Prevalence of Illicit Opioid Use Higher Than Previously Estimated
The rate of illicit opioid use, including illicitly manufactured fentanyl (IMF) use, in adults aged 18 and older was higher than previously estimated, according to findings published in JAMA Health Forum. These results are based on self-reported survey data collected in June 2024.
“The findings of this cross-sectional study indicate a higher prevalence of illicit opioid use than previously reported, highlighting the need for more timely and accurate data to inform policy and intervention strategies,” wrote David Powell, PhD, RAND, Arlington, Virginia, and Mireille Jacobson, PhD, University of Southern California, Los Angeles, California.
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Illicit opioid use rates: Of the survey’s 1515 respondents, 166 (10.96%; 95% CI, 9.38%-12.53%) reported nonprescription opioid use within the past 12 months, with 117 reporting the use as intentional and 49 as unintentional.
IMF use rates: The reported rate of IMF use was slightly lower, with 114 respondents (7.52%; 95% CI, 6.20%-8.85%) reporting use within the previous 12 months. This estimation was 25 times larger than the 2022 National Survey on Drug Use and Health (NSDUH) rate of IMF use, which was 0.3%. Among these, 75 respondents reported intentional IMF use, and 39 reported unintentional use.
Demographic associations
- Among men, the rate of illicit opioid use within the past 12 months was 5.4 percentage points higher (95% CI, 2.2-8.5) than baseline, and the rate of IMF use was 4.4 percentage points higher (95% CI, 1.6-7.2) than baseline.
- Among Black respondents, the rate was 6.6 percentage points higher than baseline for illicit opioid use (95% CI, 1.9-11.2) and 4.2 percentage points higher for IMF use (95% CI, 0.4-8.1) than baseline.
- Among Hispanic respondents, the rate of illicit opioid use was 5.5 percentage points higher (95% CI, 1.9-9.1), and the rate of IMF use was 4.0 (95% CI, 0.8-7.1) percentage points higher than baseline.
- Compared with adults aged 55 years and older, respondents aged 18 to 34 had a 23.7% higher rate of illicit opioid use (95% CI, 15.5-32.0) and a 21.4% higher rate of IMF use (95% CI, 13.2-29.7). Those aged 35 to 54 years also had higher rates of illicit opioid use (17.4; 95% CI, 9.5-25.4) and IMF use (16.1; 95% CI, 8.3-24.0) than the 55 and older group.
Initial opioid exposure: Of the survey participants who reported illicit opioid use, 65 (39.16%; 95% CI, 31.73%-46.58%) reported that their initial opioid exposure was through a prescribed opioid. Meanwhile, 60 respondents reported that their first use involved prescription opioids not prescribed to them, and 41 reported that their first exposure involved illicit opioids.
Perceived overdose likelihood: Of those who reported using nonprescription opioids in the past 12 months, 24.10% (95% CI, 17.59%-30.60%) said that it was very likely that they would experience an opioid overdose. For those who had used IMF within the past 12 months, the rate increased to 33.33% (95% CI, 24.68%-41.99%).
“The data presented herein should be treated as a substantive data point for understanding and curtailing the ongoing opioid crisis,” the authors concluded. “More near-real-time data are needed to evaluate not only where we are in the epidemic but, more importantly, whether we are making progress in reining it in.”
