NCHS Data Brief ■ No. 189 ■ February 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prescription Opioid Analgesic Use Among Adults:

United States, 1999–2012

Steven M. Frenk, Ph.D.; Kathryn S. Porter, M.D., M.S.; and Leonard J. Paulozzi, M.D., M.P.H.

Key findings 

Data from the National 

Health and Nutrition 

Examination Survey

● From 1999–2002 to 2003–

2006, the percentage of adults 

aged 20 and over who used a 

prescription opioid analgesic in 

the past 30 days increased from 

5.0% to 6.9%. From 2003–2006 

to 2011–2012, the percentage 

who used an opioid analgesic 

remained stable at 6.9%.

● From 1999–2002 to 2011–

2012, the percentage of opioid 

analgesic users who used an 

opioid analgesic stronger than 

morphine increased from 17.0% 

to 37.0%. 

● During 2007–2012, the use 

of opioid analgesics was higher 

among women (7.2%) than men 

(6.3%).

● During 2007–2012, the use 

of opioid analgesics was higher 

among non-Hispanic white 

adults (7.5%) compared with 

Hispanic adults (4.9%). There 

was no significant difference 

in use between non-Hispanic 

white adults and non-Hispanic 

black adults (6.5%).

Prescription opioid analgesics are used to treat pain from surgery, injury, and 

health conditions such as cancer. Opioid dependence and opioid-related deaths 

are growing public health problems. Opioid analgesic sales (in kilograms per 

10,000) quadrupled from 1999 to 2010 (1), and from 1999 to 2012,

opioid-related deaths (per 100,000) more than tripled (2). During 1999–2002, 

4.2% of persons aged 18 and over used a prescription opioid analgesic in 

the past 30 days (3). This report provides updated estimates and trends in 

prescription opioid analgesic use among adults aged 20 and over, overall and 

by selected subgroups.

Keywords: pain • medication • National Health and Nutrition Examination 

Survey (NHANES) 

During 2011–2012, what percentage of adults used a 

prescription opioid analgesic? Has the percentage changed 

since 1999–2002?

In 2011–2012, 6.9% of adults aged 20 and over reported using a prescription 

opioid analgesic in the past 30 days (Figure 1). A significant increase in the 

0

2

4

6

8

1999–2002 2003–2006 2007–2010 2011–2012

Figure 1. Trend in prescription opioid analgesic use in the past 30 days among adults aged 20 and 

over: United States, 1999–2012 Percent

5.0

6.9 1

6.9

1

Significantly higher than 1999–2002.

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db189_table.pdf#1. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2012.

6.7

Survey years
NCHS Data Brief ■ No. 189 ■ February 2015

■  2  ■

use of opioid analgesics was observed between 1999–2002 and 2003–2006, from 5.0% to 6.9%. 

Since 2003–2006, the percentage of adults using opioid analgesics has remained stable. 

Among adults who used a prescription opioid analgesic during 2011–2012, 

what percentages used opioids weaker than, equivalent to, or stronger than 

morphine? Have these rates changed since 1999–2002? 

In 2011–2012, 37.0% of opioid users used an opioid stronger than morphine in the past 30 days; 

20.0% of opioid users used only a weaker-than-morphine opioid. For 43.0% of opioid users, the 

strongest opioid used was a morphine-equivalent strength opioid (Figure 2).

The percentage who used only a weaker-than-morphine opioid in the past 30 days declined from 

42.4% in 1999–2002 to 20.0% in 2011–2012, while the percentage who used a stronger-thanmorphine opioid significantly increased from 17.0% in 1999–2002 to 37.0% in 2011–2012.

0

10

20

30

40

50

60

1999–2002 2003–2006 2007–2010 2011–2012

Percent

Weaker than morphine

Morphine-equivalent

Stronger than morphine

Figure 2. Trends in the use of different strength opioid analgesics among adults aged 20 and over who used opioids in the 

past 30 days: United States, 1999–2012

1

Significant linear trend for use of stronger-than-morphine opioid analgesics.

