Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States

Theodore J. Cicero, Hilary Surratt, James A. Inciardi, Alvaro Munoz

Research output: Contribution to journalArticlepeer-review

166 Scopus citations


Purpose: The goal of these studies was to determine the relationship between prescribed use of opioid analgesics and their non-medically related use (abuse) at a regional level across the country. Methods: To gather information about prescription drug abuse, we asked 233 drug abuse treatment specialists to provide us Quarterly reports on the number of cases of prescription opioid analgesic abusers who used opioid analgesics to get high in the past 30 days. Results and conclusions: We found that there was a very strong correlation between therapeutic exposure to opioid analgesics, as measured by prescriptions filled, and their abuse. There were, however, geographical loci that represented outliers in which abuse was disproportionately high relative to therapeutic use (>95th percentile), most of which were in very small urban, suburban, and rural areas. The rank order of abuse shows that buprenorphine products, extended release (ER) oxycodone and methadone are the most intensely abused prescription opioid analgesics, with hydrocodone the least abused, when the data are corrected for degree of exposure, i.e., cases/ 1000 persons filling a prescription. If, on the other hand, one uses the number of cases/100 000 population, hydrocodone ranked as high as ER oxycodone and all other drugs grouped together at very low levels of abuse. Since the latter conclusion ignores therapeutic exposure, we conclude that the rate of abuse of highly efficacious opioid analgesics is best expressed as cases of abuse/1000 persons filling a prescription, which yields the best possible estimate of the risk-benefit ratio of these drugs.

Original languageEnglish
Pages (from-to)827-840
Number of pages14
JournalPharmacoepidemiology and Drug Safety
Issue number8
StatePublished - Aug 2007

Bibliographical note

Funding Information:
This work was supported by National High Technology R&D Program of China (Grant Nos. 2015AA015403, 2014AA015102), NSFCNatural Science Foundation of China (Grant Nos. 61202233, 61272344, 61370055) and the joint project with IBM Research. Any correspondence please refer to Yansong Feng.


  • Drug abuse
  • Drug diversion
  • Opioid analgesics
  • Post-marketing surveillance
  • Risk management
  • Risk-benefit
  • Therapeutic use and abuse of opioid analgesics

ASJC Scopus subject areas

  • Epidemiology
  • Pharmacology (medical)


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