JAMA
Opioid use is falling—but gabapentinoid add‑on therapy is rising
Clinical Takeaway: Watch for rising combination therapy among patients on long‑term opioids. Gabapentinoids are increasingly added—not substituted—so monitor total CNS‑active medication burden, particularly in older adults.
National use of long-term opioid therapy has fallen over the past decade, but millions of patients continue to receive opioids for extended periods, according to a JAMA research letter analyzing U.S. prescription trends from 2015 to 2023.
Using a large longitudinal prescription database capturing approximately 92% of U.S. retail pharmacy dispensing, investigators identified long-term opioid therapy as opioid use lasting at least 90 days. The number of patients receiving long-term opioid therapy declined from approximately 5.6 million in 2015 to 4.2 million in 2023, representing a 24% reduction. In 2023, however, these patients still accounted for 11.5% of all individuals who received any opioid prescription.
The characteristics of patients receiving long-term opioids also changed substantially over time. Mean patient age increased from 52.5 to 60.5 years, and Medicare became the most common payer, covering nearly 49% of long-term therapy episodes by 2023. Over the same period, the average daily opioid dose declined from 47.9 to 38.6 morphine milligram equivalents, indicating lower-intensity prescribing.
Co‑prescribing patterns shifted as well. Overlapping benzodiazepine use declined from 43.8% to 33.5%, while gabapentinoid co‑prescribing increased from 47.0% to 58.7% of long‑term opioid therapy episodes between 2015 and 2023. Stimulant co‑prescribing also rose modestly, underscoring growing polypharmacy concerns in an aging population receiving chronic opioid therapy.
Source: Nguyen TD, Chua KP, Jiao A, et al. (2026, April 8). JAMA. US trends in long‑term opioid therapy