Opioid prescribing has declined substantially across the United States between 2014 and 2017; however, relative to large metropolitan areas, those in rural areas were 87% more likely to be prescribed opioids during this period, according to a CDC report.
As drug overdoses have become the leading cause of accidental death in the United States, the CDC and other public health authorities have moved to promote more judicious prescribing of opioid pain medications. These medications were involved in one-quarter of overdose deaths in 2017, and many individuals who use heroin have a history of misusing prescription opioids, according to the authors. To assess current prescribing trends, the CDC analyzed deidentified patient data from athenahealth, an electronic medical record provider. The analysis included more than 31 000 US primary care practices caring for 17 million patients from January 2014 through March 2017.
The analysis showed a significant decline in opioid prescribing from 7.4% of patients between January 2014 and January 2015 to 6.4% after the CDC issued its March 2016 opioid prescribing guidelines. Although prescribing rates in both rural and metropolitan areas decreased, overall prescribing in rural areas remained higher in 2016 and 2017 at about 9% vs about 5% in major metropolitan areas.
Higher prescribing in rural areas may be linked to a higher prevalence of chronic pain, larger elder populations with pain-related conditions, or prescription drug use and misuse at earlier ages, the authors note. Clinicians in these areas also may also be more strongly influenced by their relationships with patients contributing to prescribing that isn’t consistent with guidelines. Patients in these areas also have less access to alternative pain medication.
“As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics,” the authors wrote.