What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size

Opioid-related overdose deaths have increased since 2010 in the U.S., but information on trends in opioid use disorder (OUD) prevalence is limited due to unreliable data. Multiplier methods are a classical epidemiological technique to estimate prevalence when direct estimation is infeasible or unreliable. We used two different multiplier approaches to estimate OUD prevalence from 2010 to 2019. First, we estimated OUD in National Survey on Drug Use and Health (NSDUH), and based on existing capture-recapture studies, multiplied prevalence by 4.5x. Second, we estimated the probability of drug poisoning death among people with OUD (Meta -analysis indicates 0.52/100,000), and divided the number of drug poisoning deaths in the US by this probability. Estimates were weighted to account for increase in drug-related mortality in recent years due to fentanyl. Estimated OUD prevalence was lowest when estimated in NSDUH with no multiplier, and highest when estimated from vital statistics data without adjustment. Consistent findings emerged with two methods: NSDUH data with multiplier correction, and vital statistics data with multiplier and adjustment. From these two methods, OUD prevalence increased from 2010 to 2014; then stabilized and slightly declined annually (survey data with multiplier, highest prevalence of 4.0% in 2015; death data with a multiplier and correction, highest prevalence of 2.35% in 2016). The number of US adolescent and adult individuals with OUD in 2019 was estimated between 6.7-7.6 million. When multipliers and corrections are used, OUD may have stabilized or slightly declined after 2015. Nevertheless, it remains highly prevalent, affecting 6-7 million US adolescents and adults.