ANN ARBOR, Mich. — Long-term opioid prescribing has fallen in the United States over the last decade, but millions of patients still received opioids for 90 days or longer in 2023, according to a new research letter in JAMA led by University of Michigan researchers.
The team analyzed U.S. trends in long-term opioid therapy, a pattern of opioid dispensing often used for chronic pain but associated with risks, including overdose and addiction.
Using IQVIA’s Longitudinal Prescription Database, which captures 92% of U.S. retail pharmacy prescriptions, researchers defined a long-term opioid therapy episode as opioid dispensing that lasted 90 days or longer with either a medication supply of 120+ days or opioid dispensing 10+ within 180 days of an initial prescription. They examined changes from 2015 through 2023 in the number of patients receiving long-term opioid therapy and in key characteristics of those patients.
Between 2015 and 2023, the number of patients with an active long-term opioid therapy episode declined from about 5.6 million to about 4.2 million — a 24.3% decrease. In 2023, patients with long-term opioid therapy episodes accounted for 11.5% of all patients with any opioid episode, the authors reported.
A sensitivity analysis using an alternate definition also showed a decline, from 7.3 million patients in 2015 to 5.2 million in 2023.
The study found a shift in who was receiving long-term opioid therapy over time. The average patient age increased from 52.5 in 2015 to 60.5 in 2023, and Medicare coverage rose from 38.8% of long-term opioid therapy episodes in 2015 to 48.7% in 2023, making it the largest payer.
Average daily dose, measured in morphine milligram equivalents, declined from 47.9 in 2015 to 38.6 in 2023, according to the analysis.
The researchers also examined co-prescribing, or overlapping prescriptions for other common controlled substances among patients receiving long-term opioid therapy.
Co-prescribing with benzodiazepines declined from 43.8% in 2015 to 33.5% in 2023. Over the same period, co-prescribing with gabapentinoids rose from 47% to 58.7%, and co-prescribing with stimulants rose from 5.9% to 6.7%.
“Nearly 1 in 9 patients receiving prescription opioids were still chronic opioid users in 2023, highlighting the importance of developing and implementing evidence-based guidelines for chronic pain management,” said Thuy Nguyen , assistant professor of Health Management and Policy at the U-M School of Public Health and the paper’s first author.
Pooja Lagisetty , the paper’s senior author and associate professor of Internal Medicine at the University of Michigan Medical School, says the data highlights the pressing need to develop improved treatment models for pain.
“With almost 5 million Americans on long-term prescription opioids for chronic pain, and likely millions more who are taking shorter courses of prescription opioids for acute pain, most clinicians are likely to care for someone using prescription opioids for pain highlighting the pressing importance for investing in better treatment models for pain.”
The authors noted that the analysis was based on prescription dispensing data and did not include details such as prescribing indications, patient comorbidities or prescriber characteristics. The data also could not confirm whether patients took medications as dispensed.
Even so, the findings suggest that long-term opioid therapy remains common in the U.S., underscoring the need for continued attention to safer prescribing, careful monitoring and access to effective pain management options.
Additional Authors: Kao-Ping Chua, Amy Jiao, Mark Bicket, and Amy Bohnert; all of the University of Michigan
This study was partially funded by the National Institute on Drug Abuse, part of the National Institutes of Health (R01DA056438 and R01DA057943). This content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.
Paper cited: “US Trends in Long-Term Opioid Therapy.” JAMA. DOI: 10.1001/jama.2026.3241
JAMA
US Trends in Long-Term Opioid Therapy
8-Apr-2026