Pain and public health: prevalence, overdose and naloxone

About one in five US adults has chronic pain and one in fifteen high-impact pain; overdose deaths are driven mainly by illicit fentanyl, and over-the-counter naloxone is a core public health response.

1. Chronic pain is common. In 2021 an estimated 20.9% of US adults (51.6 million) had chronic pain and 6.9% (17.1 million) had high-impact chronic pain ¹.
2. Know the survey definitions. NHIS defines chronic pain as pain on most days or every day for the previous 3 months; high-impact pain also limits daily life or work on most days or every day ¹.
3. Burden is unequal. Age-adjusted prevalence was notably higher among American Indian or Alaska Native adults, bisexual adults, and adults who were divorced or separated ¹.
4. Undertreatment is a recognized risk. CDC notes marginalized racial and ethnic groups, women, older adults, people with cognitive impairment, and people with sickle cell disease or cancer pain may receive inadequate pain treatment, alongside people with mental and substance use disorders ².
5. Overdose is driven by illicit opioids. FDA cited 101,750 reported fatal overdoses in the 12 months ending October 2022, primarily from synthetic opioids such as illicit fentanyl ³.
6. Naloxone is over the counter. In March 2023, FDA approved Narcan 4 mg naloxone nasal spray for nonprescription use, the first naloxone product available without a prescription, so bystanders such as family members can buy it directly ³.

Naloxone can precipitate severe opioid withdrawal in opioid-dependent people, with body aches, diarrhea, tachycardia, fever, sweating, nausea and other symptoms; it remains the standard treatment that rapidly reverses opioid overdose ³.

• Chronic pain is linked with depression, dementia, higher suicide risk and substance use ¹.
• The 2016 National Pain Strategy called for more precise prevalence estimates of chronic and high-impact pain ¹.
• An estimated 50 million US adults had chronic pain in 2016, with substantial health care costs and lost productivity ¹.
• NHIS is considered the best US source for pain surveillance data ¹.
• Narcan nasal spray was first approved as a prescription product in 2015 ³.
• CDC recommends offering naloxone as part of opioid risk mitigation (category A) ².
• About 9% of suicide decedents in 18 states had evidence of chronic pain at death ².

• Attributing most current overdose deaths to prescribed opioids rather than illicit fentanyl ³.
• Assuming naloxone still requires a prescription ³.
• Equating chronic pain with high-impact chronic pain, which adds limits on daily life or work ¹.
• Assuming pain care is distributed equally; CDC and NHIS data show unequal burden and undertreatment ¹².