The duration and prescribing rate of opioids increased between 2006 and 2017, and the amount of opioids prescribed per person and the prescribing rate for high-dose, extended-release, long-acting, and short-term opioid prescriptions decreased during this time, according to a population-based cross-sectional analysis of opioid prescriptions filled in US pharmacies published in JAMA Network Open.
Researchers from the Centers for Disease Control and Prevention (CDC) performed a cross-sectional analysis of data from the IQVIA Xponent database on opioid prescriptions filled between January 1, 2016 and December 31, 2017 at retail pharmacies in the United States. The study’s primary outcomes included the annual amount of opioids prescribed per person in morphine milligram equivalents (MMEs), the mean duration (in days) per prescription, and 4 separate prescribing rates (ie, prescriptions lasting ≤3 days, ≥30 days, high daily dosage [≥90 MME] prescriptions, and prescriptions for extended-release and long-acting formulations).
A total of 233.7 million prescriptions for opioids were filled in the United States between 2006 and 2017. There were reductions in the mean amount of opioids prescribed (mean decrease, 12.8%) from 628.4 MME to 543.4 MME per person when data for all states were combined — a reduction that was significant in 23 states. There were also reductions in the mean high daily dose (mean decrease, 53.1%; from 12.3 to 5.6 per 100 persons), a decrease which showed statistical significance in 49 states; in short-term (ie, ≤3 days) prescriptions (mean decrease, 43.1%; from 18.0 to 10.0 per 100 persons), which was significant in 48 states; and extended-release and long-acting formulations (mean decrease, 14.7%; from 7.2 to 6.0 per 100 persons), which was significant in 27 states.
During the study period, increases were observed in the mean duration of prescription opioids in every state (mean increase, 37.6%; from 13.0 to 17.9 days), and for prescriptions of opioids for ≥30 days (mean increase, 37.7%; from 18.3 to 24.9 per 100 persons), an increase that was significant in 39 states.
Study limitations include the lack of clinical information, the reason(s) for prescribing opioids, and the lack of adjustment for age.
“The magnitude, severity, and chronic nature of the opioid epidemic in the United States is of serious concern to clinicians, the government, the general public, and many others. As they review new studies and recommendations, clinicians should continue to consider how they might improve pain management, including opioid prescribing, in their own practice,” noted the study authors.
Schieber LZ, Guy GP Jr, Seth P, et al. Trends and patterns of geographic variation in opioid prescribing practices by state, United States, 2006-2017. JAMA Netw Open. 2019;2(3):e190665.