From Washington, D.C., head southwest into Virginia for nearly five hours and put yourself due north from Greensboro, N.C. There you will find Martinsville, Va., where more opioids were prescribed per person in 2015 than any other jurisdiction in the United States.
Clinicians in Martinsville, home to fewer than 13,500 people, prescribed almost 4,090 morphine milligram equivalents per person. The national average was 640 milligram equivalents per person.
That contrast underlines the dramatic differences in opioid prescribing across the country as health officials try to tackle a national epidemic. A report from the Centers for Disease Control and Prevention this week found that while prescribing fell nationwide from 2010 to 2015, places that prescribed the most opioids were still doling out drugs at rates six times higher than the lowest tier of communities.
With that in mind, Martinsville still stands out. Even the jurisdictions ranked No. 2 (Norton, Va.) and 3 (Campbell County, Tenn.) on the CDC’s list trailed by comfortable margins — with about 3,375 and 3,300 milligram equivalents prescribed, respectively.
(The report generally examined data at the county level, but Virginia has a number of cities like Martinsville that are not part of counties and are viewed as their own entities in federal studies.)
Dr. Anne Schuchat, who was serving as acting CDC director until Friday, told reporters that the overprescription of opioids has led to addictions and left people vulnerable to overdoses and deaths.
That’s a pattern seen around the country, and recent state data from Virginia show how pervasive the problem has become in Martinsville.
In the city and adjacent Henry County, the rate of overdoses leading to emergency department visits was the highest in the state in January, at 32 per 100,000 people. Martinsville’s monthly overdose rate has fluctuated over the months, but it has generally been among the highest rates in the state.
The demographics of Martinsville also reflect some — though not all — of the factors that the CDC researchers found were associated with high levels of opioid prescriptions. Data show more opioids being prescribed in areas with more white residents, higher unemployment rates, a greater concentration of doctors and dentists, and higher rates of disability and diabetes. The researchers estimated that the factors accounted for about a third of the prescribing differences seen among counties.
Like many of the top prescribing places, Martinsville is a “micropolitan” area, essentially a big town or small city. It also has a higher unemployment rate than the average in Virginia, and a relatively high rate of people on disability. But its population is about 50 percent white and 46 percent black.
There are a number of caveats to consider. The CDC data were based on the location of pharmacies where opioids were picked up, so people who lived elsewhere but filled their prescriptions in Martinsville could have contributed to its high rate. Many counties in the country also did not have data for the CDC to analyze.
Top 10 places where opioids prescribing was highest in 2015
|Jurisdictions||2010 Per Capita MME*||2015 Per Capita MME|
|Norton City, Va.||2647.5||3373.5|
*MME = morphine milligram equivalents.
And from 2010 to 2015, Martinsville, like half the jurisdictions studied by the CDC, actually saw a decrease in opioids prescriptions, from 5,200 milligram equivalents per person to 4,090. And it’s likely that prescriptions have continued to fall since then.
Since 2015 — the last year the CDC had data for — the agency and hospitals around the country have launched initiatives to rein in opioid prescribing. The CDC released guidelines for prescribing opioids for pain last year, and a Virginia hospital association came out with its own plan last April. Clinicians at Memorial Hospital in Martinsville also started working to reduce prescriptions in the middle of 2016, according to WSLS, a local news station.
Representatives at the hospital as well as as the local health department were not immediately available for comment.