Millions Are Still on Long-Term Opioids, and They’re Getting Older

National efforts to curb long-term opioid prescribing have made real progress, but millions of patients, particularly older adults, remain on these drugs, and the risks attached to their care are growing more complex, according to a new study published online today in JAMA.¹ These new findings offer a sobering update on America’s opioid crisis.

Using the IQVIA Longitudinal Prescription Database, researchers at the University of Michigan analyzed nearly a decade of prescription data (April 2012 through December 2023) and found that 4.2 million Americans were actively receiving long-term opioid therapy in 2023, down from 5.6 million in 2015, a decline of 24.3%. Using previous research, they defined long-term opioid therapy as “a period of opioid dispensing lasting 90 days or longer with either a medication supply of 120 days or longer or opioid dispensing 10 or more times within 180 days of an initial prescription (no opioid fills in the preceding 90 days).”²

For the entirety of the study period, there were 16,337,529 long-term opioid therapy episodes among 13,311,584 patients, the study reported. At the start of the study period, more than half of these individuals were female (57.2%).

Who Is Still Being Prescribed Opioids

The demographics of who stays on opioids for the long term have shifted significantly. The mean (SD) patient age climbed from 52.5 (12.9) years in 2015 to 60.5 (12.4) years in 2023. The share of patients aged 65 and older more than doubled, rising from 17.0% to 38.8%. An increase was also seen in patients aged 55 to 64 years, from 25.5% to 27.5%. For all other age ranges, there were decreases:

• Younger than 18 years: 0.4% to 0.1%
• 18 to 34 years: 9.1% to 2.6%
• 35 to 44 years: 13.9% to 8.6%
• 45 to 54 years: 22.1% to 16.0%
• Unknown age: 11.9% to 6.3%

Correspondingly, Medicare surpassed commercial insurance as the dominant payer, covering 48.7% of long-term opioid episodes in 2023, up from 38.8% in 2015, compared with 40.9% and 36.8%, respectively. There were also fewer reports of Medicaid coverage (14.3% to 9.6%), paying cash (6.0% to 4.8%), and unknown insurance type (0.2% to less than 0.1%). Women continued to make up a larger share of long-term opioid patients, coming in at 59.0% in 2023 compared with 57.3% in 2015, a pattern consistent with broader trends in chronic pain diagnoses, the authors explained.

One encouraging sign: average daily dosing fell, from a mean (SD) of 47.9 (71.3) morphine milligram equivalents per day in 2015 to 38.6 (50.6) in 2023. But this outcome has been complicated by a troubling rise in coprescribing. Nearly three-quarters of long-term opioid patients in 2023 (72.3%) were also prescribed a benzodiazepine, gabapentinoid, or stimulant, up from 68.5% in 2015. Individually, benzodiazepine prescribing fell (43.8% to 33.5%), but gabapentinoid and stimulant prescribing rose (47.0% to 58.7% and 5.9% to 6.7%, respectively).

Research has linked concurrent opioid and gabapentinoid use to elevated mortality risk, particularly among Medicare recipients.³

An Equity Lens on Who’s Left behind

The geographic distribution of long-term opioid therapy episodes remained notably concentrated in the South, which accounted for 48.3% of all cases in 2023, up from 43.7% in 2015. Meanwhile, rates in the 3 other regions all dropped:

• Midwest: 21.6% to 20.3%
• Northeast: 13.5% to 11.4%
• West: 21.2% to 20.0%

The convergence of older age, Medicare dependency, and Southern geography raises pointed questions about access to nonopioid pain alternatives and addiction treatment in underserved communities, the investigators noted.

The study’s authors note that limitations on their results include a lack of data on prescribing indications, patient comorbidities, and prescriber characteristics, gaps that made it difficult to assess changes among key subgroups, including by rural or urban status. Veterans Affairs pharmacy data were also not included in the analysis, and not all prescriptions were captured.

Next Steps

The decline in long-term opioid prescribing likely reflects the combined effect of CDC clinical guidelines, state-level regulations, and growing clinical awareness of opioid-related risks. But the findings underscore that policy progress has not reached everyone equally.

“Despite significant resources having been invested by the government and professional organizations in programs aimed at mitigating the risks associated with opioid prescribing (including reducing initiation of opioid prescriptions and expanding access to opioid addiction treatment),” the authors wrote, “our findings suggest that millions of individuals in the US continue to be prescribed long-term opioid therapy.”

The researchers stopped short of calling for an end to long-term opioid prescribing, noting that for some patients it remains medically appropriate. The concern, they write, is ensuring that those who remain on these regimens receive adequate safeguards—particularly as the population of long-term opioid users skews older and more medically complex.

References

1. Nguyen TD, Chua KP, Jiao A, Bicket MC, Bohnert A, Lagisetty P. US trends in long-term opioid therapy. JAMA. Published online April 8, 2026. doi:10.1001/jama.2026.3241
2. Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24(6):521-527. doi:10.1097/AJP.0b013e318169d03b
3. Corriere MA, Daniel LL, Dickson AL, et al. Concurrent gabapentin and opioid use and risk of mortality in Medicare recipients with non-cancer pain. Clin Pharmacol Ther. 2023;114(5):1050-1057. doi:10.1002/cpt.3019
4. Saloner B, Lagisetty P. The opioid crisis: scaling up treatment and harm reduction programs to reach more people who would benefit. Health Aff (Millwood). 2025;44(9):1034-1041. doi:10.1377/hlthaff.2025.00340