The first multi-state report from the Centers for Disease Control and Prevention (CDC)’s Prescription Behavior Surveillance System (PBSS) shows state prescribing practices for prescription opioid pain relievers, benzodiazepines (sedatives/tranquilizers), and stimulants vary significantly despite a similar prevalence of the conditions these medications are intended to treat. The study appears in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

Data from 2013 was submitted to the PBSS from prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) on every prescription for a controlled substance. This information represent approximately one fourth of the U.S. population.

Opioid analgesics were prescribed about twice as frequently as stimulants or benzodiazepines in all eight states, but prescribing rates by drug class varied widely by state. Prescribing rates for opioids and benzodiazepines were substantially higher for females than males in all states; in most states, opioid prescribing rates peaked in the 45–54 years or the 55–64 years age group and benzodiazepine prescribing rates increased with age. Louisiana ranked first in opioid prescribing, while Delaware and Maine had relatively high rates of use of long-acting (LA) or extended-release (ER) opioids. Delaware and Maine were greatest in both mean daily opioid dosage and in the percentage of opioid prescriptions written for >100MMEs (morphine milligram equivalents) per day.

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The top 1% of prescribers wrote one in four opioid prescriptions in Delaware, vs. one in eight in Maine. The percentage of controlled substance prescriptions paid for in cash (an indicator of abuse) varied almost threefold for the five states whose PDMPs collected the method of payment. For one of every five days of treatment with an opioid, the patient also was taking a benzodiazepine in West Virginia. Multiple-provider episode rates were highest in Ohio and lowest in Louisiana.

“A more comprehensive approach is needed to address the prescription opioid overdose epidemic, including guidance to providers on the risks and benefits of these medications,” said Debra Houry, MD, MPH, director of CDC’s National Center for Injury Prevention and Control.

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