2

Significant linear trend for use of weaker-than-morphine opioid analgesics.

NOTES: Respondents who reported using two or more opioid analgesics of different strengths were categorized based on the strongest opioid analgesic reported. 

Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db189_table.pdf#2. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 1999–2012.

42.4

40.6

17.0

45.9

36.7

17.4

51.2

26.5

22.4

43.0

1

37.0

2

20.0

Survey years
NCHS Data Brief ■ No. 189 ■ February 2015

■  3  ■

Did prescription opioid analgesic use vary by population subgroup? 

The rate of opioid analgesic use was higher among older adults (8.1% for those aged 40–59; 7.9% 

for those aged 60 and over) than among younger adults (4.7% for those aged 20–39) (Figure 3). 

The use of opioid analgesics was higher among women (7.2%) than men (6.3%). No significant 

difference in use was observed between non-Hispanic white (7.5%) and non-Hispanic black 

adults (6.5%). However, use of opioid analgesics was lower among Hispanic adults (4.9%) 

compared with non-Hispanic white and non-Hispanic black adults. 

0

2

4

6

8

10

Non- Hispanic

Hispanic

black

NonHispanic

white

60 and Men Women

over

20–39 40–59

Percent

4.7

1

8.1 1

7.9

2

7.2 7.5

6.3 6.5

3,44.9

Figure 3. Prescription opioid analgesic use in the past 30 days among adults aged 20 and over, by age, sex, and race and 

Hispanic origin: United States, 2007–2012

1

Significantly higher than adults aged 20–39.

2

Significantly higher than men.

3

Significantly lower than non-Hispanic white adults.

4

Significantly lower than non-Hispanic black adults.

5

Estimates were age-adjusted by the direct method to the 2000 U.S. census population using age groups 20–39, 40–59, and 60 and over. 

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db189_table.pdf#3.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Race and Hispanic origin Age group Sex 5
NCHS Data Brief ■ No. 189 ■ February 2015

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Did use of prescription opioid analgesics vary by age among men and 

women? 

Men aged 20–39 were less likely to use opioid analgesics (4.2%) compared with men aged 40–59 

(8.1%) or 60 and over (6.9%) (Figure 4). Women aged 20–39 also were less likely (5.2%) than 

those aged 40–59 (8.0%) or 60 and over (8.6%) to use opioid analgesics. Women aged 60 and 

over were more likely to use opioids (8.6%) than men aged 60 and over (6.9%). For the other age 

groups, no significant differences in the use of opioids were observed between men and women. 

0

2

4

6

8

10

20–39 40–59 60 and over 20–39 40–59 60 and over

Percent

4.2

1

8.1

5.2

2

8.0

1

6.9

2,38.6

Figure 4. Prescription opioid analgesic use in the past 30 days among adults aged 20 and over, by sex and age:

United States, 2007–2012

1

Significantly higher than men aged 20–39.

2

Significantly higher than women aged 20–39.

3

Significantly higher than men aged 60 and over.

NOTE: Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db189_table.pdf#4. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Men Women
NCHS Data Brief ■ No. 189 ■ February 2015

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Did use of prescription opioid analgesics vary by race and Hispanic origin 

among men and women? 

Non-Hispanic white men were more likely to use opioid analgesics (7.3%) than non-Hispanic 

black (5.7%) and Hispanic men (4.1%) (Figure 5). Non-Hispanic black men were more likely 

to use opioid analgesics than Hispanic men. Non-Hispanic white women were more likely to 

use opioid analgesics (7.8%) than Hispanic women (5.7%). No significant difference in the use 

of opioid analgesics was observed between non-Hispanic white (7.8%) and non-Hispanic black 

women (7.1%). Hispanic women were more likely to use opioid analgesics (5.7%) than Hispanic 

men (4.1%). For the other race and Hispanic origin groups, no significant differences were 

observed between men and women.

