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America’s on Opioids

BU study finds one in 30 adults takes opiates for pain

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Judy Kelly_v.jpg

Judith Kelly, an epidemiologist at BU’s Slone Epidemiology Center, led an eight-year study examining opioid use among American adults. Photo courtesy of Judith Kelly

Look around the office. Or the subway car. Chances are someone’s using an opioid.

According to a study by researchers at BU’s Slone Epidemiology Center (SEC), more than 10 million American adults — about one in 30 — take opioids in any given week, and 4 million take them at least five days a week.

Opioids are among the most widely prescribed drugs in the United States and play a key role in pain management. The term “opioid” refers to all opiates: synthetic, such as tramadol, semisynthetic, such as oxycodone, and natural, such as codeine and morphine.

From 1998 to 2006, Judith Kelly, an SEC epidemiologist and the study’s lead author, and her team surveyed 19,150 randomly selected adults 18 and older, collecting information on all prescription and nonprescription medications taken during the previous week. They also determined the reason for use, how the medications were administered, the number of days taken in the week before the interview, and the total duration of current use. Their findings were published in the September 15 issue of Pain, the journal of the International Association for the Study of Pain.

Despite concerns about potential abuse, the extent of opioid use is not well known. In fact, an analysis of the eight-year SEC study was sponsored by the pharmaceutical company GlaxoSmithKline, which was interested in developing an opioid with fewer side effects, according to Kelly.

“Studies of opioid use have been done in selected populations, like veterans and persons with mental health disorders,” she says. “However, there is little data that address the magnitude and characteristics of opioid use in the general, noninstitutionalized, adult U.S. population.”

Much of the recent opioid-use information on record comes from pharmaceutical sales data. “Prescriptions filled is not necessarily equal to medications used,” Kelly says. “Individuals share medications with others, including for nonmedical reasons. People obtain opioids from nonprescription Web sites and other illegal sources.”

The survey results revealed that 2 percent of those interviewed used opioids regularly, defined as five days a week for at least the previous four weeks. Kelly and her colleagues found that use decreased with education level, was more common in females and non-Hispanic whites, and was highest in the south-central region of the United States. Among regular users, almost half had been taking opioids for two or more years, and nearly one-fifth had been taking opioids five years or longer. Use of other medications, such as antidepressants, ACE (angiotensin-converting enzyme) inhibitors, and COX-2 NSAIDs (nonsteroidal anti-inflammatory drugs), was higher among regular opioid users compared to nonusers. A growing elderly population also contributed to a spike in use.

“Our results showed that opioid use increases with age and is highest in subjects aged 70 years or older,” Kelly says.

She says the study’s findings could be useful to a variety of medical interests, from primary care physicians and pain treatment centers to government regulatory agencies, the National Institutes of Health, and private organizations such as the American Pain Foundation. “The extent and characteristics of opioid use reinforce the need to strike a balance between opioid misuse and effective control of chronic pain,” Kelly says.

Caleb Daniloff can be reached at cdanilof@bu.edu.

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