CDC: Rural-Urban Gap Persists in PCP Opioid Prescribing

Marcia Frellick

January 17, 2019

Opioid prescribing rates are significantly higher in rural areas, though overall opioid prescribing has declined since 2016, according to the latest numbers from the Centers for Disease Control and Prevention (CDC).

Macarena C. García, DrPH, with the CDC's Center for Surveillance, Epidemiology, and Laboratory Services, and colleagues report their findings in an article published online today in Morbidity and Mortality Weekly Report.

García and colleagues analyzed national data from 31,422 primary care providers in the Athenahealth electronic health record (EHR) system from 2014 to 2017. They found that the prevalence of opioid prescriptions was 87% higher in the most rural counties compared with large metro counties (9.6% vs 5.2%).

The authors offered some context for the trend.

"Opioid prescribing in rural (nonmetropolitan) areas is strongly influenced by providers' individual relationships with their patients, and can be inconsistent with opioid prescribing guidelines," the authors write.

They also note that higher prescription rates in rural areas may be linked with higher use and misuse of prescription drugs at a younger age and higher prevalence of chronic pain among those in rural areas.

Rural areas also tend to have a higher percentage of older adults, a population with more conditions associated with pain, they note, and residents of rural areas may have less access to alternative treatments for pain.

"As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics," the authors write.

The report points out that overall opioid prescribing rates have been declining since March 2016 after the release of the CDC Guideline for Prescribing Opioids for Chronic Pain.

Among other findings in the report:

  • Of 70,237 fatal drug overdoses in 2017, prescription opioids were involved in 17,029 (24.2%);

  • In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates, which put patients at greater risk for addiction and overdose; and

  • Drug overdose is the leading cause of unintentional injury–associated death in the United States.

Among limitations of the study are that the data did not indicate the circumstances of the prescribing, such as whether a patient had chronic or acute pain, or whether prescriptions were filled and taken as the provider prescribed.

The authors write that this study shows that EHRs can help supplement traditional surveillance.

They add, "The lag between the collection of the data and this analysis could potentially be reduced to a matter of weeks with optimized workflows."

The authors report no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online January 17, 2019. Full text

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