Between 2014 and 2017, a higher percentage of patients who were prescribed an opioid analgesic resided in rural vs urban areas, although reductions in opioid prescribing were observed in all geographic areas following the release of the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain released in March 2016. This is according to an analysis of patient opioid prescription data from a national electronic health record vendor published in Morbidity and Mortality Weekly Report.

Researchers retrospectively analyzed de-identified prescription data from primary health care providers (n=31,422) serving approximately 17 million patients. Data were obtained from the Athenahealth electronic health record system. The patient-level data were aggregated from January 2014 to March 2017. Period-specific percentage of patients with opioid prescriptions and of annual rate of increase or decrease in prescribing rates were calculated. In the final analysis, data from a total of 128,194,491 patient-weeks were included.

During the study period, the overall percentage of patients who were prescribed opioids ranged from 5.2% to 9.6% in large central metropolitan counties and noncore counties, respectively. The chance of being prescribed opioids in a noncore county (ie, the most rural ones) was 87% higher than the likelihood of receiving an opioid prescription in a large metropolitan area. Large central metropolitan counties had the lowest period-specific percentages of patient-weeks with an opioid prescription (5.0%-5.4%; P <.001), with the exception of the final 51 weeks of the study period, where large metropolitan counties and large fringe metropolitan counties had comparable rates of opioid prescriptions.

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Prior to the release of the CDC guideline, there was a 6.4% per-year increase in opioid prescriptions in noncore counties (95% multiplicity-adjusted Wald CI, 2.1-10.8) as well as a 9.7% per-year increase in micropolitan counties (95% CI, 6.5-13.0). Following the release of the guideline, there were noticeable reductions in opioid prescriptions across all counties.

Study limitations include the reliance on data from Athenahealth only and the lack of adjustment for demographic variations in the cohort.

“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,” noted the study authors.

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Reference

García MC, Heilig CM, Lee SH, et al. Opioid prescribing rates in nonmetropolitan and metropolitan counties among primary care providers using an electronic health record system – United States, 2014-2017. MMWR Morb Mortal Wkly Rep. 2019;68(2):25-30.