What the Recent NSDUH Report Says About Opioid Abuse in the US

The Substance Abuse and Mental Health Services Administration recently released its annual National Survey on Drug Use and Health (NSDUH), which is one of the most comprehensive surveys in the US on the issues of substance abuse and mental health. For this 2017 report, nearly 70,000 people representative of the general US population were surveyed in all 50 states and the District of Columbia.

Although the survey covers a variety of topics - including trends in the use of tobacco, marijuana, and alcohol, as well as statistics on the mental health of both adults and youth - one of the most anticipated data sets in recent years is the use and misuse of opioids. Below are some of the highlights of the survey's findings on opioid use, including charts from the survey.

In 2017, many more people sought treatment for their substance use disorder than in 2016. For illicit drug use disorder, there was an increase of almost four percent (9.2 percent in 2016 compared to 13 percent in 2017). For people with heroin-related opioid use disorders, the number increased from about 38 percent in 2016 to 55 percent in 2017. This is an encouraging trend in light of LegitScript's 2018 rollout of addiction treatment certification, which helps to weed out bad actors in the industry so that those suffering from addiction can get the help they need.

In the NSDUH report, opioid misuse included the misuse of prescription pain relievers and/or the use of heroin. There were 11.4 million opioid misusers aged 12 or older in the United States in 2017, the vast majority of whom misused prescription pain relievers (11.1 million as opposed to less than 1 million heroin users). About 63 percent of heroin users also misuse pain relievers. See the NSDUH chart below.

The number of people initiating heroin use decreased by more than 50 percent in 2017 compared to 2016. Even so, an estimated 886,000 people aged 12 or older in 2017 used heroin in the past year.

The survey asked respondents what types of pain relievers they used. Hydrocodone products were the most commonly misused subtype of prescription pain relievers, comprising an estimated 6.3 million users in 2017, which represents about 2.3 percent of the general population. The second most common pain relievers were oxycodone products, comprising 3.7 million people (1.4 percent of people aged 12 or older). Only an estimated 245,000 people (0.1 percent of the general population) misused prescription fentanyl products in 2017, but the report notes that this number may underrepresent fentanyl users since the survey asked only about prescription forms and not forms illicitly manufactured.

About 13 percent of respondents who misused pain relievers stated their primary reason was to get high. The most common reason, at about 63 percent, was to relieve physical pain. About 8 percent said they misused pain relievers to relax or relieve tension. See the NSDUH chart below.

Of great interest to those seeking to curtail the flow of misused opioids is how they are obtained. Consistent with findings in recent years, more than half (about 53 percent) of misused pain relievers were obtained from a friend or relative. More specifically, about 39 percent obtained pain relievers from a friend or relative for free, about 11 percent purchased a pain reliever from a friend or relative, and about 4 percent took pain relievers from a friend or relative without asking. The next largest source was through a prescription from one doctor (about 35 percent).

There was no specific category for pain relievers sourced from the internet, but it presumably would fall under the category "Some Other Way," which comprised less than 5 percent of answers. This indicates that pain relievers obtained from the internet - both the dark web and the surface web - comprise a tiny fraction those misused. See the NSDUH chart below.

Even so, the sale of opioids and other controlled substances on the internet remains a pervasive problem, particularly fentanyl, which drove drug overdose deaths to a record high in 2017 to more than 72,000. This week, a woman in San Diego was indicted for conspiring to distribute fentanyl in the US using the dark web. Third-party B2B websites on the surface web, particularly China-based ones, have repeatedly faced scrutiny for hosting vendors marketing fentanyl and its analogues on their websites.

LegitScript monitors the internet for websites illicitly marketing pharmaceuticals, designer drugs, and controlled substances, including opioids. Our investigative work tracks known networks operating on the surface web and monitors popular dark web marketplaces facilitating the sale of controlled substances. To learn more about our investigative capabilities, contact us.