Prescription opioids remain one of the most closely monitored drug categories in the United States, and for good reason. They are widely prescribed for pain, yet they carry serious risks of addiction and overdose. In 2024, an estimated 7.6 million Americans aged 12 and older misused prescription opioids in the past year, and the consequences of decades of heavy prescribing continue to shape the broader opioid crisis today.
Prescribing Rates: The Peak and the Decline
Opioid prescribing in the United States rose steadily through the 2000s and reached its high point in 2012, when more than 255 million opioid prescriptions were dispensed nationwide. Prescribing has fallen substantially since then. According to the CDC, the national opioid dispensing rate dropped steadily from 46.8 prescriptions per 100 people in 2019 to 35.4 per 100 people in 2024. By 2023, the total had fallen to about 125 million opioid prescriptions, still a substantial number, and one that varies widely from state to state.
The decline in prescribing is real and meaningful, but it has not undone the harm that built up over years of heavy prescribing. The CDC describes the opioid crisis as unfolding in three waves: a first wave driven by prescription opioids beginning in the 1990s, a second wave of heroin deaths beginning in 2010, and a third wave of synthetic opioids such as illegally made fentanyl beginning in 2013. Many people who developed opioid problems during the high-prescribing years later encountered that far more lethal supply.
Misuse Prevalence: How Many Americans Misuse Prescription Opioids
The 2024 National Survey on Drug Use and Health (NSDUH) provides the most current misuse data. Among people aged 12 or older in 2024:
- About 7.6 million people misused prescription opioids in the past year, making prescription opioids the most commonly misused prescription drug category.
- Hydrocodone products were the most commonly misused subtype (45.2%, or about 3.4 million misusers).
- Oxycodone products, including OxyContin and Percocet, were misused by 28.6% (about 2.1 million people).
- Codeine products were misused by about 1 in 4 (26.4%, or about 2.0 million people).
The survey also looked at why people misused prescription pain relievers and where they got them. The most common main reason was to relieve physical pain (about 70%). As for source, the largest share, about 42%, obtained the pain reliever they last misused from a friend or relative, and a similar share obtained it through a doctor’s prescription.
Opioid Use Disorder: Scale of the Problem
In 2023, over 5 million Americans aged 12 and older met the criteria for a prescription opioid use disorder, meaning their use was causing clinically significant impairment or distress. This reflects only those who met the full diagnostic threshold; many more people use opioids in risky ways that fall short of a formal diagnosis.
The risk is real even for people taking opioids as part of medical treatment. Among patients prescribed opioids for chronic pain, an estimated 21% to 29% misuse them, and 8% to 12% of those who misuse them go on to develop an opioid use disorder. This is part of why the CDC advises that, when opioids are prescribed, the best approach is the lowest effective dose for the shortest necessary duration, noting that for acute pain, opioids are rarely needed for more than seven days.
Prescription Opioid Overdose Deaths: Historical Trends
The following figures on prescription opioid overdose deaths are drawn from NIDA’s overdose death data (sourced from CDC WONDER) and from two CDC reports:
- Overdose deaths involving prescription opioids rose from 3,442 in 1999 to a peak of 17,029 in 2017.
- From 2017 to 2023, prescription opioid overdose deaths fell to 13,026.
- The rate of these deaths decreased nearly 12% from 2022 to 2023.
- From 1999 to 2023, nearly 308,000 people died from overdoses involving prescription opioids.
An important shift sits behind these numbers. According to NIDA, illicitly manufactured fentanyl became increasingly involved in overdose deaths that also involved prescription opioids from 2014 through 2021, to the point that fentanyl, not prescribed opioids, became the main driver of those deaths. As NIDA puts it, commonly prescribed opioids are no longer driving the overdose epidemic.
Current Overdose Trends: Prescription Opioids vs. Illicit Fentanyl
The most important nuance in current prescription opioid data is the shift in what is actually killing people. The opioid crisis has moved decisively toward the illicit supply. In 2023:
- Nearly 76% of all drug overdose deaths involved an opioid (prescription or illegal).
- 69% involved synthetic opioids other than methadone, primarily illicitly manufactured fentanyl.
