Assessment of the Trends in Medical Use and
Misuse of Opioid Analgesics from 2004 to 2011
Authors: Atluri Sairam 
Published: February 2021

Background: The epidemic of medical use and abuse of opioid analgesics is linked to the economic
burden of opioid-related abuse and fatalities in the United States. Multiple studies have estimated
the extent to which prescription opioid analgesics contribute to the national drug abuse problem;
studies also assessing the trends in medical use and abuse of opioid analgesics have confirmed the
relationship between increasing medical use of opioids and increasing fatalities.
The available data is limited until 2002..
Study Design: Retrospective analysis of data from 2004 to 2011 from 2 databases: Automation
of Reports and Consolidated Orders System (ARCOS) for opioid use data and Drug Abuse Warning
Network (DAWN) for drug misuse data.
Objective: To determine the proportion of drug abuse related to opioid analgesics and the various
trends in the medical use and abuse of 8 opioid analgesics commonly used to treat pain: buprenorphine,
codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone.
Methods: The data obtained from DAWN is a nationally representative sample of hospital emergency
department admissions resulting from drug abuse.
Main outcome measure was the identification of trends in the medical use and misuse of opioid
analgesics from 2004 to 2011.
Results: From 2004 to 2011, there was an increase in the medical use of all opioids except for a
20% decrease in codeine. The abuse of all opioids including codeine increased during this period.
Increases in medical use ranged from 2,318% for buprenorphine to 35% for fentanyl, including
140% for hydromorphone, 117% for oxycodone, 73% for hydrocodone, 64% for morphine, and
37% for methadone. The misuse increased 384% for buprenorphine with available data from 2006
to 2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263% for oxycodone,
146% for morphine, 107% for hydrocodone, 104% for fentanyl, 82% for methadone, and 39%
for codeine.
Comparison of opioid use showed an overall increase of 1,448% from 1996 to 2011, with increases if
690% from 1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more dramatically:
4,680% from 1996 to 2011, with increases of 1,372% from 1996 through 2004 and 245% from 2004
to 2011. The number of patients seeking rehabilitation for substance abuse also increased 187% for
opioids, whereas it increased 87% for heroin, 40% for marijuana, and decreased 7% for cocaine.
Limitations: Limitations of this assessment include the lack of data from 2003, lack of data
available on meperidine, and that the aggregate data systems used in the study did not identify
specific formulations or commercial products.
Conclusion: The present trend of continued increase in the medical use of opioid analgesics appears
to contribute to increases in misuse, resulting in multiple health consequences.
Key words: Medical use of opioids, inappropriate use of opioids, abuse of opioids, opioid-related
fatalities, Automation of Reports and Consolidated Orders System (ARCOS), Drug Abuse Warning
Network (DAWN), International Narcotics Control Board (INCB)