Opioid Prescribing Down 21% Overall, but Variances Observed Among Groups

Opioid prescriptions dispensed by retail pharmacies declined by 21% from 2008 to 2018, but variances were observed based on geographic area, types of patients, and types of prescribers, according to a study recently released by the not-for-profit research organization RAND Corp. and published in the Annals of Internal Medicine.

With overprescribing of opioid medications for pain identified as a key driver of the US opioid crisis, initiatives to encourage providers to reduce the number of prescriptions have been taken at state, federal, and private levels, RAND noted in a news release announcing the study. The company looked at prescribing statistics during 2008-09 and 2017-18 from IQVIA Prescription data, which includes about 90% of prescriptions filled at US retail pharmacies. Metrics studied included used days’ supply and total daily opioid dose to calculate per capita morphine milligram equivalents (MME) for opioid prescriptions.

Among the study’s findings:

• Per capital MME volume declined the most in metropolitan counties (more than 22%), as well as in counties with higher rates of fatal opioid overdoses (35%).
• Substantial variations in prescribing were observed within states and across state lines. In some states, MME volume per capita increased in multiple counties, while other states saw some of their counties increase prescribing while others had substantial decreases. Also of note: Counties with substantial decreases often were found to be adjacent to counties with opioid prescribing increases.
• While most clinical specialties had declines in MME volume per practitioner, the greatest reductions were among adult primary care physicians (40% decline) and pain specialists, who after having the highest MME volume per clinician in 2008-09, dropped 15% by 2017-18.
• Emergency physicians—clinicians who are likely prescribing opioids to patients experiencing acute pain in acute care settings—had the largest drop in opioid prescriptions written (71%).

“The findings do not provide concrete answers about how much of the unnecessary prescribing of opioids has been eliminated. But the work demonstrates that there is a lot more nuance in the changes in opioid prescribing than we previously understood,” study lead author Bradley D. Stein, PhD, MD, MPH, a senior physician researcher at RAND, said in a news release.