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Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017
IMPORTANCE: Risk of opioid use disorder, overdose, and death from prescription opioids increases as dosage, duration, and use of extended-release and long-acting formulations increase. States are well suited to respond to the opioid crisis through legislation, regulations, enforcement, surveillance,...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484643/ https://www.ncbi.nlm.nih.gov/pubmed/30874783 http://dx.doi.org/10.1001/jamanetworkopen.2019.0665 |
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author | Schieber, Lyna Z. Guy, Gery P. Seth, Puja Young, Randall Mattson, Christine L. Mikosz, Christina A. Schieber, Richard A. |
author_facet | Schieber, Lyna Z. Guy, Gery P. Seth, Puja Young, Randall Mattson, Christine L. Mikosz, Christina A. Schieber, Richard A. |
author_sort | Schieber, Lyna Z. |
collection | PubMed |
description | IMPORTANCE: Risk of opioid use disorder, overdose, and death from prescription opioids increases as dosage, duration, and use of extended-release and long-acting formulations increase. States are well suited to respond to the opioid crisis through legislation, regulations, enforcement, surveillance, and other interventions. OBJECTIVE: To estimate temporal trends and geographic variations in 6 key opioid prescribing measures in 50 US states and the District of Columbia. DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional analysis of opioid prescriptions filled nationwide at US retail pharmacies between January 1, 2006, and December 31, 2017. Data were obtained from the IQVIA Xponent database. All US residents who had an opioid prescription filled at a US retail pharmacy were included. MAIN OUTCOMES AND MEASURES: Primary outcomes were annual amount of opioids prescribed in morphine milligram equivalents (MME) per person; mean duration per prescription in days; and 4 separate prescribing rates—for prescriptions 3 or fewer days, those 30 days or longer, those with a high daily dosage (≥90 MME), and those with extended-release and long-acting formulations. RESULTS: Between 2006 and 2017, an estimated 233.7 million opioid prescriptions were filled in retail pharmacies in the United States each year. For all states combined, 4 measures decreased: (1) mean (SD) amount of opioids prescribed (mean [SD] decrease, 12.8% [12.6%]) from 628.4 (178.0) to 543.4 (158.6) MME per person, a statistically significant decrease in 23 states; (2) high daily dosage (mean [SD] decrease, 53.1% [13.6%]) from 12.3 (3.4) to 5.6 (1.7) per 100 persons, a statistically significant decrease in 49 states; (3) short-term (≤3 days) duration (mean [SD] decrease, 43.1% [9.4%]) from 18.0 (5.4) to 10.0 (2.5) per 100 persons, a statistically significant decrease in 48 states; and (4) extended-release and long-acting formulations (mean [SD] decrease, 14.7% [13.7%]) from 7.2 (1.9) to 6.0 (1.7) per 100 persons, a statistically significant decrease in 27 states. Two measures increased, each associated with the duration of prescription dispensed: (1) mean (SD) prescription duration (mean [SD] increase, 37.6% [6.9%]) from 13.0 (1.2) to 17.9 (1.4) days, a statistically significant increase in every state; and (2) prescriptions for a term of 30 days or longer (mean [SD] increase, 37.7% [28.9%]) from 18.3 (7.7) to 24.9 (10.7) per 100 persons, a statistically significant increase in 39 states. Two- to 3-fold geographic differences were observed across states, measured by comparing the ratio of each state’s 90th to 10th percentile for each measure. CONCLUSIONS AND RELEVANCE: In this study, across 12 years, the mean duration and prescribing rate for long-term prescriptions of opioids increased, whereas the amount of opioids prescribed per person and prescribing rate for high-dosage prescriptions, short-term prescriptions, and extended-release and long-acting formulations decreased. Some decreases were significant, but results were still high. Two- to 3-fold state variation in 5 measures occurred in most states. This information may help when state-specific intervention programs are being designed. |
format | Online Article Text |
