Meron Mezgebe, Mercer University College of Pharmacy
The national opioid crisis has reached epidemic levels, with 33,091 drug overdose deaths involving an opioid in 2015.  The estimated economic burden of prescription opioid overdose, abuse, and dependence was estimated to be $78.5 billion in 2013.  The exposure to prescription opioids was found to be a strong risk factor opioid use disorder among individuals with a new episode of a chronic non-cancer pain condition in a 2000-2005 database analysis  Accordingly, in 2016 the Center for Disease Control’s (CDC) Guidelines for Prescribing Opioids for Chronic Pain outline specific criteria for the initiation and continuation of opioids for chronic pain. 
|Vital Signs: Changes in Opioid Prescribing in the United States |
|Design||Population database analysis|
|Objective||To assess changes in national-level and county-level opioid prescribing during 2006-2015|
|Methods||The QuintilesIMS Transactional Data Warehouse provided data on the number of opioid prescriptions dispensed based on a sample of approximately 59,000 pharmacies in the United States. Data included overall opioid prescribing rates, high-dose prescribing rates, and prescribing rates by days’ supply (≥30 days and <30 days). High-dose prescribing rates include prescriptions with daily dosage ≥90 morphine milligram equivalents (MME). Cold and cough products containing opioids and buprenorphine products indicated for conditions other than pain were excluded.
Changes in opioid prescribing at the national level were analyzed from 2006 to 2015. A change of ≥10% was considered an increase or decrease, whereas changes <10% were considered stable.
County characteristics were obtained from the U.S. Census Bureau; American Community Survey; U.S. Diabetes Surveillance System; Dartmouth Atlas of Health Care; Centers for Medicare and Medicaid Services; Behavioral Risk Factor Surveillance System; and the Area Health Resource File.
|Primary Outcome Measure||Annual opioid prescribing rates in the United States|
|Study Author Conclusions||The amounts of opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level.|
Variations in opioid prescribing patterns across the United States suggests a lack of consensus and demonstrate the value of greater implementation of evidence-based guidelines such as CDC’s Guideline for Prescribing Opioids for Chronic Pain. Opioid prescription appropriateness was not analyzed and a limitation of this report since clinical outcomes and prescription indications were not included. As such, appropriateness of opioid prescriptions could not be assessed. Finally, the QuintilesIMS data used to provide estimates on opioid dispensing, have not been validated.
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