Opioid Prescribing Rates – Are We Making Progress?

ZACHARY HERMAN, BS

ASIF ILYAS, MD, MBA, FACS


SUMMARY POINTS



  • Understanding opioid prescribing habits and patient utilization of opioids is crucial in determining the balance between effective pain control and inappropriate opioid distribution.

  • A total of 168,158,611 opioid prescriptions were dispensed in the United States in the year 2018, resulting in an average of 51.4 prescriptions per 100 persons.

  • Prescribing rates in Pennsylvania, New Jersey, and New York are 49.9, 38.9, and 34.0 prescriptions per 100 persons, respectively.

  • Rates of opioid prescribing rates had peaked in 2012 and have decreased annually since; yet, certain areas of the country are still hot spots for opioid prescribing.


ANALYSIS


Postoperative pain management in orthopaedic surgery accounts for a substantial portion of opioid medications prescribed in the United States. Understanding prescribing habits and patient utilization of these medications following a surgical procedure is critical to establishing appropriate prescribing protocols that effectively control pain while minimizing potential for abuse. The purposes of this article are to present the most recent data on opioid prescribing patterns and elucidate trends and hot spots of opioid prescription rates.


Most recent data on opioid prescription rates exist from 2018. In that year, 168,158,611 opioid prescriptions were dispensed. The prescribing rate per 100 persons was 51.4 prescriptions annually. More historically, after a steady increase in the overall national opioid prescribing rate starting in 2006, the total number of prescriptions dispensed peaked in 2012 at more than 255 million and a prescribing rate of 81.3 prescriptions per 100 persons annually. Overall, the overall national opioid prescribing rate declined from 2012 to 2018, and in 2018, the prescribing rate had fallen to the lowest in the 13 years. Table 1 shows the total number of opioid prescriptions and the number of prescriptions per 100 persons from the years 2006 to 2018.


Yet, in 2018, prescribing rates continue to remain very high in certain areas across the country. In 11% of U.S. counties, enough opioid prescriptions were dispensed for every person to have one. As mentioned, while the overall opioid prescribing rate in 2018 was 51.4 prescriptions per 100 people, some counties had rates that were six times higher than that. It is important to examine areas of the country in order to uncover any emerging hot spots in opioid prescribing.


Figure 1 depicts opioid prescribing rates at the level of the states. Darker colors represent more prescriptions per 100 people. In 2018, Alabama and Arkansas were the states with the highest number of opioids prescribed, with approximately 97.5 and 93.5 prescriptions per 100 persons. Locally, prescribing rates in Pennsylvania, New Jersey, New York were 49.9, 38.9, and 34.0 prescriptions per 100 persons, respectively- all below the United States average of 51.4 prescriptions per 100 persons.


As we continue to study and attempt to limit the use of opioids, effective this source of potential abuse. We must continue to monitor the rates at which opioids are dispensed in order to identify hot spots and trends.


REFERENCES


1. Gomes, T., Tadrous, M., Mamdani, M., Paterson, J. and Juurlink, D., 2018. The Burden of Opioid-Related Mortality in the United States. JAMA Network Open, 1(2), p.e180217.


2. Cdc.gov. 2020. U.S. State Prescribing Rates, 2018 | Drug Overdose | CDC Injury Center. [online] Available at: https://www.cdc.gov/drugoverdose/maps/rxstate2018.html


3. Cdc.gov. 2020. U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. [online] Available at: <https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html> [Accessed 2 September 2020]


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