0

2

4

6

8

10

Non- Hispanic

Hispanic

black

NonHispanic

white

Non- Hispanic

Hispanic

black

NonHispanic

white

Percent

7.3

1

5.7

7.8

7.1

1,24.1

3,45.7

Figure 5. Prescription opioid analgesic use in the past 30 days among adults aged 20 and over, by sex and race and 

Hispanic origin: United States, 2007–2012

1

Significantly lower than non-Hispanic white men.

2

Significantly lower than non-Hispanic black men.

3

Significantly lower than non-Hispanic white women.

4

Significantly higher than Hispanic men. 

NOTES: Estimates were age-adjusted by the direct method to the 2000 U.S. census population using age groups 20–39, 40–59, and 60 and over. Access data 

table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db189_table.pdf#5.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Men Women

Summary

The percentage of adults aged 20 and over who used a prescription opioid analgesic in the past 30 

days significantly increased from 5.0% in 1999–2002 to 6.9% in 2003–2006, and then remained 

stable through 2011–2012 (6.9%). Together with findings from the third National Health and 

Nutrition Examination Survey (1988–1994), these findings indicate that the use of opioid 

analgesics among U.S. adults has more than doubled since 1988–1994, when 3.4% used opioid 

analgesics (4). 

Among adults who used opioids during 1999–2012, the percentage of adults who used only a 

weaker-than-morphine opioid analgesic declined from 42.4% to 20.0%, while the percentage of 

adults who used a stronger-than-morphine opioid increased from 17.0% to 37.0%. 
NCHS Data Brief ■ No. 189 ■ February 2015

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Use of opioid analgesics varied significantly among population subgroups. Older adults (aged 40–

59 and 60 and over) were more likely to use opioid analgesics than adults aged 20–39. Women 

were more likely to use opioid analgesics than men, and non-Hispanic white adults were more 

likely to use opioid analgesics than Hispanic adults. There was no significant difference in the use 

of opioid analgesics between non-Hispanic white and non-Hispanic black adults. Women aged 60 

and over were more likely to use opioid analgesics than men aged 60 and over. 

Definitions

Prescription medication use: Survey participants were asked if they had taken a prescription 

medication in the past 30 days. Those who answered “yes” were asked to show the interviewer 

the medication containers of all prescription medications. For each drug reported, the interviewer 

recorded the product’s complete name from the container (5). Prescription medications were 

classified based on the therapeutic classification scheme of Cerner Multum’s Lexicon (6). 

Information on dosage was not collected. Information on whether the medication had been 

prescribed to the respondent was not collected. Respondents were not asked whether they used 

the medication for the prescribed use or for nonmedical reasons.

Opioid analgesics: Opioid analgesics were identified using the Multum ingredient category codes 

60 (narcotic analgesics) and 191 (narcotic analgesic combinations). Two drugs, buprenorphine 

(primarily used to treat opioid addiction) and opium (typically not prescribed for pain), were 

excluded. These categories included a small number of opioid drugs typically used for cough and 

colds rather than pain. These drugs accounted for about 4% of all opioids reported. Nine opioid 

analgesics with the ingredient category code 59 (miscellaneous analgesics) were also included. 

Opioid strength: Prescription opioid analgesics were categorized based on their strength relative 

to morphine (7). Respondents who reported using two or more opioid analgesics of different 

strengths were categorized based on the strongest opioid analgesic they used. About 11% of 

respondents reported using two or more opioid analgesics in the past 30 days. 

Weaker-than-morphine opioid analgesics: Includes codeine, dihydrocodeine, meperidine, 

 pentazocine, propoxyphene, and tramadol. 

Morphine-equivalent opioid analgesics: Includes hydrocodone, morphine, and tapentadol. 

Stronger-than-morphine opioid analgesics: Includes fentanyl, hydromorphone, 

 methadone, oxycodone, and oxymorphone. 
NCHS Data Brief ■ No. 189 ■ February 2015

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Data source and methods

NHANES is a cross-sectional survey designed to monitor the health and nutritional status of 

the civilian noninstitutionalized U.S. population (8). It is conducted by the Centers for Disease 

Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). Data from 

NHANES 1999–2002 through 2011–2012 were used for trend analysis. The three most recent 

cycles (2007–2008, 2009–2010, and 2011–2012) were used to examine the use of opioid 

analgesics among population subgroups.

