Does where you live influence how likely you are to be prescribed an opioid drug for pain relief? Yes, according to a new report from the CDC.
Researchers at the agency examined retail prescription data (pulled from a national electronic database) for the entire U.S. from 2006 to 2015, and county-level prescribing patterns from 2010 to 2015. They found that, although the amount of opioids prescribed nationwide has decreased since peaking in 2010, prescriptions for these narcotic pain relievers—which include the natural opioids hydrocodone (Vicodin) and oxycodone (OxyContin) and the synthetic (and much more powerful) drug fentanyl—remain high. In 2015, for example, the number of opioid prescriptions was more than triple the amount in 1999. In 2014, more than 240 million prescriptions were written for opioids—more than enough to give each American adult his or her own bottle of bills.
When the CDC looked at prescribing by county, major differences emerged. The researchers found that there were six times more prescriptions for opioids per person in the highest-prescribing counties than in the lowest-prescribing counties. Characteristics associated with higher-prescribing counties included a higher percentage of white residents, more dentists and primary care physicians per capita, more uninsured or unemployed residents, and more individuals with a disability, diabetes, or arthritis. The highest-prescribing counties were also more likely to contain small cities or big towns, rather than larger cities.
These trends are cause for concern because higher opioid prescribing puts more patients—as well as relatives or friends who may obtain their leftover pills—at risk of addiction and even death. In 2015, opioid overdoses killed more than 33,000 people in the U.S.; half of those deaths were related to prescription opioids. (Others were from illegal opioids such as heroin and illegal fentanyl.) The longer a person takes an opioid, even at low doses, the greater the risk of addiction. In fact, taking an opioid for more than three months increases the risk of addiction by 15 times. As a result, individuals who become addicted may seek illegal sources of opioids, including heroin and illegal fentanyl. In 2014, two million Americans abused or were dependent on opioids, according to the CDC.
Stemming the tide of opioid abuse
The CDC report encourages health care providers to be proactive and aware when prescribing opioids, and advises them to look to other, safer options for pain control whenever possible including over-the-counter drugs like acetaminophen (Tylenol) and ibuprofen (Motrin), physical therapy, and cognitive behavioral therapy. Opioids should be prescribed for only three to seven days at a time, and only the lowest effective dose should be used.
Federal and state governments are also working on solutions to the prescription opioid problem, including educating health care providers and the public on the dangers of opioids, engaging in research on pain management and addiction, and improving access to addiction services.
For your part, if you are prescribed an opioid, don’t share it with anyone, and if you have any leftover pills, safely dispose of them rather than keeping them lying around. A report in JAMA Internal Medicine in 2016 found that most adults and adolescents using prescription opioids for nonmedical uses got them from family and friends (i.e., leftovers), rather than having their own prescriptions. In a study of adults who had received prescriptions for opioids following a surgical procedure, published in August 2017 in JAMA Surgery, at least two-thirds of participants reported having unused opioid tablets. And about three-quarters of those who had the pills in their homes reported that their drugs were not stored in a locked container.
To learn more about opioids and opioid abuse, visit this CDC web page.
Originally published July 2017. Updated August 2017.
Also see Alternative Therapies for Chronic Pain.