Prescriptions for opioid analgesics are increasing. Simultaneously, there has been an increase in the prevalence of nonmedical use of these medications by patients and the public, leading to more patients with prescription opioid abuse and dependence. This population-based survey* collected demographic, psychiatric, and substance use data from 42,734 US adults to determine whether nonmedical use of prescription opioids is driven by untreated pain. Respondents were questioned about past-year nonmedical use of prescription opioids and the extent to which pain interfered with their activities of daily living (i.e., low, moderate, high). Primary findings were as follows:

• The past-year rate of nonmedical use of prescription opioids was 1.8%. Twenty percent of these individuals met criteria for opioid abuse/dependence. 
• Pain was positively associated with an increased probability of nonmedical use and prescription opioid abuse/dependence.
• Within each level of pain, the odds of past-year nonmedical use and abuse /dependence were significantly higher for those with unhealthy alcohol use.

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*The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Comments by James Harrison, MHS, CADC
This study helps raise clinician awareness that individuals who meet criteria for opioid abuse/dependence may have untreated pain. Pain and unhealthy alcohol use should be assessed in patients reporting nonmedical use of prescription opioids. This study was limited to adults only; it is not known if link between physical pain and nonmedical prescription analgesic use exists among youth.