Opioid Intensity Overlooked in Study

New Study Highlights Gaps in Opioid Use Monitoring

A recent study conducted by researchers from Carnegie Mellon University, RAND, and the University of Maryland is prompting a reevaluation of how public health officials approach opioid use. The research highlights a critical blind spot: while attention has been focused on the number of people using opioids, the intensity of their use has largely been overlooked. This oversight could have significant implications for understanding and addressing the opioid crisis.

The findings suggest that when more drugs are available and prices are lower, users tend to consume higher amounts, often with greater potency. This phenomenon is particularly evident with fentanyl, which has flooded the market. Users are not only taking larger doses but also engaging in riskier behaviors more frequently.

Jonathan P. Caulkins, coauthor of the study and professor of operations research and public policy at Carnegie Mellon’s Heinz College, explained the motivation behind the research. “We wanted to explore whether various populations who use opioids frequently consume roughly the same amounts per day of use, on average, or whether there is appreciable variation from place to place or from time to time,” he said.

The study notes that the long-term effects of high-intensity opioid use remain unclear, as most previous research has focused on historical data where the intensity of use was much lower. The current era, dominated by fentanyl and fentanyl-related opioid use disorder (OUD), presents new challenges compared to the earlier waves of prescription drug and heroin use.

To better understand the intensity of opioid use across different types of drugs, researchers analyzed data from 135 articles on OUD. They used a metric called “morphine milligram equivalents” to compare the effects of doses of fentanyl, heroin, and prescription hydrocodone. This method helps provide a clearer picture of how different substances affect users.

In one state, the rate of OUD is among the highest in the country, with over 2.5% of the population affected. Law enforcement efforts have been focused on combating the surge of fentanyl and its synthetic counterparts, which have entered the market primarily through China via Mexico. Over a year-long period between 2023 and 2024, the state seized three million individual doses of fentanyl and an additional 50,000 fentanyl pills.

The state has adopted a multi-pronged strategy to tackle the opioid epidemic. Funds from settlements with pharmaceutical companies responsible for the crisis have been allocated to prevention and treatment programs. Additionally, the Attorney General’s office has supported the HALT Fentanyl Act, which permanently classifies fentanyl copycats as Schedule I narcotics. This law was signed into effect by President Trump.

“Synthetic opioid manufacturers and traffickers have exploited loopholes in scheduling classifications which contributed to widespread distribution of variations of fentanyl,” said the Attorney General in February. “Those variations have the same disastrous effects as fentanyl, and this office remains committed to doing everything in our power to deter trafficking in Pennsylvania communities.”

The study suggests that treatment professionals and public health officials may need to adjust their approaches to account for a “higher baseline consumption.” Beau Kilmer, co-Director of RAND’s Drug Policy Research Center and coauthor of the study, emphasized the importance of gathering more detailed data on opioid use.

“One is to regularly ask people who use opioids about their consumption and combine this with purity information obtained from law enforcement or drug checking services,” said Kilmer. “Another is to ask people who use opioids about their spending on opioids and combine this with law enforcement data on drug prices, accounting for variation in purity.”

These insights could lead to more effective strategies for addressing the opioid crisis, ensuring that public health responses are better aligned with the realities of current opioid use patterns.