![]() The age group with the greatest past-year nonmedical use of opioids is young adults aged 18 to 25, yet the greatest use (i.e., exposure) of prescription opioids is among adults aged 26 and older. Opioid-related death rates also were higher among those who had recently been released from prison, those who obtained opioid prescriptions from multiple pharmacies, and those who obtained prescription opioids in combination with other scheduled medications. In Massachusetts during the period 2013–2014, 76 percent of opioid overdose deaths occurred among people under the age of 50, and men aged 18 to 34 had opioid-related death rates nearly three times higher than those of women of the same age ( Massachusetts Department of Public Health, 2016). While death rates associated with opioid overdose have increased for virtually every population group, the rates are highest among males under age 50 ( CDC, 2015a). Overdose mortality is the most dramatic consequence of increased opioid use, but it is not the only one rates of emergency room visits for nonmedical opioid use ( SAMHSA, 2013a), neonatal abstinence syndrome (NAS) ( Patrick et al., 2012), and OUD treatment admissions all have soared since 2002 ( SAMHSA, 2010). From 1999 to 2011, hydrocodone use increased more than two-fold, oxycodone use more than five-fold ( Jones, 2013b), and the mortality rate of opioid-related overdose almost four-fold ( Chen et al., 2014). The annual number of new nonmedical users slowly declined to about 1.8 million in 2012 ( SAMHSA, 2013b), but the overall pool of people continuing to use nonmedically is very large. Shortly thereafter, nonmedical opioid use also started to increase markedly, reaching a peak of 2.7 million new users in 2002 ( Kolodny et al., 2015). Medical prescriptions for opioids started to increase sharply in the mid-to late 1990s ( NIDA, 2014). TRENDS IN PRESCRIPTION OPIOID USE AND MISUSE Each aspect of this chapter identifies considerations that should be taken into account when weighing the societal perspective and public health impact relevant to these products when they are being considered for new drug approval or during post-market surveillance. Food and Drug Administration's (FDA's) exercise of its authority to regulate pharmaceutical opioid products (analgesics, agonists, and antagonists). ![]() The committee selected these topics to discuss in particular for their relevance to the U.S. ![]() This chapter updates key statistics regarding use and misuse of prescription opioids, identifies risk factors for opioid-related harms, describes the recent increase in use of heroin and illicitly manufactured synthetic opioids and its relation to the prescription opioid epidemic, describes the impact of prescription opioids on illicit markets, reviews the current state of surveillance systems, and summarizes recent trends in treatment of OUD and use of naloxone to prevent overdose deaths. The opioid epidemic's toll is felt across the life span and in every sociodemographic group, but more heavily burdens vulnerable populations, such as those in economically depressed areas of the country. Each day 90 Americans die prematurely from an overdose that involves an opioid ( Rudd et al., 2016b), leaving families and friends bereft. ![]() Current national trends indicate that each year more people die of overdoses-the majority of which involve opioid drugs-than died in the entirety of the Vietnam War, the Korean War, or any armed conflict since the end of World War II. Not since the HIV/AIDS epidemic has the United States faced as devastating and lethal a health problem as the current crisis of opioid misuse and overdose and opioid use disorder (OUD). ![]()
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