Study: Long-term opioid prescribing fell, but millions still receive extended opioid therapy
In 2023, about 4.2 million U.S. patients had an active long-term opioid therapy episode, according to a JAMA research letter led by University of Michigan researchers
University of Michigan School of Public Health
ANN ARBOR, Mich. — Long-term opioid prescribing has fallen in the United States over the last decade, but millions of patients still received opioids for 90 days or longer in 2023, according to a new research letter in JAMA led by University of Michigan researchers.
The team analyzed U.S. trends in long-term opioid therapy, a pattern of opioid dispensing often used for chronic pain but associated with risks, including overdose and addiction.
Using IQVIA’s Longitudinal Prescription Database, which captures 92% of U.S. retail pharmacy prescriptions, researchers defined a long-term opioid therapy episode as opioid dispensing that lasted 90 days or longer with either a medication supply of 120+ days or opioid dispensing 10+ within 180 days of an initial prescription. They examined changes from 2015 through 2023 in the number of patients receiving long-term opioid therapy and in key characteristics of those patients.
Between 2015 and 2023, the number of patients with an active long-term opioid therapy episode declined from about 5.6 million to about 4.2 million — a 24.3% decrease. In 2023, patients with long-term opioid therapy episodes accounted for 11.5% of all patients with any opioid episode, the authors reported.
A sensitivity analysis using an alternate definition also showed a decline, from 7.3 million patients in 2015 to 5.2 million in 2023.
Patients were older, with more Medicare coverage
The study found a shift in who was receiving long-term opioid therapy over time. The average patient age increased from 52.5 in 2015 to 60.5 in 2023, and Medicare coverage rose from 38.8% of long-term opioid therapy episodes in 2015 to 48.7% in 2023, making it the largest payer.
Average daily dose, measured in morphine milligram equivalents, declined from 47.9 in 2015 to 38.6 in 2023, according to the analysis.
Co-prescribing patterns changed
The researchers also examined co-prescribing, or overlapping prescriptions for other common controlled substances among patients receiving long-term opioid therapy.
Co-prescribing with benzodiazepines declined from 43.8% in 2015 to 33.5% in 2023. Over the same period, co-prescribing with gabapentinoids rose from 47% to 58.7%, and co-prescribing with stimulants rose from 5.9% to 6.7%.
“Nearly 1 in 9 patients receiving prescription opioids were still chronic opioid users in 2023, highlighting the importance of developing and implementing evidence-based guidelines for chronic pain management,” said Thuy Nguyen, assistant professor of Health Management and Policy at the U-M School of Public Health and the paper’s first author.
Why it matters and what the study could not measure
Pooja Lagisetty, the paper’s senior author and associate professor of Internal Medicine at the University of Michigan Medical School, says the data highlights the pressing need to develop improved treatment models for pain.
“With almost 5 million Americans on long-term prescription opioids for chronic pain, and likely millions more who are taking shorter courses of prescription opioids for acute pain, most clinicians are likely to care for someone using prescription opioids for pain highlighting the pressing importance for investing in better treatment models for pain.”
The authors noted that the analysis was based on prescription dispensing data and did not include details such as prescribing indications, patient comorbidities or prescriber characteristics. The data also could not confirm whether patients took medications as dispensed.
Even so, the findings suggest that long-term opioid therapy remains common in the U.S., underscoring the need for continued attention to safer prescribing, careful monitoring and access to effective pain management options.
Additional Authors: Kao-Ping Chua, Amy Jiao, Mark Bicket, and Amy Bohnert; all of the University of Michigan
This study was partially funded by the National Institute on Drug Abuse, part of the National Institutes of Health (R01DA056438 and R01DA057943). This content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.
