Understanding multi-pill ingestion of prescription opioids: Prevalence, characteristics, and motivation

Pharmacoepidemiol Drug Saf. 2019 Jan;28(1):117-121. doi: 10.1002/pds.4687. Epub 2018 Nov 9.


Purpose: Oral use is the primary route of administration among non-medical prescription opioid users. While progression to non-oral routes and shifts to stronger opioids have been previously studied as ways to cope with tolerance, the prevalence and patterns of those who cope by increasing the number of pills/tablets ingested at one time (ie, multi-pill use) has not been assessed.

Methods: A subset (N = 231) of treatment-seeking opioid users from a national opioid surveillance system, participating in the Researchers and Participants Interacting Directly (RAPID) Program, completed an online survey centered on multi-pill use.

Results: Over two-thirds of non-medical prescription opioid users had a history of multi-pill use (67.7%), defined as ingesting four or more of the same pill, intact and at the same time. Among these (n = 154), the median maximum number of pills taken at one time was eight, with over 20% ingesting 11 or more pills in a single instance. Nearly half engaged in multi-pill ingestion more than once a day in the past month (43.8%), with accessibility to lower dose pills being the primary motivator (85.4%). Hydrocodone immediate-release (IR) compounds were by far the most frequently endorsed (90.3%), followed by oxycodone IR tablets with acetaminophen (76.0%) and oxycodone IR tablets containing no acetaminophen/ibuprofen (56.5%).

Conclusions: These results indicate that the ingestion of multiple opioid pills/tablets is extremely common among treatment-seeking opioid users. This, and other forms of non-medical oral use of prescription opioids, should be taken under consideration when developing prevention and intervention efforts targeting the opioid epidemic.

Keywords: multi-pill ingestion; non-medical opioid use; opioid surveillance; pharmacoepidemiology; prescription opioids; survey data collection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Male
  • Opioid Epidemic / etiology
  • Opioid Epidemic / prevention & control*
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / prevention & control
  • Prescription Drug Misuse / prevention & control
  • Prescription Drug Misuse / statistics & numerical data*
  • Prescription Drugs / administration & dosage*
  • Prescription Drugs / adverse effects
  • Prevalence
  • United States / epidemiology


  • Analgesics, Opioid
  • Prescription Drugs