Vital Signs

Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines

United States, 2012

Leonard J. Paulozzi, MD; Karin A. Mack, PhD; Jason M. Hockenberry, PhD


Morbidity and Mortality Weekly Report. 2014;63(26):563-568. 

In This Article


Prescribers wrote 82.5 OPR prescriptions and 37.6 benzodiazepine prescriptions per 100 persons in the United States in 2012 ( Table ). LA/ER OPR accounted for 12.5%, and high-dose OPR accounted for 5.1% of the estimated 258.9 million OPR prescriptions written nationwide. Prescribing rates varied widely by state for all drug types. For all OPR combined, the prescribing rate in Alabama was 2.7 times the rate in Hawaii. The high/low ratio was greater for LA/ER OPR and high-dose OPR compared with all OPR together: for high-dose OPR, state rates ranged 4.6-fold (Delaware versus Texas), and for LA/ER OPR, state rates ranged 5.3-fold (Maine versus Texas). State rates ranged 3.7-fold (West Virginia versus Hawaii) for benzodiazepines. For both OPR and benzodiazepines, Alabama, Tennessee, and West Virginia were the three highest-prescribing states. Among the OPR drugs, interstate variation was greatest for oxymorphone (CV = 0.72, IQ = 2.50, high/low = 21.9). OPR prescribing rates correlated with benzodiazepine prescribing rates (r = 0.80; p<0.01).

The distribution of state prescribing rates was skewed toward higher rates (Figure 1). For both OPR and benzodiazepine rates, Alabama, Tennessee, and West Virginia were ≥2 SDs above the mean. For LA/ER opioids, Maine and Delaware were ≥2 SDs above the mean. For high-dose OPR, Delaware, Tennessee, and Nevada were ≥2 SDs above the mean. Texas's rate for LA/ER OPR was the only rate ≥2 SDs below the mean for any category.

Figure 1.

Distribution of state prescribing rates,* by drug type — IMS Health, United States, 2012
* State rates are rounded to the nearest 0.25 standard deviation for purposes of presentation.

The South region had the highest rate of prescribing OPR and benzodiazepines (Figure 2). The Northeast had the highest rate for high-dose OPR and LA/ER OPR, although high rates also were observed in individual states in the South and West. In the Northeast, 17.8% of OPR prescribed were LA/ER OPR. States in the South ranked highest for all individual opioids except for hydromorphone, fentanyl, and methadone, for which the highest rates were in Vermont, North Dakota, and Oregon, respectively.

Figure 2.

Prescribing rates per 100 persons (in quartiles), by state and drug type — IMS Health, United States, 2012.