Paper cited: “US Trends in Long-Term Opioid Therapy.” JAMA. DOI: 10.1001/jama.2026.3241
Journal
JAMA
Article Title
US Trends in Long-Term Opioid Therapy
Article Publication Date
8-Apr-2026
Reported 2025 drug overdose ‘spike’ was an illusion, new study finds
Findings address speculation CDC drug overdose data are ‘being cooked. They’re not,’ author says
Northwestern University
- A January 2025 CDC report indicating an escalation in overdose deaths reflected a statistical artifact from modeling lagged data, not a true increase or data manipulation
- Surveillance systems must adapt to rapid shifts in drug overdose epidemic dynamics
CHICAGO --- Last June, several mainstream media outlets reported a surge in U.S. drug overdose deaths in early 2025 that was based on data from the U.S. Centers for Disease Control and Prevention (CDC).
A new Northwestern University study has found that surge was not real, and the apparent spike was a statistical modeling artifact, not a true reversal in overdose trends. In fact, the study found overdose deaths have continued to decline following a peak in August 2023, marking the longest sustained decrease in more than four decades.
The findings directly address speculation that the CDC made data reporting errors or intentionally mischaracterized or concealed public health data due to political pressure or interference, said lead author Lori Ann Post.
“Many people think CDC drug overdose data are being cooked, but they’re not,” said Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine. “We can trust them because they’re scientists trying to do the best job they can with difficult circumstances. There was no clear incentive for any administration to inflate these numbers. This was not politics.”
The study was published today (April 8) in the American Journal of Public Health.
What happened?
To prepare the June 2025 report, CDC scientists used data from prior years (2022 and 2023) when there was a massive acceleration of drug overdose deaths, Post said. Because of that, provisional federal data suggested overdose deaths had risen sharply in January 2025, prompting national concern and media coverage.
“That spike made headlines at the time, but it didn’t reflect reality,” Post said “What we found was a mismatch between predictive models and a rapidly changing epidemic. CDC scientists did the best job they could with fewer people, more constraints and more people watching them.”
Subsequent revisions to federal estimates corrected the overestimate and confirmed that overdose deaths had continued to fall, Post said.
The U.S. relies on provisional mortality estimates from the National Center for Health Statistics, which uses statistical models to account for reporting delays in death investigations. These models performed well for years but struggled when overdose deaths began declining after a prolonged period of rapid growth, Post said.
The study authors emphasize the episode highlights a broader issue: surveillance systems are most vulnerable during turning points, when trends shift direction.
Why it matters
Accurate data are essential for public health response. Misinterpreting trends can misdirect policy decisions, undermine public trust and distort resource allocation, Post said.
Despite this episode, the researchers stress that federal mortality data remain the most reliable near real-time source for tracking overdose death.
Why the models broke
The overdose crisis has been reshaped by fentanyl, a synthetic opioid that spread unevenly across the country and drove rapid increases in deaths through 2022 and 2023.
Models trained on that explosive growth were later applied to a period of decline. The result:
- Overestimation of deaths in early 2024 and 2025
- False signals of a national “spike”
- Confusion among policymakers, researchers and the public
Looking ahead
The authors call for greater transparency in federal data systems, including advance notice of methodological changes and clear documentation of revisions.
“When the numbers change, people notice,” Post said. “We need to make sure they understand why.”
More about the study
The scientists used Northwestern’s national, regional and state dashboard, the OD Pulse, which is designed to track drug overdose deaths between January 1999 to April 2025, with unprecedented timeliness and precision. They analyzed national overdose death data from 2015 through early 2025, comparing observed counts with multiple versions of federal predictive estimates.
The paper is titled, “The 2025 Drug Overdose Spike That Wasn’t: Neither Politics nor Data Errors Explain the Anomaly.” Co-authors include researchers from University of California, San Francisco, University of Maryland, Baltimore, and University of North Carolina at Chapel Hill.
Journal
American Journal of Public Health
Article Title
The 2025 Drug Overdose Spike That Wasn’t: Neither Politics nor Data Errors Explain the Anomaly
Article Publication Date
8-Apr-2026
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