Decline in Long-Term Opioid Use but Rise in Gabapentinoid Co-Prescribing, Reveals Research
USA: A recent research letter published in JAMA reports a considerable decline in long-term opioid use alongside a rise in gabapentinoid co-prescribing. Between 2015 and 2023, the number of individuals in the United States receiving long-term opioid therapy dropped from 5.6 million to 4.2 million, marking a 24.3% reduction. Despite this decline, co-prescribing of opioids with gabapentinoids increased significantly, rising from 47% to 58.7% over the same period. In contrast, benzodiazepine co-prescribing decreased, while stimulant use showed a slight uptick.
The patient population receiving long-term opioid therapy has also aged over time, with the mean age increasing from 52.5 to 60.5 years. In addition, there has been a notable shift in insurance coverage, with Medicare emerging as the primary payer by 2023, replacing commercial insurance. These changes highlight evolving prescribing patterns and highlight the need for careful monitoring of combination therapies, particularly in an older population.
Long-term opioid therapy, defined as opioid use for 90 days or more, is commonly prescribed for chronic pain but carries well-documented risks such as misuse, dependence, and overdose. In recent years, regulatory measures and updated clinical guidelines in the US have aimed to curb inappropriate opioid use, contributing to a broader decline in prescribing. However, less is known about how these changes have influenced long-term opioid therapy patterns.
To address this, researchers led by Thuy D. Nguyen from the University of Michigan School of Public Health analysed national prescription data from the IQVIA Longitudinal Prescription Database, which captures the majority of retail pharmacy prescriptions in the US. The study examined opioid prescriptions dispensed between 2012 and 2023, identifying long-term therapy episodes based on duration and frequency of opioid dispensing.
Key Findings:
- The analysis included over 16 million long-term opioid therapy episodes among more than 13 million patients.
- Women constituted the majority of the study population.
- By 2023, patients on long-term opioid therapy accounted for 11.5% of all individuals receiving any opioid prescriptions.
- Despite an overall decline in use, a substantial number of patients continued on long-term opioid therapy.
- The average opioid dosage decreased over time, with reductions in daily morphine milligram equivalents.
- Overall, co-prescribing with other medications increased from 68.5% in 2015 to 72.3% in 2023.
- Co-prescribing with benzodiazepines declined during the study period.
- Co-prescribing with gabapentinoids increased notably.
- Use of stimulants alongside opioids also showed a slight increase.
The authors suggest these trends likely reflect ongoing opioid stewardship efforts and increased awareness of opioid-related risks. However, they raise concerns about the safety of rising polypharmacy, particularly in older adults who are more susceptible to adverse drug events.
The study has limitations, including the absence of detailed clinical data such as prescribing indications, comorbidities, and prescriber characteristics. It also does not capture all opioid prescriptions, including those from Veterans Affairs pharmacies.
Overall, the findings indicate a shift in US prescribing patterns, with fewer patients on long-term opioids but greater exposure to combination therapies. The authors stress the need for continued vigilance to ensure safe prescribing, given that millions still remain on long-term opioid treatment.
Reference:
Nguyen TD, Chua K, Jiao A, Bicket MC, Bohnert A, Lagisetty P. US Trends in Long-Term Opioid Therapy. JAMA. Published online April 08, 2026. doi:10.1001/jama.2026.3241
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