Opioid Prescriptions Drop, Millions Still on Long-Term Therapy

Long-term opioid prescribing has fallen in the U.S., but millions of patients still received opioids for 90 days or longer in 2023.

Apr. 9, 2026 at 4:26am

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A ghostly, translucent X-ray photograph revealing the internal structures of prescription opioid pills in various stages of dissolution, conceptually representing the complex and often hidden nature of long-term opioid use.An X-ray view of the complex and often hidden nature of long-term opioid use in the United States.Ann Arbor Today

A new study led by researchers at the University of Michigan found that while long-term opioid prescribing has declined in the U.S. over the last decade, millions of patients still received opioids for 90 days or longer in 2023. The number of patients with an active long-term opioid therapy episode decreased from about 5.6 million in 2015 to 4.2 million in 2023, a 24.3% drop. However, these patients still accounted for 11.5% of all patients with any opioid prescription in 2023.

Why it matters

The study highlights the pressing need to develop improved treatment models for chronic pain, as nearly 1 in 9 patients receiving prescription opioids were still chronic opioid users in 2023. With millions of Americans on long-term prescription opioids, most clinicians are likely to care for someone using these medications, underscoring the importance of safer prescribing, careful monitoring, and access to effective pain management options.

The details

The researchers analyzed U.S. trends in long-term opioid therapy, defined as opioid dispensing that lasted 90 days or longer. They found that while the number of patients with an active long-term opioid therapy episode declined, the average patient age increased from 52.5 in 2015 to 60.5 in 2023, and Medicare coverage rose from 38.8% to 48.7% over the same period. The average daily opioid dose also decreased from 47.9 morphine milligram equivalents in 2015 to 38.6 in 2023. Co-prescribing patterns changed, with benzodiazepine co-prescribing declining from 43.8% to 33.5%, gabapentinoid co-prescribing rising from 47% to 58.7%, and stimulant co-prescribing increasing from 5.9% to 6.7%.

  • The study examined changes from 2015 through 2023 in the number of patients receiving long-term opioid therapy and in key characteristics of those patients.
  • In 2023, patients with long-term opioid therapy episodes accounted for 11.5% of all patients with any opioid episode.

The players

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.

Kao-Ping Chua

Additional author from the University of Michigan.

Amy Jiao

Additional author from the University of Michigan.

Mark Bicket

Additional author from the University of Michigan.

Amy Bohnert

Additional author from the University of Michigan.

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What they’re saying

“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.”

— Thuy Nguyen, assistant professor of Health Management and Policy at the U-M School of Public Health and the paper's first author

“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.”

— Pooja Lagisetty, the paper's senior author and associate professor of Internal Medicine at the University of Michigan Medical School

What’s next

The researchers 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. Further research is needed to better understand the long-term use of opioids and develop more effective pain management strategies.

The takeaway

While long-term opioid prescribing has declined in the U.S., millions of patients are still receiving these medications for chronic pain, highlighting the urgent need to invest in improved treatment models and pain management options to address this public health issue.