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Changes in Opioid Prescribing in the US

MMWR; ePub 2017 Jul 7; Guy Jr, Zhang, et al

The amount of opioids prescribed in the US remains high relative to 1999 levels, despite decreasing each year from 2010 through 2015 after peaking in 2010. This according to a Centers for Disease Control and Prevention (CDC) analysis of retail prescription data to assess opioid prescribing in the US from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. Among the key findings:

  • The amount of opioids prescribed in the US peaked in 2010 and then decreased each year through 2015. Despite reductions, the amount of opioids prescribed remains approximately 3 times as high as in 1999.
  • Opioid prescribing varied substantially across the country, with average per capita amounts prescribed in the top-prescribing counties approximately 6 times the amounts prescribed in the lowest prescribing counties in 2015.
  • Higher amounts of opioids were prescribed in counties with a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan counties; and counties with higher rates of unemployment and Medicaid enrollment.
  • The substantial variation in opioid prescribing observed at the county-level suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use.
  • Health care providers can follow the CDC’s Guideline for Prescribing Opioids for Chronic Pain, which 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.

Citation:

Guy GP Jr, Zhang K, Bohm MK, et al. Vital Signs: Changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:697–704. doi:10.15585/mmwr.mm6626a4.

Commentary:

Drug overdoses lead to over 50,000 deaths per year in the US, of which about 60% are due to opioids, half of which are prescription opioids.1 After the prescription of opioids increased by over 400% from 1999 to 2010, there is now evidence that opioid prescribing has not only leveled off, but has begun to decrease. It is important to be careful in initiating opioid use as well as to make sure when opioids are prescribed they be for as short a time as possible. The likelihood of long-term use increases with length of prescriptions >5 days. The opioid epidemic is a national tragedy, requiring ongoing vigilance in careful prescribing. —Neil Skolnik, MD

  1. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445–52. doi:10.15585/mmwr.mm655051e1.