Opioid prescriptions down since 2010, but big differences seen among counties

The United States has seen an overall decrease in opioid prescriptions in recent years, but some counties are doling out the drugs at six times the rate of lowest-prescribing counties, according to a federal report released Thursday.

Counties with more opioid prescriptions tended to be places with more white residents, more doctors and dentists, higher unemployment and Medicaid enrollment rates, and higher rates of diabetes, officials at the Centers for Disease Control and Prevention found in their report. Those factors only accounted for about a third of the variation among counties, however.

Officials noted that opioid prescriptions can push people toward addiction and the use of heroin and other illicit drugs.

“The bottom line remains, we still have too many people getting opioid prescriptions for too many days at too high a dose,” said acting CDC Director Anne Schuchat.

The report analyzed data through 2015, and CDC officials noted the agency released its guidelines for prescribing opioids for chronic pain only last year.

The data were based on the location of the pharmacy where the prescriptions were picked up, not where the patients lived. That could be one reason why rural counties had unexpectedly low rates of opioid prescribing, Schuchat said — residents had to travel to another county with a bigger town to get their prescription.

The researchers found that the amount of opioids prescribed topped out in 2010 at 782 morphine milligram equivalents per person and dipped to 640 by 2015. Officials said they were interested to see if the CDC prescribing guidelines — as well as other prescription policies enacted by states — could drive down prescriptions further.

Still, the amount of opioids prescribed on a per person level was about three times as high in 2015 as it was in 1999.

The report found that every part of the country had counties that had much higher prescribing rates than others, which officials said was a sign that clinicians did not have standards to use or disregarded them when prescribing opioids for pain.

Still, Appalachia — one of the regions most marred by the opioid epidemic — appeared to have a relatively large number of counties where prescription opioids were being dispensed at high rates.

“Clinical practice is really all over the place,” Schuchat said.

Schuchat noted that smart prescribing of painkillers could only help prevent more people from developing addictions, but that new limits wouldn’t help people who were already facing addiction.