for chronic pain do not fuel much of this crisis. Instead, pill mills and “unscrupulous” physicians fuel opioid use disorder (OUD). This path to OUD exists outside the world of chronic pain care.
The opioid crisis has many faces. It is one of the most complex health crises, and it harms both body and mind. The drug scene also keeps changing. So researchers warn against oversimplifying the problem.
For example, saying that chronic pain prescriptions alone fuel the epidemic is an oversimplification. In fact, studies show that very few patients abuse opioids prescribed for chronic pain. So opioids that doctors prescribe for chronic pain do not add much to OUD.
In the same way, this factor played a role in OUD early on, since prescription drugs were cheaper. But this factor no longer matters. Pill mills still feed the crisis, but they are not the only source.
It is true that opioid prescriptions played a big role early in the opioid epidemic. The epidemic had a humble start. Doctors wanted to help their patients living with chronic pain. So they began prescribing opioids to many patients. But demand for opioids soon rose, and many people began buying them on the illegal market. High demand flooded the market with illegal drugs. It also changed the illegal drug market. Supply shifted from heroin from Asia to illegally made fentanyl from Latin America.
Still, researchers say we cannot blame pill mills and unscrupulous physicians alone. Many hospitals still prescribe opioids, even for conditions where opioids help little.
Opioid prescriptions have fallen since the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. In 2022, the CDC Clinical Practice Guideline for Prescribing Opioids for Pain replaced it. The new guideline removed the hard dose limits that had been treated as rules. Even so, opioid prescriptions stay fairly high in the US compared with other nations. Studies also confirm that 90% of people living with OUD often use these drugs for non-medical reasons.
Studies suggest that very few people prescribed opioids for chronic pain will ever develop OUD. Still, that is a significant number of people. Studies also show that more and more people older than 50 are seeking treatment for OUD. People in this age group are more likely to get opioids from doctors.
We still do not fully know why some people are more likely to develop OUD. Researchers think there is no single answer. Most people who develop OUD already have other mental health conditions besides chronic pain. So this group is more likely to develop OUD. They keep using prescription opioids, and they are also quite likely to buy illegal drugs.
To sum up, some tools may help lower the risk of OUD. These include alerts in electronic health records and motivational interviewing, along with opioid dependence treatment. But much work is still needed to understand what causes OUD.
Frequently asked questions
What is the main cause of the opioid crisis?
Opioid prescriptions played a big role at the start. Back then, doctors wanted to help patients living with chronic pain. As demand rose, many people began buying opioids on the illegal market. Then pill mills, “unscrupulous” physicians and illegally made opioids took over. Researchers warn that blaming the crisis on any single cause is an oversimplification. That includes prescriptions for chronic pain.
What is the current status of the opioid crisis?
The opioid crisis shows no signs of fading. Opioid use disorder (OUD) and overdose deaths keep rising. That is true even though opioid prescriptions have dropped significantly in recent years. Many people now get prescription opioids that were made illegally. The illegal market has also shifted from heroin from Asia to illegally made fentanyl from Latin America.
Do opioids prescribed for chronic pain cause addiction?
Studies show that very few patients abuse opioids prescribed for chronic pain. So these prescriptions do not add much to opioid use disorder. Most people who develop OUD already have other mental health conditions besides chronic pain. Even so, a small share of a large number of patients is still a significant number of people.
Who is most at risk of opioid use disorder?
There is no single reason why some people develop opioid use disorder. Most who do already have other mental health conditions on top of chronic pain. They are more likely to keep using prescription opioids and to buy illegal drugs. The number of people older than 50 seeking treatment for OUD has also risen steadily. This age group is more likely to get opioids from doctors.
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Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.
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