Prevalence
Opioids are a class of drugs that derive from or mimic the natural substances found in the opium poppy plant, and include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others.
Opioids are often used as a form of medication to relax and relieve the body of moderate to severe pain. Due to its relaxing and euphoric effects, many may misuse opioids for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common.
In 2023, 26.3% of people aged 12+ had used any opioids (i.e., used heroin or used any prescription pain relievers) in the past year in the United States (US). Adults aged 26+ (28.7%) had the highest prevalence of opioid use in the past year, followed by young adults aged 18-25 years (19.1%), and youth aged 12-17 years (14.7%) (Figure 1).
In 2023, 3.1% of people aged 12+ had misused opioids (i.e., used heroin, or used prescription pain relievers in any way not directed by a doctor, including use without their own prescription; use in greater amounts, more often, or longer than prescribed; or use in any other way not directed by a doctor) in the past year. From 2016-2023, past year opioid misuse declined slowly from 4.0% to 3.3% among adults aged 26+, while opioid misuse fell quickly from 7.3% to 2.5% (Figure 2).
Prescription Pain Reliever Misuse
In 2023 in the US, 8.6 million individuals aged 12+ (3.0%) misused prescription pain relievers (i.e., used prescription pain relievers in any way not directed by a doctor, including use without their own prescription; use in greater amounts, more often, or longer than prescribed; or use in any other way not directed by a doctor) in the past year. This represented 11.5% of individuals aged 12+ who used any prescription pain relievers in the past year (NSDUH 2023).
About 1.4 million individuals aged 12+ misused prescription pain relievers for the first time in their life in 2023.
(Note: Prescription pain relievers include products containing hydrocodone, oxycodone, tramadol, codeine, morphine, prescription fentanyl, buprenorphine, oxymorphone, hydromorphone, Demerol, methadone, or other prescription medication for pain relief. Prescription pain relievers could include some non-opioids because survey respondents could occasionally specify the misuse of other prescription pain relievers that are not opioids.)
In the US, among all individuals aged 12+, past year misuse of prescription pain relievers was highest among young adults aged 18-25 years, though the prevalence has been steadily decreasing since 2015 while remaining relatively stable for adults aged 26+ years. In 2023, past year misuse of prescription pain relievers among young adults 18-25 years (2.5%) had decreased to below that of adults 26+ years (3.2%) (Figure 3).
Among past year users of any prescription pain relievers, misuse was also most common among users aged 18-25 years, whose prevalence of prescription pain reliever misuse had been steadily decreasing since 2015. By 2023, prescription pain reliever misuse among young adult users aged 18-25 years (12.9%) had dropped to below that of youth users aged 12-17 years (15.0%) (Figure 4).
In 2022-2023, 2.7% of people aged 12+ had misused prescription pain relievers in the past year in California. Similar to national trends, the prevalence of prescription pain reliever misuse was highest among young adults aged 18-25 years, but had been decreasing since 2015 and decreased to below that of adults aged 26+ years in 2022-2023 (Figure 5).
In Los Angeles County (LAC), 3.7% of individuals aged 12 or older had misused prescription pain relievers in the past year in 2016-2018. The prevalence of prescription pain reliever misuse was highest among young adults aged 18-25 years (Figure 6).
(Note: Recent data at the substate level not available.)
In LAC, the SPA1-Antelope Valley and SPA5-West regions (3.93%) had the highest prevalence rates of prescription pain reliever misuse among individuals aged 12 years or older, followed by the SPA8-South Bay (3.88%) and SPA6-South (3.87%) regions (Figure 7).
Figure 7. Prevalence of prescription pain reliever misuse in the past year (age 12+), LAC, 2016-2018
Source: NSDUH
Gone to Work/School Under the Influence of Prescription Medications
In 2017, among those who have ever misused prescription medications in LAC, over one-third (36.1%) had misused prescription medications (including pain relievers, sedatives/benzodiazepines and/or stimulants) before or during work/school (Figure 8). (Note: Adults were asked if they had gone to work, and youth were asked if they had gone to school under the influence of prescription medication.)
In 2017, among those who have ever misused prescription medications, 39.7% of males and 31.1% of females misused prescriptions medications before or during work/school (Figure 9).
In 2017, among those who have ever misused prescription medications, the prevalence of ever going to work/school under the influence was highest for youth aged 12-17 years (55.3%) compared to other age groups (Figure 10).
In 2017, among those who ever misused prescription medications, Whites (42.4%) were most likely to have gone work/school under the influence, followed by multi-race/ethnicity (39.2%), Blacks (39.0%), and Latinx (36.5%) (Figure 11).
Heroin Use
In 2023, an estimated 660,000 people aged 12+ years (0.2%) in the US had used heroin in the past year. Of those, 28,000 began using heroin for the first time in the past year in 2023 (NSDUH 2023).
In the US, past year heroin use has been declining among young adults aged 18-25 years since 2016, dropping from 0.7% to 0.1% in 2023. Past year heroin use has been fluctuating around 0.3% among adults aged 26+ years (Figure 12).
In California in 2022-2023, 0.25% of individuals aged 18 years or older had used heroin in the past year (Figure 13).
In 2016-2018, past year use of heroin in LAC was highest among those aged 26+ (0.22%), followed by those aged 18-25 years (0.2%) (Figure 14).
(Note: Recent data at the substate level not available.)
In LAC, heroin use among individuals age 12+ years was highest in the SPA4-Metro region (0.25%), followed by the SPA6-South region (0.24%) (Figure 15).
Figure 15. Prevalence of heroin use in the past year (age 12+), LAC, 2016-2018.
Source: NSDUH
References
Figure 1-4, 12. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). National Reports and Tables. NSDUH Detailed Tables. 2016-2020, 2022-2023.
Figure 5, 13. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). State Reports and Tables. NSDUH All State Specific Tables. 2015-2023.
Figures 6-7, 14-15. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). NSDUH Substate Region Estimates by Age Group. 2016-2018.
Figures 8-11. Prescription Medication Misuse and Public Perceptions in Los Angeles County: Findings from the 2017 Community Needs Assessment. Health Outcomes and Data Analytics, Substance Abuse Prevention and Control, Los Angeles County Department of Public Health, March 2019.
