Opioid Crisis

Prescription Opioid Abuse vs Illicit Opioid Abuse

By Charles Li MD

February 06, 2019

  • Prescription opioid abuse has attracted significant media attention.

  • Looking forward to 2025, one well-cited projection shows that prescription opioid abuse will in fact decline.

  • Meanwhile, abuse of illicit opioids including heroin and fentanyl is projected to rapidly rise.

Projections of Prescription and Illicit Opioid Abuse

Statistics on Prescription and Illicit Opioid Abuse

Over the past 20 years, most opioid overdoses have been with prescription opioids. These are opioids that were legally obtained from hospitals and pharmacies.

After 2010, illicit opioid overdoses began exponentially rising. These include heroin and illicit fentanyl obtained from the street. In 2014 and 2015, data shows that illicit opioid overdoses had caught up to prescription opioid overdoses. Today, illicit opioid overdoses are responsible for most opioid overdose deaths.

In order to predict future trends, researchers have created and validated a mathematical model to project trends in opioid overdoses up to 2025.

Source: Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

Based on their model, overdoses from illicit opioids are projected to rise from just over 20,000 today to nearly 68,000 per year in 2025.

Meanwhile, prescription opioid overdoses will likely remain at a similar level or decline slightly.

According to this model, stopping prescription opioid abuse today may only slightly slow our growing opioid crisis.

Our biggest issue moving forward will be slowing the growth of illicit opioids manufacturered here or smuggled in from abroad.

Projections of Illicit Opioid Users and Deaths

Chart of Illicit Opioid Abuse and overdose deaths

According to researchers, the overall number of illicit opioid users is projected to rise from 930,000 to 1.5 million. While this rise is certainly significant, it is projected to have a proportionally larger impact on deaths from opioid overdoses.

Researchers predict that deaths from opioid overdoses will more than double from 33,100 in 2015 to 82,000 in 2025.

This shows that illicit opioid use may be far more dangerous and more likely to cause deaths than prescription opioid abuse.

The Rise of Synthetic Opioids

Synthetic Opioids vs Heroin and other illicit drugs

Behind this rise in illicit opioid abuse is the unprecendented and exponential increase in synthetic opioid use. Synthetic opioids such as fentanyl are chemicals synthesized in laboratories to be 100x or 1000x more powerful than morphine.

These were initally developed for medical purposes, but have since been manufactured illicitly as well.

Their potency allows for significant doses to be easily smuggled and sold. The vast differences in potency between these different drugs also contribute to the risk of accidental overdoses.

According to data from the National Institute on Drug Abuse, these synthetic opioids cause more overdoses than any other drug and continue to rise faster as well.

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