- Prescription opioid overdose deaths, while still significant at 13,026, now make up a far smaller share of the total than in the epidemic’s first wave.
Prescription opioids remain a serious problem, but the crisis has shifted toward the illicit supply. Much of the population that first developed opioid problems during the high-prescribing era now faces a drug supply dominated by fentanyl, where the risk of a fatal overdose is far higher.
Demographic Patterns in Prescription Opioid Misuse
Prescription opioid misuse and its harms follow several consistent patterns:
- Age. Drug overdose deaths are concentrated among working-age adults. In 2023, the drug overdose death rate was highest for adults aged 35 to 44. Older adults face elevated overdose risk for a different reason: they often take multiple medications and metabolize drugs more slowly, and the CDC lists being 65 or older as an overdose risk factor.
- Source of misused opioids. In 2024, about 42% of people who misused prescription pain relievers obtained the pain reliever they last misused from a friend or relative. Diversion within social networks remains a major pathway to misuse.
- Reason for misuse. About 70% of people who misused prescription pain relievers in 2024 reported doing so to relieve physical pain rather than to get high, a pattern that ties pain management closely to addiction prevention.
- Methadone. Prescribing volume alone does not capture overdose risk. A CDC analysis found that methadone, while accounting for only a few percent of opioid pain reliever prescriptions, was involved in about a third of opioid pain reliever overdose deaths during the years it studied (1999 to 2010), a disproportionate share.
Leftover Prescriptions at Home: Storage and Disposal
Most misused prescription opioids do not come from a dealer. As noted above, about 42% of people who misused prescription pain relievers in 2024 got the pills they last misused from a friend or relative. That points to something simple and fixable: leftover opioids sitting in medicine cabinets.
Opioids are commonly found in homes where someone is recovering from surgery or managing pain from a serious illness, including cancer care and end-of-life care, and in the homes of older adults who take several medications.
Those leftovers carry two risks. The first is to children. Poison Control reports that US poison centers handled nearly 2.1 million human exposures in 2024, with pain medications the most common substance in adult exposures (10.4%) and among the top three substances for children aged 5 and under (9.1%). The CDC reports that unintentional medication overdoses are the leading cause of emergency department visits in young children, and advises picking “a storage place in your home that children cannot reach or see” and putting medicines away “every time.”
The second risk is diversion, meaning pills taken by someone they were not prescribed to. That is the 42% figure in practice, and it usually starts with a bottle nobody needed anymore.
The fix is to not keep opioids “just in case.” The DEA holds National Prescription Drug Take Back Day twice a year and keeps a year-round locator for authorized collection sites, which include many pharmacies and law enforcement agencies. If you cannot get to one, the FDA advises checking whether your medicine is on its flush list, since certain opioids can be flushed when no take-back option is available. For everything else, mix the medicine with something unappealing such as used coffee grounds, dirt, or cat litter, seal it in a bag or container, and put it in the household trash.
The Treatment Gap
One of the most significant statistics in this area is the treatment gap. The CDC reports that in 2023, an estimated 54.2 million Americans aged 12 or older needed substance use disorder treatment, but only 12.8 million received it. Effective treatment for opioid use disorder exists, including medications for opioid use disorder (MOUD, previously called medication-assisted treatment, or MAT), yet this gap means many people who could benefit never receive that care.
What These Numbers Mean for People Seeking Help
The statistics in this article reflect a crisis that began with legitimate prescriptions, moved into the illicit supply, and has left millions of people with opioid use disorder without access to effective care. The treatment gap shows how many people who need help have not yet been connected to it.
Effective treatment for opioid use disorder exists. Medications like buprenorphine and methadone reduce overdose deaths and provide the stability needed for the work of recovery. They work best as a bridge toward a life free of opioid dependence, not as a permanent endpoint, and the counseling and support that accompanies medication is what makes that recovery last.
If you or someone you care about is among the millions affected by prescription opioid misuse or opioid use disorder, that 54.2 million treatment gap does not have to include you. An addiction medicine specialist or accredited treatment program can assess the situation and recommend the right level of care. Help is available and it works.