Efforts to Reduce Opioid Prescribing Varied Across the Country

The volume of prescription opioids dispensed from retail pharmacies declined by 21% from 2008 to 2018, a new study finds.

Although the volume of opioid prescriptions has decreased, the decline varied depending on the location, the kind of patient, and who was doing the prescribing, according to a new RAND Corporation study published by the Annals of Internal Medicine.

The study found that the volume of prescription opioids dispensed from retail pharmacies declined by 21% from 2008 to 2018.

It declined the most in metropolitan counties (more than 22%) and in counties with higher rates of fatal opioid overdoses (a 35% decline).

Among prescribers, the greatest percentage decrease was among emergency physicians (71% decline), who are likely prescribing opioids predominantly to patients experiencing acute pain in acute care settings.

"The findings do not provide concrete answers about how much of the unnecessary prescribing of opioids has been eliminated," Dr. Bradley D. Stein, the study's lead author and a senior physician researcher at RAND, said in a statement. "But the work demonstrates that there is a lot more nuance in the changes in opioid prescribing than we previously understood."

RAND researchers examined differences in opioid prescriptions filled at pharmacies during the periods of 2008 through 2009 and 2017 through 2018. The prescription information came from IQVIA Prescription data, which captures about 90% of prescriptions filled at U.S. retail pharmacies. It's the first study to examine the decline in opioid prescriptions filled at retail pharmacies based on both volume and potency of the drugs dispensed.

They used days' supply and total daily opioid dose to calculate per capita morphine milligram equivalents (MME) for opioid prescriptions filled during the study period. Because opioids are available in different forms, this measurement provides a better assessment of the total amount of opioids filled by patients as compared to just the number of pills dispensed, the researchers said.

The study also found variation both within and across states. In some states, MME volume per capita increased in multiple counties. In many other states, there were counties with both increases and others with substantial decreases. Counties that experienced substantial decreases in per capita MME often were adjacent to counties with per capita increases.

Most clinical specialties recorded declines in the MME volume per practicing clinician. The greatest decrease in MME volume per practicing clinician was among adult primary care physicians (40% decline) and pain specialists (15% decline).

 "Future efforts to enhance clinically appropriate opioid prescribing may need to be more clinically nuanced and targeted for specific populations," Stein said.