Opioid Prescribing Remains High, Varies Widely by County

Megan Brooks

July 06, 2017

In the United States, opioid prescribing declined between 2010 and 2015 but remains at high levels and varies widely from county to county, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention (CDC).

"The 'good news' is that half of US counties saw a decrease in the amount of opioids prescribed per person from 2010 to 2015. And overall opioid prescribing in the US is down 18% since 2010," Acting CDC Director Anne Schuchat, MD, said during a media briefing.

"But despite these overall declines, the bottom line remains, with opioid medications, we are still seeing too many [patients] getting too much for too long. The amount of opioids prescribed in 2015 was enough for every American to be medicated around the clock for three weeks," Dr Schuchat said.

CDC researchers Gery P. Guy Jr, PhD, and colleagues analyzed retail prescription data from QuintilesIMS to assess trends in opioid prescribing in the United States from 2006 to 2015, as well as county-level prescribing patterns in 2010 and 2015.

The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per person in 2010 and then decreased to 640 MME per person in 2015, the authors report online July 6 in the Morbidity and Mortality Weekly Report. Yet the amount of opioids prescribed in 2015 remains about three times as high as in 1999, they note.

There is also huge variation in opioid prescribing between US counties. "Opioid prescribing varies as much from place to place as the weather and even neighbouring counties can have a major difference in prescribing levels," Dr Schuchat said.

In 2015, six times more opioids per resident were prescribed in the highest counties compared with the lowest prescribing ones. The Appalachian region of the United States remains "hard hit, but no part of the country is spared," Dr Schuchat said.

"The dramatic increase we've been seeing in heroin overdose is another tragic consequence of exposing too many people to prescription opioids since most people who use heroin started off with misusing prescription opioids," she noted.

The county-level data also show higher opioid prescribing in "micropolitan" counties with small cities or towns, as well as counties with a greater percentage of white residents, with a higher concentration of family physicians and dentists, where more people are uninsured or unemployed, and where more people have diabetes, arthritis, or disabilities.

"The substantial variation in opioid prescribing observed at the county-level suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use and demonstrates the need for better application of guidance and standards around opioid prescribing practices," Dr Guy and colleagues write.

"The opioid overdose epidemic didn't arise overnight and we won't be able to resolve it overnight. But changes in annual prescribing from 2006 to 2015 hold promise that prescribing practices can improve," said Dr Schuchat.

The CDC's 2016 Guideline for Prescribing Opioids for Chronic Pain is a "vital step toward this end," she said. The guideline provides evidence-based recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain, outside of active cancer treatment, palliative care, and end-of-life care.

The study had no commercial funding and the authors have disclosed no relevant financial relationships.

MMWR.  Published online July 6, 2017. Full text

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