In the evolving landscape of pain management in the United States, a recent comprehensive analysis led by researchers from the University of Michigan unveils a nuanced transformation in long-term opioid prescribing patterns over the past decade. Published in the prestigious journal JAMA, this research letter meticulously examines trends from 2015 to 2023, revealing both progress and persistent challenges in the chronic use of opioids for pain therapy.
Utilizing the expansive scope of IQVIA’s Longitudinal Prescription Database—which encompasses 92% of retail pharmacy prescriptions across the U.S.—the researchers established a stringent definition for long-term opioid therapy. This was characterized by opioid dispensing lasting 90 days or more, accompanied by either a cumulative medication supply exceeding 120 days or multiple opioid dispensations within a critical 180-day window from the initial prescription. Through this lens, the team monitored shifts in patient populations and prescribing behaviors, yielding crucial insights into the opioids crisis’s trajectory.
The data exposed a significant yet incomplete decline in long-term opioid therapy episodes. From a peak of approximately 5.6 million patients engaged in sustained opioid use in 2015, this figure diminished by nearly one-quarter, settling at around 4.2 million in 2023. Despite this progress, individuals receiving long-term opioid therapy still comprised over 11% of all patients with any opioid prescription in 2023, underscoring the therapy’s entrenched use. An alternative analytic approach reinforced these findings, illustrating a drop from 7.3 million long-term users in 2015 to 5.2 million in 2023.
Beyond raw numbers, the study highlights a profound demographic shift within the population reliant on long-term opioid therapy. The average age of patients increased notably, from 52.5 years in 2015 to 60.5 years in 2023, pointing to an aging cohort managing persistent pain conditions. Concurrently, Medicare emerged as the predominant payer, financing nearly half (48.7%) of long-term opioid therapy episodes by the study’s end period, reflecting the therapy’s increased prevalence among older Americans and raising questions about the implications for public health systems.
Intriguingly, the prescribed opioid dosages underwent a measurable reduction. Expressed in morphine milligram equivalents (MME), the average daily dose decreased from 47.9 MME in 2015 to 38.6 MME in 2023. This attenuation indicates heightened prescriber awareness and possibly adherence to emerging guidelines advocating for minimized opioid exposure to reduce dependency risks. Nevertheless, the persistence of substantial opioid doses continues to pose overdose and addiction hazards, demanding ongoing vigilance.
The dynamic of co-prescribing—simultaneous prescriptions of opioids with other controlled substances—also evolved. Notably, co-prescriptions involving benzodiazepines, a class associated with heightened respiratory depression risk when combined with opioids, declined substantially from 43.8% to 33.5%. Conversely, co-prescription with gabapentinoids, drugs often used to address neuropathic pain, grew from 47% to 58.7%, while stimulant co-prescribing modestly increased from 5.9% to 6.7%. This pattern signals shifts in clinical strategies for managing complex pain profiles and comorbid conditions.
These intertwined trends reflect an ongoing reconciliation between the benefits and risks of opioid therapy in chronic pain management. As Thuy Nguyen, the study’s lead author and an assistant professor of Health Management and Policy at the U-M School of Public Health, emphasized, the reality that nearly one in nine opioid users remain chronic consumers highlights the imperative for evidence-based chronic pain management protocols. Such protocols must strike a delicate balance—ameliorating pain while mitigating addiction and overdose risk.
Senior author Pooja Lagisetty, an associate professor of Internal Medicine at the University of Michigan Medical School, underscored the pressing need for robust, innovative treatment paradigms. With almost five million Americans on long-term opioid regimens—alongside many others undergoing shorter-term prescriptions—healthcare providers face daily challenges requiring nuanced pain assessment and personalized therapeutic plans that prioritize safety and efficacy.
However, the study also acknowledges intrinsic limitations. Its reliance on pharmacy dispensing data precludes insight into the clinical indications driving opioid prescribing, the nuanced health profiles of patients including comorbidities, and characteristics of the prescribers themselves. Crucially, dispensing records cannot confirm actual patient adherence or medication consumption, meaning the observed trends may not fully represent patient behaviors or outcomes.
Despite these constraints, the study delivers a compelling portrait of opioid therapy’s evolving role in American healthcare. The sustained prevalence of long-term opioid use, even amidst reductions, underscores an urgent need for policy and clinical innovation. Efforts must coalesce around safer prescribing practices, vigilant patient monitoring, and expanded access to multimodal pain management strategies that reduce reliance on opioids without compromising quality of life.
In sum, this research furnishes critical, data-driven insights necessary for informing policymakers, clinicians, and public health stakeholders committed to curbing the opioid epidemic while addressing the complex realities of chronic pain. As the opioid landscape continues to shift, an emphasis on integrated, evidence-based approaches remains paramount to safeguard patients and communities alike.
Subject of Research: Long-term opioid therapy trends and prescribing patterns in the United States
Article Title: US Trends in Long-Term Opioid Therapy
News Publication Date: 8-Apr-2026
Web References:
https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.3241
References:
Chua, K.-P., Jiao, A., Bicket, M., Bohnert, A., Nguyen, T., & Lagisetty, P. (2026). US Trends in Long-Term Opioid Therapy. JAMA. https://doi.org/10.1001/jama.2026.3241
Keywords: Opioids, Long-term opioid therapy, Chronic pain, Pain management, Prescription trends, Medicare, Co-prescribing, Benzodiazepines, Gabapentinoids, Stimulants, Health policy, Public health
