July 10, 2017

Opioid prescribing has fallen in recent years—but increased threefold since 1999, CDC data show

Daily Briefing

    Opioid prescribing rates in the United States declined from 2012 to 2015, but the amount of opioids prescribed varied substantially across U.S. counties, according to CDC's Morbidity and Mortality Weekly Report published Thursday.

    Three imperatives for addressing the opioid crisis

    Study details

    For the study, CDC researchers examined data on opioid prescribing rates in the United States from 2006 to 2015. Researchers reviewed retail prescription data from QuintilesIMS' Transactional Data Warehouse to analyze the rates, amounts, dosages, and durations of opioids prescribed during those year, as well as county-level prescribing patterns in 2010 and 2015.

    Findings

    The researchers found that annual opioid prescribing rates in the United States decreased by 13.1 percent from 2012 to 2015. According to the report, opioid prescribing rates fell from about 81.2 prescriptions per 100 persons in 2012 to about 70.6 prescriptions per 100 persons in 2015.  

    In addition, the researchers found that annual high-dose opioid prescribing rates dropped by 41.4 percent from 2010 to 2015, falling from 11.4 per 100 persons to 6.7 per 100 persons.

    However, the researchers said the amount of opioids prescribed in the United States remained about three times higher than it was in 1999, and varies substantially across counties. For instance, the researchers found that the average per capita amount of opioids prescribed in 2015 was about six times higher in the top-prescribing counties than in the lowest-prescribing counties. According to the report, higher amounts of opioids were prescribed in counties with:

    • A higher prevalence of arthritis and diabetes;
    • A larger share of non-Hispanic whites;
    • Higher rates of Medicaid enrollment;
    • Higher rates of unemployment; and
    • Higher uninsured rates.

    According to then acting CDC Director Anne Schuchat, those factors contributed to about one third of the variation in opioid prescribing identified across the counties, but it was unclear what factors drove the remaining variation.

    Further, CDC researchers found the duration of opioid prescriptions increased from an average of 13 days in 2006 to 18 days in 2015.

    Comments

    Schuchat said the report shows "the beginning of the dip" in opioid prescribing rates. "It's like we're at 100 degrees and we've gone to 95, but we want to go to 60," she said, adding, "We have a lot more work to do here."

    The researchers said the variation in opioid prescribing patterns across the country suggests there is a lack of consensus on the appropriate use of opioids and a need for regions to better apply certain guidance and standards on opioid prescribing practices.

    Schuchat said, "Clinical practice is really all over the place, which is usually a sign that you need better standards." Particularly, she said, "With opioid medications, we're still seeing too many getting too much for too long." She added that the increase in prescription length is concerning because the longer an individual has access to an opioid, the greater the possibility they might misuse the drug, "and that is driving our problem with drug overdoses and drug overdose deaths in the country."

    Deborah Dowell, one of the report's authors and CMO at CDC's National Center for Injury Prevention and Control, said the report "highlights the need for health care providers to consider evidence-based guidance when prescribing opioids."

    Eric Weil, CMO for primary care at the Center for Population Health at Partners Healthcare, said certain counties might have higher amounts of opioids prescribed "because of limited resources to manage pain (in those areas)." Weil added, "If you're in an area where there are good pain management alternatives, there may be a decreased chance where you would be prescribed an opioid, and if you're in an area where a physician has less in their toolbox, it is conceivable that you would be more likely to prescribe an opioid because you have fewer options" (Stein, "Shots," NPR, 7/6; Stobbe, AP/Sacramento Bee, 7/6; McKay, Wall Street Journal, 7/6; Ross Johnson, Modern Healthcare, 7/6; Toy, USA Today, 7/6).

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    Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties, and providers typically intervene only after the patient has shown signs of misuse and addiction.

    This research report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.

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