Overprescribing Opioids: How It Has Contributed To The Opioid Epidemic

Approximately 80,000 of the 105,000 drug overdose deaths in the United States in 2023 involved opioids, which was also about 76% of all overdose deaths that year.

Opioid overdose deaths fell sharply from 2023 to 2024, dropping from approximately 79,000 to 54,000. This 24% decline was driven largely by decreases in fentanyl-involved deaths. Even so, deaths remain above pre-pandemic levels.

The misuse of opioids has been well-researched now, and the leading causes have changed over the years. It started with overprescribing, then heroin, and has now moved on to synthetic opioids, namely fentanyl.

Although opioid prescribing has decreased significantly and overdose deaths have begun to decline, opioid use disorder and its consequences remain a serious public health crisis.

Why Doctors Prescribe Opioids

In the 1990s and 2000s, many doctors were misled by pharmaceutical companies’ marketing campaigns, which falsely claimed opioids carried a low risk of addiction. This contributed directly to the overprescribing that sparked the epidemic.

Many doctors did not want their patients to suffer or be in pain and were led to believe these painkillers were safe.

The most common reasons someone is prescribed opioids include:

• management of chronic pain (pain management)
• acute pain
• postoperative pain

View a list of opioids from strongest to weakest

How Overprescribing Opioids Contributed To The Opioid Epidemic

Prescribing narcotics at high rates has affected the opioid use disorder epidemic in a number of ways. Some possible causes of this impact include the following.

Influence Of Hospitals And Policymakers

The trend of overprescribing these pain medications was the result of policy changes and reimbursement structures for doctors.

Opioid prescribing practices have changed to include hospital rankings based on patient satisfaction surveys. If these surveys were not positive, the hospital could lose funding. This practice has since been scrutinized and modified. CMS removed pain management questions from HCAHPS scoring in 2018, specifically to reduce incentives for overprescribing opioids.

Surgeons, in particular, have a hard time with these policy changes as the definition of “adequate treatment” of post-surgical pain is not adequately defined.

Healthcare Providers Prescribing A Larger Prescription Than Needed

While this was a significant problem at the epidemic’s peak—opioid prescriptions hit a high of more than 255 million in 2012—prescribing rates have since declined substantially following updated CDC guidelines and stricter oversight.

When someone is overprescribed opioids, it can result in:

• distribution of opioids into communities
• potential opioid misuse and addiction
• possible transition to illicit drug misuse (i.e., illicitly manufactured fentanyl or other street opioids)

Some Doctors Prescribed Opioids To Turn A Profit

Aside from well-meaning doctors who believed the pharmaceutical companies’ false claims, some doctors saw opioids as a way to increase their profits.

They set up opioid “clinics” in strip malls across the country and used the lack of regulation to hand out opioid prescriptions to virtually anyone who walked through their doors.

These are the healthcare professionals who have seen the most regulation since the truth about the addictive nature of opioids was discovered. Beyond individual providers, major pharmaceutical manufacturers and distributors, including Purdue Pharma, Johnson & Johnson, and the three largest U.S. drug distributors, have faced billions of dollars in settlements and legal penalties for their role in the opioid crisis.

OxyContin And Other Opioids Were Overprescribed For Decades

Increased prescribing of opioids like oxycodone led to widespread misuse of prescription and non-prescription opioids before it was clear that these medications were highly addictive.

Consider the following opioid misuse rates related to the opioid epidemic:

• 21 to 29 percent of those prescribed opioids for chronic pain misuse them.
• Eight to 12 percent of individuals using opioids for chronic pain become addicted.
• Four to six percent of people who misuse their opioid prescription transition to illicit opioid use, such as fentanyl.

How Likely Is It To Develop An Opioid Addiction?

The chances someone will develop an opioid use disorder depend on many individual factors, including:

• length of time a person is prescribed to take opioids for acute pain
• the amount of time someone continues to take an opioid medication (whether prescribed or misused)

Updated CDC prescribing guidelines, most recently revised in 2022, now encourage providers to consider non-opioid pain management options before prescribing opioids, and to use the lowest effective dose for the shortest necessary duration when opioids are warranted.

Some of these non-opioid painkillers include:

• ibuprofen
• acetaminophen
• physical therapy
• nerve blocks
• topical analgesics
• cognitive behavioral therapy for chronic pain
• newer options like low-dose naltrexone for certain pain conditions

Getting Help For Opioid Abuse And Addiction

Pain control is possible without an opioid prescription. Call our helpline today for a free substance abuse assessment and to find a rehab center for opioid addiction.

Written by the Addiction Resource Editorial Staff