Opioid Use Declines, but Gabapentinoid Co-Prescribing Rises

Millions of U.S. patients still on long-term opioid therapy, though average daily dose has fallen

Apr. 8, 2026 at 8:21pm

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A ghostly, translucent X-ray image showing the internal structures of a pill bottle and prescription capsules, conveying the complex and potentially dangerous interactions between opioids and gabapentinoids.As opioid prescriptions decline, the increased co-prescribing of gabapentinoids raises safety concerns, especially for older adults on long-term pain medication.Ann Arbor Today

The number of U.S. individuals on long-term opioid therapy fell from 5.6 million in 2015 to 4.2 million in 2023, but co-prescribing of opioids with gabapentinoids increased from 47% to 58.7% during that time period. Meanwhile, the mean age of long-term opioid therapy patients rose from 52.5 years to 60.5 years, raising safety concerns about polypharmacy in older adults.

Why it matters

While long-term opioid use has declined, it remains common, and the rise in co-prescribing opioids with gabapentinoids is concerning because the FDA has warned that this combination can lead to respiratory depression. As the population of long-term opioid users skews older, there are increased risks from polypharmacy and adverse events.

The details

The researchers analyzed data from 2015 through 2023 and found that the number of U.S. patients prescribed long-term opioid therapy declined by 24.3%, from 5.6 million in 2015 to 4.2 million in 2023. However, co-prescribing of opioids with gabapentinoids (such as gabapentin and pregabalin) rose substantially, from 47% in 2015 to 58.7% in 2023. Meanwhile, the mean age of patients with long-term opioid therapy increased from 52.5 to 60.5 years.

  • In 2023, 4.2 million people had an active long-term opioid therapy episode.
  • In 2015, 5.6 million people had an active long-term opioid therapy episode.
  • Co-prescribing of opioids with gabapentinoids increased from 47% in 2015 to 58.7% in 2023.
  • The mean age of patients with long-term opioid therapy increased from 52.5 years in 2015 to 60.5 years in 2023.

The players

Thuy Nguyen

A PhD researcher at the University of Michigan School of Public Health who co-authored the study.

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What they’re saying

“Because older adults are at higher risk of adverse events from polypharmacy, the increased rate of co-prescribing, particularly with gabapentinoids, raises additional safety concerns.”

— Thuy Nguyen, Researcher

“Our main finding is that while long-term opioid therapy has declined, it remains common among Americans. Also, co-prescribing with gabapentinoids rose between 2015 and 2023. This is concerning because the FDA warns that concurrent gabapentin and opioid use may lead to respiratory depression.”

— Thuy Nguyen, Researcher

What’s next

Researchers and policymakers will likely continue to monitor trends in opioid and gabapentinoid prescribing, with a focus on ensuring safe and appropriate use of these medications, especially among older adults.

The takeaway

While the decline in long-term opioid use is a positive step, the rise in co-prescribing opioids with gabapentinoids is a concerning trend that requires ongoing attention and intervention to address the risks of polypharmacy and respiratory depression, particularly in the aging population of chronic pain patients.