Elsevier

The Journal of Pain

Volume 13, Issue 10, October 2012, Pages 988-996
The Journal of Pain

Original Report
Geographic Variation in Opioid Prescribing in the U.S.

https://doi.org/10.1016/j.jpain.2012.07.007Get rights and content
Under an Elsevier user license
open archive

Abstract

Estimates of geographic variation among states and counties in the prevalence of opioid prescribing are developed using data from a large (135 million) representative national sample of opioid prescriptions dispensed during 2008 by 37,000 retail pharmacies. Statistical analyses are used to estimate the extent to which county variation is explained by characteristics of resident populations, their healthcare utilization, proxy measures of morbidity, availability of healthcare resources, and prescription monitoring laws. Geographic variation in prevalence of prescribed opioids is large, greater than the variation observed for other healthcare services. Counties having the highest prescribing rates for opioids were disproportionately located in Appalachia and in southern and western states. The number of available physicians was by far the strongest predictor of amounts prescribed, but only one-third of county variation is explained by the combination of all measured factors. Wide variation in prescribing opioids reflects weak consensus regarding the appropriate use of opioids for treating pain, especially chronic noncancer pain. Patients’ demands for treatment have increased, more potent opioids have become available, an epidemic of abuse has emerged, and calls for increased government regulation are growing. Greater guidance, education, and training in opioid prescribing are needed for clinicians to support appropriate prescribing practices.

Perspective

Wide geographic variation that does not reflect differences in the prevalence of injuries, surgeries, or conditions requiring analgesics raises questions about opioid prescribing practices. Low prescription rates may indicate undertreatment, while high rates may indicate overprescribing and insufficient attention to risks of misuse.

Key words

Opioids
prescribing
prevalence
geographic variation

Cited by (0)

This study was supported by grant RC2 DA028920 awarded by the Office of the Director, National Institutes of Health, National Institute on Drug Abuse. Prescription LRx Data, 2008 was obtained by Abt Associates under license from IMS Health Incorporated; all rights reserved. County location of prescribers’ offices obtained from Physician Professional Data, 2008, American Medical Association; all rights reserved. None of the authors has any institutional or personal conflict of interest. Authors had full access to all of the data in the study and are responsible for the integrity of the data and the accuracy of the analyses. Abt Associates' Institutional Review Board approved this study. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of the National Institutes of Health, the National Institute on Drug Abuse, Abt Associates Inc., or IMS Health Incorporated or any of its affiliated or subsidiary entities.