CDC Highlights Statewide Disparities in Opioid Prescribing

In 2012, the Centers for Disease Control and Prevention (CDC) found that for every 100 people in the United States, US clinicians wrote 82.5 prescriptions for opioid painkillers and 37.6 prescriptions for benzodiazepines [JAMA. 2014;312(7):684-686]. The CDC also found that state-by-state differences in opioid prescribing were vastly different and difficult to explain.

Hawaii had the lowest prescribing rate for painkillers in 2012, with 52 prescriptions per 100 individuals. Conversely, the second top prescribing state, Tennessee, had a rate of 143 prescriptions per 100 individuals. Additionally, in 2012, US clinicians wrote 259 million opioid prescriptions, which is enough for every adult to have 1 bottle, according Thomas Frieden, MD, MPH, director, CDC, during a recent press briefing.

Since 2010, Florida has become a model in an effort to curb inappropriately prescribed opioids for nonmedical reasons. The state housed 98 of the nation’s top 100 opioid dispensing prescribers in 2010. Subsequently, Florida required all pain clinics in the state to register by January 2010, beginning a major crackdown known as Operation Pill Nation. By February 2011, undercover officers had made 340 purchases of medication from 60 physicians at more than 40 pain clinics without showing proper evidence of valid medical claims to warrant opioid prescribing, according to the Drug Enforcement Administration. Twenty-two individuals were arrested and $2.2 million in cash was seized related to this crackdown.

Florida released a report indicating that between 2003 and 2009, the number of overdose deaths increased by 61% from 1804 to 2905. However, since the operation began in 2010, the state has seen a decrease in deaths from 3201 in 2010 to 2666 in 2012, according to data from state medical examiners. Similarly, Tennessee saw its prescription overdose deaths rise from 422 in 2003 to 1059 in 2010.

Both Florida and Tennessee have started prescription drug monitoring programs for physicians to check the database before prescribing opioids to gauge for doctor shopping. For Tennessee, this initiative resulted in a 50% decrease in patients using ≥5 prescribers or ≥5 dispensing facilities in the preceding 90 days, according to Timothy F. Jones, MD, epidemiologist, Tennessee Department of Health.

New York also began a prescription monitoring system in 2012, and by 2013, the state saw a 75% decline in the risky use of multiple prescribers, according to a report by the CDC.

The CDC noted that high prescribing of opioids is specifically more frequent in the South, the
Appalachia, and parts of the West and Southwest. The cause for this is not clear, although there is speculation that poverty and access to healthcare delivery may be factors. According to Tennessee data, white males are disproportionately higher risk users of opioids.

Though deaths from overdose of opioids have continued to rise, the rate has slowed. In 2011, 16,917 deaths were related to painkillers, which amounted to a 2% increase from the 16,651 deaths in 2010. Conversely, from 2009 to 2010 there was an increase in deaths of 8% from 15,597 to 16,917.—Kerri Fitzgerald