Changes in Opioid Prescribing in the United States, 2006–2015
Key Points
• The amount of opioids prescribed in the United States peaked in 2010 and then decreased each year through 2015. Despite reductions, the amount of opioids prescribed remains approximately three times as high as in 1999.
• Opioid prescribing varied substantially across the country, with average per capita amounts prescribed in the top-prescribing counties approximately six times the amounts prescribed in the lowest prescribing counties in 2015.
• Higher amounts of opioids were prescribed in counties with a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan counties; and counties with higher rates of unemployment and Medicaid enrollment.
• The substantial variation in opioid prescribing observed at the county-level suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use and demonstrates the need for better application of guidance and standards around opioid prescribing practices.
• Health care providers can follow the CDC's Guideline for Prescribing Opioids for Chronic Pain, which provides evidence-based recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain, outside of active cancer treatment, palliative care, and end-of-life care.
• Additional information is available at https://www.cdc.gov/vitalsigns/.
Abstract
Background: Prescription opioid–related overdose deaths increased sharply during 1999–2010 in the United States in parallel with increased opioid prescribing. CDC assessed changes in national-level and county-level opioid prescribing during 2006–2015.
Methods: CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.
Results: The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015. Despite significant decreases, the amount of opioids prescribed in 2015 remained approximately three times as high as in 1999 and varied substantially across the country. County-level factors associated with higher amounts of prescribed opioids include a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan status (i.e., town/city; nonmetro); and higher unemployment and Medicaid enrollment.
Conclusions and Implications for Public Health Practice: Despite reductions in opioid prescribing in some parts of the country, the amount of opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level. Given associations between opioid prescribing, opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing opioids outside of end-of-life care, follow evidence-based guidelines, such as CDC's Guideline for Prescribing Opioids for Chronic Pain, and consider nonopioid therapy for chronic pain treatment. State and local jurisdictions can use these findings combined with Prescription Drug Monitoring Program data to identify areas with prescribing patterns that place patients at risk for opioid use disorder and overdose and to target interventions with prescribers based on opioid prescribing guidelines.
FIGURE 1. Annual opioid prescribing rates, by number of days' supply, average daily morphine milligram equivalent (MME) per prescription, and average number of days' supply per prescription — United States, 2006–2015
The figure above is a set of four line graphs showing the annual opioid prescribing rates, by number of days' supply, average daily morphine milligram equivalent (MME) per prescription, and average number of days' supply per prescription in the United States during 2006–2015.
FIGURE 2. Morphine milligram equivalents (MMEs) of opioids prescribed per capita in 2015 and change in MMEs per capita during 2010–2015, by county — United States, 2010–2015
TABLE 1. Percentage of counties with changes* in opioid prescribing — United States, 2010–2015
TABLE 2. Sociodemographic characteristics of counties by MME per capita quartiles* — United States, 2015
