The opioid use disorder (OUD) crisis in the U.S. is dire. Every day, 136 people die from an opioid overdose, and this number continues to grow every year. OUD reaches across every population group and every part of the country.
Trends have shifted as opioid use has moved from prescription to street drugs. Much of what experts know about how often it happens in different groups and why (called epidemiology) comes from statistics on opioid deaths.
How Common Is Opioid Use Disorder?
According to the National Center for Drug Abuse Statistics, 3.8 percent of American adults abuse opioids each year. That’s over 10 million people. New users are on the decline, but by only a single-digit percentage, and opioid misuse is still widespread. The epidemic is now in its third decade and holding strong, in part due to the COVID-19 pandemic and economic factors.
History of the Opioid Epidemic
Opioids are a class of drugs that includes prescription pain relievers like codeine and morphine, whose active ingredients come from plants like poppies. They also include the semi-synthetic drugs oxycodone and hydrocodone, which are made in labs using natural opiates. It also includes the fully synthetic fentanyl and tramadol, and street drugs like heroin.
The opioid crisis has had two phases: First, an initial explosion of opioid prescriptions around 2000. Then, a new wave in the 2010s when heroin and fentanyl drove it to new heights. As national initiatives led to awareness about opioid addiction and doctors wrote fewer prescriptions, people with OUD switched to street drugs.
According to one study, 80 percent of current heroin users said they began with prescription opioids. So even though the number of opioid prescriptions went down, as people shifted to street opioids, OUD cases and deaths went up.
Fentanyl has helped fuel many of those overdoses. Scientists developed the drug, which is up to 100 times stronger than morphine, to manage pain in cancer patients. It quickly became a street drug. Because people often secretly add it to heroin or sell it as heroin, users don’t always know they’re taking it. That has led to thousands of accidental overdoses.
Who's at Risk for an Opioid Use Disorder?
Your risk of developing an opioid use disorder depends on many things, including the length of time you’re prescribed opioids for pain and how long you continue to take them, whether they’re prescribed or not. Government efforts have cut the number of prescriptions, but there’s a lack of affordable and legal alternatives to manage pain, and there’s been less and less federal funding to find new ones.
By the Numbers:
- 21-29 percent of people on prescription opioids for chronic pain misuse them.
- 8-12 percent of people taking opioids for chronic pain develop an OUD.
Other risk factors for an OUD include:
- Disabling pain
- Pain without a clear cause
- Young age
- Lack of social support
- Personal or family history of substance abuse
- Psychological stress or trauma
- Childhood sexual abuse or other adversity
- Mood swings
Opioid Use Disorder by Age
More than 3/4 of people with OUD are young white men. Half are between the ages of 18 and 34. But a growing number of young women have developed OUD in recent years, especially those of childbearing age. Because of the increase in pregnant women with OUD, 0.7 percent of newborns have neonatal opioid withdrawal syndrome, or NOWS.
The average age of people with OUD increased with the epidemic’s shift from prescription to street drugs. During the prescription phase, drug-overdose deaths went up most among middle-aged men and women 25-54 years old in both rural and urban areas. Men ages 25-39 seem to be most affected as drug use involving heroin and fentanyl has grown.
Government efforts to stem the opioid epidemic have had the greatest effect on people ages 18-25. In recent years, the percentage of people misusing pain relievers in this age group went down 42 percent and OUDs with heroin went down 40 percent.
OUDs are also down among teens (those ages 12-17). They make up about 2 percent of people with OUD. Overall, fewer than 1 percent of all teens use opioids. But the number is 3.4 percent among Hispanic/Latino kids. Teens who use opioids prescribed by their doctors are 33 percent more likely to misuse opioids after high school.
There haven’t been significant declines in OUD rates in people 26 and older. This group makes up nearly 80 percent of all cases of OUDs.
Opioid Use by Gender
Across every age group, more males than females misuse opioids except those from ages 12 to 17. But women are just as likely as men to develop a use disorder.
The CDC reports that use of both prescription and illegal opioids has been going up steadily among women ages 15-44 over the past decade. Opioid use disorder in women affects every demographic group across the U.S.
Some explanations for this include:
- Women seem to be more sensitive to pain.
- Women are more likely to have chronic pain.
- Women are more likely to use opioids to self-treat for additional problems like anxiety.
- Women are more susceptible than men to the cravings and relapses that are part of a use disorder.
Men make up 70 percent of preventable opioid overdose deaths. But throughout the opioid epidemic, overdose deaths among women have gone up at a faster pace: a 1,326 percent increase for women compared to a 901 percent increase for men.
Opioid Use by Race and Ethnicity
The opioid epidemic affects most racial and ethnic groups in the U.S., but not in equal numbers. Among adults, opioid use has been highest among people who identify as being two or more races as well as among American Indian and Alaska Native people. Over 5% of these populations are affected.
Numbers continue to go up among other groups. Between 2018-2019 alone, opioid use grew 38.5 percent among Asian people and 8.3 percent among Hispanic/Latino people.
Some groups are more likely to use certain types of opioids more than others. For instance:
- White women and men are at higher risk for overdose from any opioid.
- Black and Hispanic women and men are more likely to use heroin.
- For American Indian/Alaska Native women and men, prescription opioids are the biggest risk.
In rural areas, recent opioid death rates per 100,000 people are:
- 47.4 among American Indian/Alaskan Native people
- 41.2 among white people
- 17.8 among Black people
- 15.8 among Hispanic people
In urban areas, the numbers are even higher:
- 49.3 among American Indian/Alaskan Native people
- 50 among white people
- 34.4 among Black people
- 18.6 among Hispanic people
Opioid Misuse by Income and Education
Across the U.S., nearly 50 percent of adults with OUD have low incomes and nearly 25 percent live in poverty. Some studies have also found a link between rising OUD rates and bad economic times, such as the Great Recession at the end of the 2000s. This is thought to be one reason for the increase in opioid misuse in the Northeast in the years that followed.
Opioid use varies by education and employment, but can still affect anyone:
- 4.2 percent of people with some college or an associate’s degree misuse opioids. That’s a higher rate than that of both college graduates and those who didn’t finish high school.
- 7 percent of unemployed adults, 3.9 percent of full-time employees, and 3.6 percent of part-time employees misuse opioids.
Opioid Use by Geography
Parts of the country with low economic prospects tend to have more opioid use and misuse. Appalachia, parts of the West and Midwest, and New England have higher rates than other areas.
Although many people think of drug misuse as a city problem, the opioid crisis has touched many rural areas. Throughout the 2000s, rural drug overdose deaths rose faster than urban rates and surpassed urban rates by the end of the decade.
Rural rates continued to go up in the 2010s, but urban rates jumped even more. Most of this second phase of the epidemic was concentrated in nine Northeast states, within both urban and rural areas, and it involved more street drugs than prescriptions. As one analysis summed it up, the Northeast has the highest overall opioid overdose rate and the South has the highest prescription overdose rate.
Opioid Overdose Deaths
Data from the CDC’s National Center for Health Statistics shows there were 75,673 opioid overdose deaths for the 12 months ending in April 2021. This is up from 56,064 the year before. Up to 80 percent of all of the U.S. drug overdose deaths -- 100,000 for this period -- involve opioids.
The sharp rise is likely due to several things. Many people have turned to drugs as an escape from:
- Changes in everyday life
- Increased stress caused by COVID-19
- Shrinking local economic opportunities
Street drugs are also easily available. Currently, 72 percent of preventable opioid deaths occur among people ages 25-54, and the number of deaths among those 55 and older is growing rapidly.