id | pubmed-6484643 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-64846432019-05-21 Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 Schieber, Lyna Z. Guy, Gery P. Seth, Puja Young, Randall Mattson, Christine L. Mikosz, Christina A. Schieber, Richard A. JAMA Netw Open Original Investigation IMPORTANCE: Risk of opioid use disorder, overdose, and death from prescription opioids increases as dosage, duration, and use of extended-release and long-acting formulations increase. States are well suited to respond to the opioid crisis through legislation, regulations, enforcement, surveillance, and other interventions. OBJECTIVE: To estimate temporal trends and geographic variations in 6 key opioid prescribing measures in 50 US states and the District of Columbia. DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional analysis of opioid prescriptions filled nationwide at US retail pharmacies between January 1, 2006, and December 31, 2017. Data were obtained from the IQVIA Xponent database. All US residents who had an opioid prescription filled at a US retail pharmacy were included. MAIN OUTCOMES AND MEASURES: Primary outcomes were annual amount of opioids prescribed in morphine milligram equivalents (MME) per person; mean duration per prescription in days; and 4 separate prescribing rates—for prescriptions 3 or fewer days, those 30 days or longer, those with a high daily dosage (≥90 MME), and those with extended-release and long-acting formulations. RESULTS: Between 2006 and 2017, an estimated 233.7 million opioid prescriptions were filled in retail pharmacies in the United States each year. For all states combined, 4 measures decreased: (1) mean (SD) amount of opioids prescribed (mean [SD] decrease, 12.8% [12.6%]) from 628.4 (178.0) to 543.4 (158.6) MME per person, a statistically significant decrease in 23 states; (2) high daily dosage (mean [SD] decrease, 53.1% [13.6%]) from 12.3 (3.4) to 5.6 (1.7) per 100 persons, a statistically significant decrease in 49 states; (3) short-term (≤3 days) duration (mean [SD] decrease, 43.1% [9.4%]) from 18.0 (5.4) to 10.0 (2.5) per 100 persons, a statistically significant decrease in 48 states; and (4) extended-release and long-acting formulations (mean [SD] decrease, 14.7% [13.7%]) from 7.2 (1.9) to 6.0 (1.7) per 100 persons, a statistically significant decrease in 27 states. Two measures increased, each associated with the duration of prescription dispensed: (1) mean (SD) prescription duration (mean [SD] increase, 37.6% [6.9%]) from 13.0 (1.2) to 17.9 (1.4) days, a statistically significant increase in every state; and (2) prescriptions for a term of 30 days or longer (mean [SD] increase, 37.7% [28.9%]) from 18.3 (7.7) to 24.9 (10.7) per 100 persons, a statistically significant increase in 39 states. Two- to 3-fold geographic differences were observed across states, measured by comparing the ratio of each state’s 90th to 10th percentile for each measure. CONCLUSIONS AND RELEVANCE: In this study, across 12 years, the mean duration and prescribing rate for long-term prescriptions of opioids increased, whereas the amount of opioids prescribed per person and prescribing rate for high-dosage prescriptions, short-term prescriptions, and extended-release and long-acting formulations decreased. Some decreases were significant, but results were still high. Two- to 3-fold state variation in 5 measures occurred in most states. This information may help when state-specific intervention programs are being designed. American Medical Association 2019-03-15 /pmc/articles/PMC6484643/ /pubmed/30874783 http://dx.doi.org/10.1001/jamanetworkopen.2019.0665 Text en Copyright 2019 Schieber LZ et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Schieber, Lyna Z. Guy, Gery P. Seth, Puja Young, Randall Mattson, Christine L. Mikosz, Christina A. Schieber, Richard A. Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title | Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title_full | Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title_fullStr | Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title_full_unstemmed | Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title_short | Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017 |
title_sort | trends and patterns of geographic variation in opioid prescribing practices by state, united states, 2006-2017 |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484643/ https://www.ncbi.nlm.nih.gov/pubmed/30874783 http://dx.doi.org/10.1001/jamanetworkopen.2019.0665 |
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