What are the risk factors for misusing prescription opioids?

Understand how prescription opioid abuse may lead users to seek and take illicit drugs to deal with their resulting opioid dependency.

Ophelia team
Prescription vs. illicit opioids
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Arthur Robin Williams, MD

Opioids are involved in the majority of overdose deaths in the United States. Though people often assume overdose deaths are tied to illicit drugs, prescription opioids also contribute to these outcomes—both directly and indirectly. 

Prescription opioid abuse may lead users to seek and take illicit drugs to deal with their resulting opioid dependency. After all, just because a doctor must prescribe opioids for relief, it does not mean that these drugs are risk-free. Using prescription opioids can lead to a high risk of misusing the drugs and developing a dependency. When the prescription runs out, some patients may turn to illicit opioids to meet their body’s need for the medication. This dangerous progression unfortunately affects many people who are prescribed opioids. 

Prevalence of prescription opioids

Doctors prescribe opioids to treat moderate to severe pain, often after a patient undergoes surgery or sustains a severe injury. Common prescription opioids include hydrocodone (Vicodin), morphine (Kadian), oxycodone (OxyContin, Percocet), and hydromorphone (Dilaudid). 

Though the average opioid dispensing rate dropped between 2012 and 2020, dispensing rates remain high, particularly in certain parts of the country. The overall dispensing rate in 2020 was 43.3 opioid prescriptions per 100 persons in the United States, totaling over 142 million prescriptions. In some counties, however, this dispensing rate was as high as 390 prescriptions per 100 people. According to the 2020 data, Louisiana, Mississippi, Alabama, Tennessee, and Kentucky have the highest dispensing rates in the U.S. 

Risk factors for misuse of prescription opioids

Prescription opioid abuse occurs when a person consumes the opioid to experience the euphoric effects rather than find pain relief, which is how the doctor who prescribed the drug intended for it to be used. Signs of misuse and prescription opioid addiction include:

  • Taking someone else’s prescription opioids
  • Using a different ingestion method than prescribed
  • Taking a larger dose   

Anyone taking prescription opioids is at some risk for misuse, but this risk is not equal from person to person. The following are risk factors for the misuse of prescription opioids:

  • Past or current substance abuse
  • Family history of substance abuse
  • Younger (18 to 25 years old) or older (65 years old and above)
  • Stressful environment
  • Poverty
  • Unemployment
  • Regular exposure to high-risk environments or individuals
  • History of depression or anxiety
  • Untreated mental illness

None of these risk factors guarantee that a person will misuse prescription opioids. Instead, when one or more of these risk factors are present, the patient is more likely to become dependent on prescription opioids, possibly leading to illicit drug use. 

The dose and duration of the opioid prescription can also play a key role in whether the patient misuses opioids. In general, higher-dose opioids create a higher risk of misuse. Doses above 100 morphine milligram equivalents (MME) create a risk of misuse that’s two times higher relative to lower opioid doses. Similarly, prolonged opioid use carries a greater risk of misuse. 

From prescription opioids to illicit drugs

If a patient becomes dependent on opioids during their prescribed regimen, they’ll often look for an alternative source of the drug after their prescription ends. Without a prescription, they may turn to illicit opioids to meet their dependency on the drug.

This path from prescription opioid use to illicit drug use is not unusual. In a survey of people abusing opioids in the 2000s, 75% said that the first opioids they used were prescription opioids. For comparison, 80% of those abusing opioids in the 1960s started with heroin. Even as the overall opioid dispensing rate has decreased in recent decades, overdose deaths related to prescription opioid addiction have not decreased. The Food and Drug Administration recently updated prescribing guidelines to reduce unnecessary opioid prescriptions. 

Preventing the transition from prescription opioid use to illicit drug use is key to preventing opioid deaths. When patients move from misusing prescription opioids to using illegal drugs, they encounter an even greater risk of overdose, and even death. 

Illicit opioids may be laced with dangerous contaminants or mislabeled, making it challenging to take a safe dose. For example, illicit drug dealers sometimes lace drugs with fentanyl—an incredibly potent opioid—thus creating a much higher risk of overdose, especially if the person using the drugs does not know the fentanyl content. 

Kratom as an alternative to drugs

Kratom is a legal herbal substance derived from the leaves of a tree found in Southeast Asia and parts of Africa. The leaves have been used as a form of traditional medicine, leading some in the Western world to consider a viable alternative to opioids. Although kratom is legal in the U.S., it’s not well-researched or well-regulated, meaning there are a lot of questions about its safety and efficacy. But that hasn’t stopped people from using it to self-medicate. In one survey of kratom users, more than 90% of those who used kratom as an opioid alternative reported that it helped reduce pain, opioid use, and withdrawal symptoms. 

However, using kratom comes with its own risks. Additional research discovered that people who took kratom for over six months went through withdrawal symptoms similar to opioid withdrawal. Overdosing on kratom is another risk. At least 36 people's deaths were related to kratom use. Before trying any alternative to opioids, it’s wise to discuss options with a knowledgeable healthcare provider or a trusted opioid dependency agency. 

Comprehensive solutions for opioid dependency

Rather than turning to potentially dangerous opioid alternatives, contact Ophelia for private, individual care. Our clinicians get to know your unique circumstances to develop the right treatment plan, including Suboxone® (important safety information) or another buprenorphine-naloxone medication and virtual meetings with your care team. All the support you need, right from the comfort of your home. Schedule a consultation call with our care team today to find out if you’re eligible.


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