Kimberly Townsend, M.S.
Jenna Adalbert, M.P.H.
Asif Ilyas, MD, MBA, FACS
SUMMARY POINTS
Drug-induced deaths have increased in the last five years in both Allegheny and Philadelphia Counties.
Hydrocodone and Oxycodone are the most commonly prescribed opioids in both counties. Hydrocodone was prescribed significantly more in Allegheny County while Oxycodone was prescribed significantly more in Philadelphia County.
Allegheny County prescribers wrote for significantly lower drug quantity prescriptions: including less than 21 pills and 22-60 pills, while Philadelphia County prescribers wrote significantly more 90+ pills prescriptions.
Philadelphia County prescribed significantly more opioids by volume and morphine milligram equivalents per 100,000 persons than Allegheny County.
ANALYSIS
Background
The opioid epidemic began in the 1990s and remains ongoing (1). Almost half a million Americans have died from drug overdoses since 2000 (2). While not all drug overdose deaths are attributed to opioids, at least 50% of all opioid overdose mortalities in the United States involve a prescription opioid (1). Moreover, a gateway to heroin and other illicit drugs for many individuals has been prescription opioids. About 80% of new heroin users have reported previously misused prescription opioids (3).
The Prescription Drug Monitoring Program (PDMP) was designed to help prevent prescription misuse by allowing monitoring and analysis of prescribing and dispensing of controlled substances (4). The PDMP system in Pennsylvania is a statewide electronic database that tracks prescriptions of controlled substances across the Commonwealth. Each state has its own PDMP system. Physicians, government officials, and public health professionals alike can use this data to optimize patient opioid management, as well as analyze prescribing practices that may have state-specific public health implications (4). Pennsylvania has two large metropolitan counties on each side of the state, Philadelphia County in the east and Allegheny County in the west, that offer similar demographics but different public health policy challenges. According to the U.S. Census, Philadelphia County has a population of 1,526,006 persons and Allegheny County has a population of 1,223,348 persons (5). The race makeup of the two counties differs: Philadelphia County has 44.8% White alone and 43.6% Black or African American alone, while Allegheny County has 79.9% White alone, and 13.4% Black or African American alone. The median income in Philadelphia is $45,927, and in Allegheny County, the median income is $61,043. Philadelphia has a higher percentage of people in poverty, with 23% compared to Allegheny County’s 10.8%. These two counties will be analyzed to identify trends in opioid prescribing that can better inform policymakers.
Findings
Bar charts were created to show the trends in drug-induced deaths and prescribing trends. The Pennsylvania Department of Health Enterprise Data Dissemination Informatics Exchange was used for data about drug-induced deaths in Philadelphia and Allegheny counties.
The PDMP data from Philadelphia and Allegheny counties were used to compare prescription trends by drug names, days of supply, quantity, and morphine milligram equivalents (MME) by volume and per 100,000 population. Data used included Q1 2016 through Q1 2020. Belladonna Opium, Levorphanol, and Tapentadol were excluded from analysis due to the low volume of usage. Methadone was excluded from analysis, as it is primarily prescribed for the treatment of opioid use disorder. P-values were calculated based on the null hypothesis that the means in Allegheny County and Philadelphia County would be the same for each category analyzed. If the p-value is less than 0.05, then the null hypothesis is rejected, and the difference between the two means is significant.
Figure 1 shows the age-adjusted rates of drug-induced rates in both Philadelphia and Allegheny counties. Age-adjusted death rates were higher in Philadelphia County than in Allegheny County in 2010-2014 and 2015-2019. Additionally, rates have increased over the last five years in both counties. (Disclaimer: This data was provided by the Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations, or conclusions.)
Figure 2 shows the opioid drug by name and quantity, relative to county per 100,000 persons.
Table 1 shows the number of opioid drugs by name and quantity relative to county per 100,000 persons, and their statistically significant difference.
Figure 3 shows the average opioid drug supply by day, relative to county per 100,000 persons.
Table 2 shows the number of opioid drug supply by days, relative to county per 100,000 persons, and their statistically significant difference.
Figure 4 shows the average opioid drug supply by quantity per prescription, relative to county per 100,000 persons.
Table 3 shows the number of opioid drug supply by quantity per prescription, relative to county per 100,000 persons, and their statistically significant difference.
Table 4 shows MME by Volume of total prescriptions as well as per 100,000 persons, relative to county.
Discussion
Despite large and similar population demographics, opioid prescribing trends differ between Allegheny and Philadelphia counties. Hydrocodone and Oxycodone are the most prescribed opioids in both counties; however, Hydrocodone was prescribed significantly more in Allegheny County, while Oxycodone was prescribed significantly more in Philadelphia County. Allegheny County prescribers wrote for significantly fewer drug quantities in prescriptions, including less than 21 pills and 22-60 pills, while Philadelphia County prescribers wrote significantly more 90+ pill prescriptions. Philadelphia County prescribed significantly more opioids by volume and morphine milligram equivalents per 100,000 persons than Allegheny County. Future studies should explore and analyze geographic variables contributing to these trends in order to optimize opioid prescribing and reduce patient harm for populations in these areas of Pennsylvania, as well as look into the differing numbers of prescriptions coming from palliative care physicians in each county.
REFERENCES
Labrum JT 4th, Ilyas AM. The Opioid Epidemic: Postoperative Pain Management Strategies in Orthopaedics. JBJS Rev. 2017 Aug;5(8):e14. doi: 10.2106/JBJS.RVW.16.00124. PMID: 28857933.
Burke DS. Forecasting the opioid epidemic. Science. 2016 Nov 4;354(6312):529. doi: 10.1126/science.aal2943. PMID: 27811241.
Gostin LO, Hodge JG Jr, Noe SA. Reframing the Opioid Epidemic as a National Emergency. JAMA. 2017 Oct 24;318(16):1539-1540. doi: 10.1001/jama.2017.13358. PMID: 28832871.
D'Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. 2020 Sep 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30335332.
United States Census Bureau, QuickFacts, Philadelphia County, Pennsylvania; Allegheny County, Pennsylvania [Internet]. Available from: https://www.census.gov/quickfacts/fact/table/philadelphiacountypennsylvania,alleghenycountypennsylvania/PST045219.
Pennsylvania Department of Health. Enterprise Data Dissemination Informatics Exchange. https://www.phaim1.health.pa.gov/EDD/WebForms/DeathCntySt.aspx.