How to Prevent Opioid Dependence

In 2021, more than 80,400 people died from an opioid overdose in the United States. (1) As the nation continues to grapple with the devastating effects of the opioid epidemic, many in the scientific community are looking at ways to prevent addiction before it takes hold.

Physicians are being taught about more conservative prescribing practices and ways to identify patients who are abusing painkillers; states have implemented prescription drug monitoring programs; and the U.S. Drug Enforcement Administration (DEA) is offering events where people can learn about safe disposal of unused medication to avoid abuse. Researchers are also looking into nonaddictive alternatives to opioids for pain relief, such as vaccines.

“When you look at the numbers of overdoses and how many people are affected by these problems, in the United States and outside the United States, what we’re doing now is not sufficient,” says Marco Pravetoni, PhD, a professor in the department of psychiatry and behavioral sciences and director of the Center for Medication Development for Substance Use Disorders and Overdose at the University of Washington in Seattle. “We either have to optimize existing treatments or develop new ways to address the problem.”

Many people who become addicted to opioids first get hooked by taking pain medication prescribed by their doctor or dental clinician.

According to the 2015 National Survey on Drug Use and Health, nearly 92 million U.S. adults — or about 38 percent of the adult population — had taken a legitimately prescribed opioid. (2) Of these people, approximately 11.5 million misused the drugs, and 1.9 million had an opioid use disorder.

In an effort to reverse these numbers, several steps have been taken to help doctors practice more cautious and responsible prescribing of opioid medication.

In 2022, the Centers for Disease Control and Prevention (CDC) published an updated version of the 2016 CDC Clinical Practice Guideline for Prescribing Opioids for Chronic Pain. (3) These standards are meant to help doctors balance the benefits and risks of chronic opioid treatment. The guidelines focus on when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing the risk of opioid use, as well as addressing the potential harms.

The CDC also offers a training module for clinicians and other healthcare providers called Assessing and Addressing Opioid Use Disorder, which summarizes how to discuss the problem with patients and treat opioid use disorder. (4)

The American College of Physicians offers a course, too, called Prescribing Opioids for Chronic Pain, which is available to doctors on its website and provides an overview of the CDC’s guidelines. (5)

A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions.

These databases can help identify patients who may be misusing prescription opioids. Doctors can also use the PDMP to assess patients’ history of controlled substance use before prescribing medication.

The programs were first established as tools for law enforcement officials to oversee the prescribing and dispensing of opioids by medical professionals. The focus has since shifted to center more on the care of the patient and on developing opioid abuse prevention and treatment strategies. (6)

According to the CDC, these measures have been shown to lead to changes in how doctors prescribe opioids, reduced patients’ ability to use multiple healthcare providers to obtain these drugs, and decreased the number of substance abuse treatment admissions. (7)

That said, evidence regarding the effectiveness of PDMPs is mixed. A review published in BMC Health Services Research notes that while PDMP implementation was associated with reduced opioid prescriptions in certain states, including New York and Florida, other states did not show similar results. (8)

And, a StatPearls article published in June 2023 noted that while there’s evidence that PDMPs may slow the rate of increase in opioid misuse, the actual number of cases hasn’t decreased. (9)

Bottom line: There isn’t enough solid evidence yet that PDMPs will have a significant positive impact on opioid misuse and related illnesses and deaths. But, according to the CDC, PDMPs “continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.” (7)

Currently, 49 states, the District of Columbia, and Guam (a U.S. territory) have a PDMP that is operational. A variety of state agencies administer these programs, including state health departments, boards of pharmacy, and law enforcement agencies. (9)

When someone no longer needs their prescription medication, it should be disposed of promptly. This will help reduce the risk of others, including friends and family members, accidentally taking or intentionally misusing the unneeded medicine.

One way to properly dispose of unused opioid medication is to participate in the National Prescription Drug Take Back Day, periodically hosted by the DEA. During these events, temporary collection sites are set up in communities around the country so people can bring their unused or unwanted prescription drugs for safe disposal.

In April 2023 nearly 4,500 law enforcement agencies across the country participated, collecting 332 tons of prescription drugs.

People who miss the date can still bring unneeded medicines to DEA-registered permanent collection sites, which may be located in retail, hospital, and clinic pharmacies and law enforcement facilities in your community. Some authorized collection sites may even offer mail-back programs or collection receptacles to make the process easier for consumers.

To get more information about National Prescription Drug Take Back Day and locate a DEA-registered collection site, visit the DEA’s website. (10)

There are steps people can take to reduce their risk of opioid dependence:

• Communicating with your doctor about any side effects or concerns you have about your medication, as well as any personal or family history with addiction
• Closely following the directions on the label on prescription medication
• Being aware of potential interactions with alcohol and other drugs
• Never using medication from another person’s prescription and never sharing your prescription medication with others for any reason
• Never increasing your dose or taking extra doses on your own
• Never abruptly stopping a dosing regimen without consulting your physician
• Safely storing prescription stimulants, sedatives, and opioids (11) where nobody else can get access to your medication

Scientists are currently looking into the development of effective, nonaddictive pain medication as an alternative to opioids. But, these studies are still in the very early stages, Dr. Pravetoni notes, and have a ways to go before being used in humans.

In the meantime, researchers are also working on novel strategies to prevent opioid abuse and overdose.

While opioid prescription rates have declined in the past several years, a large number of people still remain on long-term opioid therapy and at risk of becoming dependent: An estimated one in four people on long-term opioid therapy have opioid use disorder, according to a study published online in April 2023 in Health Informatics Journal. The study, which used the Veterans Health Administration’s electronic health records data to develop machine-learning predictive models, found that the models were reasonably able to accurately predict opioid use disorder and could be a useful tool for doctors prescribing these medications. (Factors the program looked for included a patient’s age; history of prescriptions including early refills and length of prescription; previous diagnosis of relevant disorders that could increase the risk of developing an opioid addiction; other forms of substance abuse; recreational drug use; alcohol disorder; and mental health disorders, such as anxiety and depression.) (12)

Another study, published in 2023 in The Canadian Journal of Psychiatry, found that researchers were able to predict opioid use disorder with a high degree of accuracy by applying machine learning to large administrative health databases. (13)

Vaccines are being looked at as another potential strategy for treating opioid abuse and preventing overdose. Pravetoni, along with a team of scientists from the University of Minnesota Medical School and Hennepin Healthcare Research Institute, are currently developing experimental vaccines for prescription opioids, such as oxycodone and fentanyl, as well as heroin. (14)

These vaccines work by using the immune system to produce antibodies that target, bind to, and prevent opioids from reaching the brain. Notably, in animal studies, the vaccines appear to help in preventing opioid-induced respiratory depression, a hallmark of a fatal opioid overdose. Pravetoni says preclinical trials in rodents show promising results, and he is planning to begin a clinical trial in humans. He also points out that the vaccines could be used in conjunction with traditional opioid treatments, such as methadone.

Controlled Substance Public Disposal Locations

American Public Health Association: “Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medication”

U.S. Department of Health and Human Services

American Medical Association: Reversing the Opioid Epidemic