Who Is at Risk for Opioid Use Disorder?

Opioid use disorder (OUD) is extremely common. The condition affects over 20 million people worldwide and over 3 million people in the United States. OUD has been declared an epidemic in America due to the rising number of opioid-linked deaths.¹

OUD can affect people of all ages, genders, races, and income levels. Understanding who is at risk can help people living with OUD, their families, and healthcare providers identify early signs and get help. Here is a breakdown of the groups who may be at the highest risk of developing OUD.¹

People with a history of substance misuse

People who live with other substance use disorders are at a higher risk of developing OUD. Research shows that even past addiction can make it harder for the brain to regulate impulses. This increases a person’s vulnerability to opioids.^2,3

People with a family history of opioid use disorder

Genetics and family environments play a role in OUD risk. If a person’s close relative has had OUD, that person is more likely to develop OUD. This may be due to a combination of genetic predisposition and learned behaviors.^1,2

People who had childhood trauma

Childhood trauma increases the risk of OUD later in life. This trauma may include:^1,2,4

• Physical abuse
• Emotional abuse
• Neglect
• Exposure to violence

Early trauma can lead to changes in the brain's stress response system. This makes people more vulnerable to substance use as a coping mechanism for emotional pain.^1,2,4

Trauma is also strongly linked with mental health disorders like depression, anxiety, and post-traumatic stress disorder (PTSD). These conditions are common in people with OUD.^1,2,4

Cancer patients

People with cancer often receive opioid prescriptions to help manage their pain. This is because opioids are effective in controlling severe pain. But long-term use or higher doses increase the risk of dependence on the drugs. About 4 to 7 percent of people with cancer also have an opioid or other substance use disorder.⁵

OUD in cancer patients can complicate their overall health and treatment options. Close monitoring by healthcare providers is key.⁵

People with mental health disorders

People who have conditions like depression, anxiety, or PTSD are at increased risk for OUD. Studies show that about half of people with OUD also have a mental health disorder. This connection can create a cycle of pain and dependence.^1,2,6

People with chronic pain and other complex medical issues

Chronic pain is a common reason that people develop OUD. It starts innocently – a person with chronic pain is prescribed opioids by their doctor to manage their pain. The drugs provide much-needed pain relief. But their chronic use can lead to tolerance.¹

Once they develop a tolerance to the drug, they need higher doses to get the same effect. This can increase the risk of misusing opioids. Without other effective therapies, people with chronic pain or complex medical issues may become dependent on opioids. This may happen even when they take the drugs as directed by their doctor.¹

Vulnerable populations

Vulnerable populations include people in marginalized communities. Specific populations who are more vulnerable to OUD include:^1,6

• People without stable housing
• People living in poverty
• People who are unemployed
• People who are incarcerated

In general, groups with limited access to healthcare or who have financial struggles are more vulnerable to OUD. Barriers to education and prevention services also add to their risk.^1,6

Young people

Young adults and teenagers are particularly at risk for OUD. This may be due to peer pressure, a desire to experiment, or increased exposure to opioids. Young people may be exposed to the drugs within their household (a family member with a prescription) or through illicit sources. Opioid misuse among people aged 18 to 25 is rising.⁷

American Indian and Alaska Native populations

American Indian and Alaska Native communities face especially high rates of OUD. These communities have the highest overdose death rates of any racial or ethnic group in the United States.⁸

This issue is complex. Research has found many possible reasons, including:⁸

• Family history of drug or alcohol misuse
• High levels of stress
• Historical and intergenerational trauma
• Lack of quality healthcare
• Mental health disorders
• Poverty

Veterans

Veterans often face unique health and mental health challenges, including chronic pain and PTSD. Studies show that veterans are twice as likely as the general population to die from an opioid overdose.⁹

Raising awareness of OUD for at-risk groups

For the last 2 decades, drug overdose deaths have been on the rise. According to the Centers for Disease Control and Prevention (CDC), there were 107,000 drug overdose deaths in the US in 2021. Three-fourths of those were linked to opioids. Worldwide, opioids take the lives of over 120,000 people every year. Synthetic opioids like fentanyl have worsened the crisis.^1,10

Many people who need medication-assisted treatment (MAT) for OUD do not receive it. In 2021, the US recorded over 2.5 million adults 18 and older who had OUD. But only 1 in 5 received medicine to treat it.¹¹

Expanding access to MAT and community support is critical in helping at-risk populations. Raising awareness of at-risk groups and increasing access to prevention and treatment can help reduce the devastating impact of OUD.^1,2,11