Wide variation in opioid prescribing among U.S. counties, report finds

Inconsistencies in prescribing practices is leading to significant variation across the country in opioid usage, according to a new government report.

Overall, annual opioid prescribing rates fell by 13% between 2012 and 2015 to 70.6 prescriptions for every 100 people, according to a new Vital Signs analysis released Thursday by the Centers for Diseases Control and Prevention.

But the decline was not seen across the board, with only half of U.S. counties experiencing reductions between 2010 and 2015. The number of opioids per resident in the highest-prescribing counties was six times more than the amount found in the lowest-prescribing counties, the CDC found.

Higher-prescribing counties shared a number of characteristics: higher rates of uninsured and Medicaid enrollment; higher rates of unemployment; a high prevalence of such chronic conditions as arthritis and diabetes, or people suffering from a disability; higher suicide rates; a larger percentage of non-Hispanic whites. These counties also had larger concentrations of dentists and primary care physicians, the medical specialties that do most of the prescribing of opioids.

Acting CDC Director Dr. Anne Schuchat said such factors only explained about one-third of the variations in opioid prescribing. It was not entirely clear what was driving the other two-thirds.

"Clinical practice is really all over the place, which is usually a sign that you need better standards," Schuchat said during a call with reporters.

Schuchat said the report's findings offer a baseline measure of the scope of the opioid epidemic prior to the CDC's release of its opioids prescribing guidelines for chronic pain in March 2016, and that plans were underway to examine in the next year or so how the numbers may have changed since the recommendation were issued.

Despite the decline nationally, the rate remained much higher compared to years prior to the start of the epidemic, with the rate in 2015 more than three times what it was in 1999.

The number of higher-dosage opioids prescribed also declined, going from 782 morphine milligrams equivalents in 2010 to 640 in 2015. But the average number of days' supply per prescription increased by 33% between 2006 and 2015 from 13 days to 18.

"With opioid medications, we're still seeing too many getting too much for too long," Schuchat said. "The amount of opioids prescribed in 2015 was enough for every American to be medicated round the clock for three weeks."