A complex, multistage probability sampling design was used to generate a representative sample 

of the civilian noninstitutionalized U.S. population (9).

Interview sample weights, accounting for the differential probabilities of selection, nonresponse, 

and noncoverage, were used for analyses. Variance estimates accounted for the complex survey 

design using Taylor series linearization. Estimates for the race and Hispanic origin subpopulations 

were age-adjusted by the direct method to the 2000 U.S. census population, using age groups 

20–39, 40–59, and 60 and over (10). Orthogonal contrast matrices generated using the Stata 

command “_contrast_” (adjusted for the uneven midpoints of the time periods used in the analysis 

[three 4-year periods and one 2-year period]) were used to test for the presence of linear trends. 

For all tests, a significance level of 0.05 was used. All differences reported are statistically 

significant unless otherwise indicated. Statistical analyses were conducted using the SVY

commands in Stata 12.1 (11).

About the authors

Steven M. Frenk and Kathryn S. Porter are with CDC’s National Center for Health Statistics, 

Division of Health and Nutrition Examination Surveys. Leonard J. Paulozzi is with CDC’s 

National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. 

References

1. CDC. Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999–

2008. MMWR 60(43):1487–92. 2011.

2. Warner M, Hedegaard H, Chen LH. Trends in drug-poisoning deaths involving opioid 

analgesics and heroin: United States, 1999–2012. NCHS health e-stats. 2014. Available from: 

http://www.cdc.gov/nchs/data/hestat/drug_poisoning/drug_poisoning_deaths_1999-2012.pdf.

3. NCHS. Health, United States, 2006: With chartbook on trends in the health of Americans. 

Hyattsville, MD: 2006. Available from: http://www.cdc.gov/nchs/data/hus/hus06.pdf.

4. Paulose-Ram R, Hirsch R, Dillon C, Losonczy K, Cooper M, Ostchega Y. Prescription 

and non-prescription analgesic use among the U.S. adult population: Results from the third 

National Health and Nutrition Examination Survey (NHANES III). Pharmacoepidemiol Drug Saf 

12(4):315–26. 2003.

5. NCHS. National Health and Nutrition Examination Survey, 2011–2012 data documentation, 

codebook, and frequencies: Prescription medications. 2014. Available from: 

http://wwwn.cdc.gov/nchs/nhanes/2011-2012/RXQ_RX_G.htm.
NCHS Data Brief ■ No. 189 ■ February 2015

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS 

PERMIT NO. G-284

6. NCHS. National Health and Nutrition Examination Survey, 1988–2010 

data documentation, codebook, and frequencies: Prescription medications—

drug information. 2012. Available from:

http://www.cdc.gov/nchs/nhanes/nhanes1999-2000/RXQ_DRUG.htm.

7. Von Korff M, Saunders K, Thomas Ray G, Boudreau D, Campbell C, 

Merrill J, et al. De facto long-term opioid therapy for noncancer pain. Clin J 

Pain 24(6):521–7. 2008.

8. NCHS. About the National Health and Nutrition Examination Survey. 

Available from: http://www.cdc.gov/nchs/nhanes/about_nhanes.htm.

9. Curtin LR, Mohadjer LK, Dohrmann SM, et al. National Health and 

Nutrition Examination Survey: Sample design, 2007–2010. National Center 

for Health Statistics. Vital Health Stat 2(160). 2013.

10. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected 

U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, MD: 

National Center for Health Statistics. 2001.

11. StataCorp. Stata Statistical Software (Release 12) [computer software]. 

2011.

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Suggested citation

Frenk SM, Porter KS, Paulozzi LJ. 

Prescription opioid analgesic use among 

adults: United States, 1999–2012. NCHS 

data brief, no 189. Hyattsville, MD: National 

Center for Health Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science 

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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