According to today’s Vital Signs report by the Centers for Disease Control and Prevention (CDC), 259 million prescriptions for opioid painkillers were written in 2012. Specifically, prescribers wrote 82.5 opioid painkillers and 37.6 benzodiazepine prescriptions per 100 persons in the U.S.
In an effort to assess the potential for improved prescribing of opioid painkillers and other drugs, the CDC analyzed prescribing data of 2012 gathered from retail pharmacies in the U.S. by a vendor. The CDC then calculated prescribing rates by state for various types of opioid painkillers, long-acting/extended-release (LA/ER) opioid painkillers, high-dose opioid painkillers, and benzodiazepines.
Some key points include:
- Southern states – especially Alabama, Tennessee, and West Virginia – had the most painkiller prescriptions per person.
- The Northeast – especially Maine and New Hampshire – had the most prescriptions per person for LA/ER painkillers and for high-dose painkillers.
- State variation was the greatest for oxymorphone among all prescription painkillers; nearly 22 times as many prescriptions were written for oxymorphone in Tennessee as were written in Minnesota.
- The report also highlighted that Alabama, the highest prescribing state, wrote almost 3 times as many prescriptions per person as compared to Hawaii, the lowest prescribing state. Regarding benzodiazepines, state rates ranged 3.7 fold (West Virginia vs. Hawaii). Comparing both opioid painkillers and benzodiazepines, Alabama, Tennessee, and West Virginia were the 3 highest prescribing states.
One of the studies in the Vital Signs report highlights Florida’s success in reversing its prescription drug overdose trends. During 2003–2009, the number of drug overdose deaths increased 61%, from 1,804 to 2,905. After Florida’s enforcement laws in 2010 and 2011, there was a 23% decrease in death rate from prescription drug overdose between 2010–2012 (from 14.5 to 11.1 per 100,000 persons). Based on data from the Florida Medical Examiners Commission and the IMS Health National Prescription Audit, this decline in death rates in Florida for specific prescription opioids (eg, oxycodone, methadone, hydrocodone) and sedatives correlated to declines in prescribing rates for these painkillers.
Research in the past has demonstrated that state variation does not always result in better health outcomes or patient satisfaction. Factors responsible for the regional variation are unknown. The report concluded that wide variations are unlikely to be due to underlying differences in the health status of the population. The high prescribing rates show the need to evaluate prescribing behavior that may better achieve (or balance?) pain relief and patient safety.
The CDC recommends the following steps that states can take to address the overprescribing of painkillers:
- Considering ways to increase use of prescription drug monitoring programs, which are state-run databases that track prescriptions for painkillers and can help find problems in overprescribing.
- Considering policy options, including laws and regulation, relating to pain clinics to reduce prescribing practices that are risky to patients.
- Evaluating their own data and programs and considering ways to assess their Medicaid, workers’ compensation programs, and other state-run health plans to detect and address inappropriate prescribing of painkillers.
- Identifying opportunities to increase access to substance abuse treatment and considering expanding first responder access to naloxone.
For more information visit CDC.gov.