In the midst of a still-intense crisis in opioid abuse, a new study by healthcare researchers has found very broad variation in opioid prescribing patterns among clinicians, across different states, with policy implications for state governments.
Under the headline “Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017,” a team of clinical researchers posted an article published online March 28 in JAMA Open Network, that examined some of the clinical and policy issues involved. Lyna Z. Schieber, M.D., D.Phil., Gery P. Guy Jr., Ph.D., M.P.H., Puja Seth, Ph.D., Randall Young, Christine L. Mattson, Ph.D., Christina A. Milkosz, M.D., M.P.H., and Richard A. Schieber, M.D., M.P.H., looked at patterns of opioid prescribing in order to “estimate temporal trends and geographic variations in six key opioid prescribing measures in 50 U.S. states and the District of Columbia.”
The team performed a population-based cross-sectional analysis of opioid prescriptions filled nationwide at U.S. retail pharmacies between January 1, 2006 and December 31, 2007, analyzing a total of 233.7 million opioid prescriptions.
The researchers wrote, “In this study, across 12 years, the mean duration and prescribing rate for long-term prescriptions of opioids increased, whereas the amount of opioids prescribed per person and prescribing rate for high-dosage prescriptions, short-term prescriptions, and extended-release and long-acting formulations decreased. Some decreases were significant, but results were still high. Two-to-three-fold state variation in five measures occurred in most states. This information may help when state-specific intervention programs are being designed,” the researchers noted.
Where the clinical and policy issues meet is around state-level policy interventions. As the researchers noted, “Large variation among states has been observed in opioid-related overdose rates and consequent emergency department visits, hospital use, and deaths. Long-term trend data on opioid prescribing have been published at the county but not the state level. However,” they wrote, “the states have jurisdictional responsibility to establish and fund state- and often county-level intervention programs, as well as to change state policies, licensing, regulations, legislation, medical reimbursements, surveillance, and professional education concerning prescriptions written. Accordingly,” they added, “we examined key measures of opioid prescriptions filled in each state from 2006 through 20017, to help guide the development of state-specific interventions.”
The researchers found very wide variations among prescribers across states, along numerous dimensions, including annual amounts of opioids filled per person, duration per prescription, the prescribing of high dosages, and the prescribing of medications with extended-release and long-acting formulations.
