Wei YJJ, et al. - Researchers examined the year before an incident opioid use disorder (OUD) or overdose diagnosis using a 2005–2016 commercial healthcare database for the prescribed opioid fills and dose trajectories. In this cross-sectional study of 227,038 adults with incident OUD or overdose in the United States, they identified that 33.1% were aged 18 to 30 years, 52.9% were males, and 85.0% were metropolitan residents. A diagnosis of chronic pain was reported in half (50.5%) of the patients, depression was reported in 32.7%, and anxiety was reported in 20.3%. No filling of opioid prescription was reported in 79,747 (35.1%) patients in the 12 months before OUD or overdose diagnosis; the proportion significantly raised between 2006 and 2016. This indicates the prevalence of the absence of opioid prescription fills in the year before incident OUD or overdose diagnosis, and that the majority of the patients received prescription opioid doses below the risk threshold of 90 mg morphine equivalent dose. It seems that current programs that are solely based on opioid prescribing and dispensing information in this new era of limited access to prescription opioids, may lead to missing of an increasing proportion of high-risk patients.