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

Despite the observed decline, data from 2023 indicate that a substantial population—estimated between four to five million patients—continued to be prescribed long-term opioid therapy. This variation in patient numbers depends on the operational definition of ‘long-term’ opioid use applied in the study. The persistence of such a large cohort underscores the complexity of managing chronic pain amid evolving regulatory and clinical guidelines.

A significant demographic shift has also been documented among patients prescribed these therapies. Over the years, the average age of patients on long-term opioid treatment has increased, with a substantial proportion now being covered under Medicare. This trend highlights an aging population reliant on these medications and points to the necessity of considering age-related physiological changes and comorbidities when evaluating treatment risks and benefits.

The intersection of aging and opioid therapy introduces heightened vulnerability to adverse outcomes, particularly in the context of polypharmacy. Older adults often present with multiple chronic conditions requiring numerous medications, increasing the risk of drug-drug interactions and cumulative side effects. The study draws attention to the growing rates of coprescribing alongside opioids, especially with gabapentinoids, a class of medications frequently used to treat neuropathic pain and other conditions.

The concurrent prescription of opioids with gabapentinoids raises important safety concerns due to their synergistic effects on the central nervous system. Both drug categories can depress respiratory function, which may significantly increase the risk of overdose and mortality. This interaction necessitates vigilant patient monitoring and underscores the importance of integrative prescribing practices that prioritize patient safety.

Opioid stewardship initiatives have played a central role in the decline of long-term opioid use. These programs typically involve comprehensive strategies encompassing provider education, prescription monitoring programs, and updated clinical guidelines aimed at reducing unnecessary opioid exposure and promoting alternative pain management modalities. The effectiveness of such stewardship reflects a successful public health response to the opioid epidemic.

However, the study also cautions against an overly simplistic interpretation of reduced opioid prescribing rates. The persistence of millions of long-term opioid users highlights ongoing challenges, including the need to adequately manage chronic pain and the risks posed by abrupt discontinuation or inadequate pain control. Medical professionals face a delicate balancing act in mitigating risks while providing compassionate and effective care.

Another aspect emerging from the research pertains to insurance coverage dynamics. The fact that Medicare now covers the largest portion of long-term opioid therapy patients brings to the forefront the implications of public insurance policies on medication access, monitoring, and patient outcomes. This shift necessitates policy initiatives that align with clinical best practices to optimize therapy safety in older populations.

The study also frames these findings within the broader social and economic context of healthcare, population aging, and disease management. Understanding prescription patterns in conjunction with demographic trends allows for a more nuanced approach to healthcare resource allocation and patient education efforts. It emphasizes the critical need for tailored interventions that address the unique vulnerabilities of specific patient groups.

In terms of research innovation, this investigation leveraged robust datasets spanning multiple years, enabling an intricate exploration of temporal trends and demographic variables. Such methodological rigor ensures that conclusions drawn are reflective of real-world practices and patient experiences, providing a valuable evidence base for clinical and policy decision-making.

Furthermore, the research underscores the importance of ongoing surveillance of prescription practices and adverse event tracking. As new medications and treatment paradigms emerge, continuous data collection and analysis are indispensable to identify emerging risks and inform timely adjustments in clinical guidelines.

In summary, the study published in JAMA offers an essential update on the state of long-term opioid therapy in the United States, revealing a complex interplay of declining prescription rates, demographic shifts, and safety challenges. It calls for sustained vigilance and multifaceted strategies to improve patient outcomes in an aging population increasingly dependent on chronic opioid treatment.

Subject of Research: Trends and demographic shifts in long-term opioid therapy prescribing in the United States from 2015 to 2023.

Article Title: (doi:10.1001/jama.2026.3241)

News Publication Date: Not specified in the provided content.

Web References: Access to the embargoed study available on the JAMA For The Media website (link not provided).

Keywords: Opioids, Long-term opioid therapy, Opioid stewardship, Polypharmacy, Gabapentinoids, Medicare, Older adults, Chronic pain management, Prescription trends, Patient safety, Adverse events, Drug interactions