Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015

TLDR

Prescription opioid‑related overdose deaths rose sharply from 1999 to 2010 in the United States, coinciding with increased opioid prescribing and underscoring the need for careful, guideline‑based prescribing. The study aims to help providers and jurisdictions weigh the risks of opioid use, follow evidence‑based guidelines, and target interventions to reduce opioid‑related harm. CDC analyzed national and county‑level opioid prescribing from 2006‑2015 using QuintilesIMS retail prescription data, assessing rates, amounts, dosages, and durations, and combined these findings with Prescription Drug Monitoring Program data to identify high‑risk areas. Opioid prescribing peaked at 782 MME per capita in 2010, fell to 640 MME in 2015, yet remained about three times higher than 1999 levels and varied widely across counties, with higher prescribing linked to larger non‑Hispanic white populations, diabetes and arthritis prevalence, micropolitan status, unemployment, and Medicaid enrollment.

Abstract

Prescription opioid-related overdose deaths increased sharply during 1999-2010 in the United States in parallel with increased opioid prescribing. CDC assessed changes in national-level and county-level opioid prescribing during 2006-2015.CDC analyzed retail prescription data from QuintilesIMS to assess opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015. Despite significant decreases, the amount of opioids prescribed in 2015 remained approximately three times as high as in 1999 and varied substantially across the country. County-level factors associated with higher amounts of prescribed opioids include a larger percentage of non-Hispanic whites; a higher prevalence of diabetes and arthritis; micropolitan status (i.e., town/city; nonmetro); and higher unemployment and Medicaid enrollment.Despite reductions in opioid prescribing in some parts of the country, the amount of opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level. Given associations between opioid prescribing, opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing opioids outside of end-of-life care, follow evidence-based guidelines, such as CDC's Guideline for Prescribing Opioids for Chronic Pain, and consider nonopioid therapy for chronic pain treatment. State and local jurisdictions can use these findings combined with Prescription Drug Monitoring Program data to identify areas with prescribing patterns that place patients at risk for opioid use disorder and overdose and to target interventions with prescribers based on opioid prescribing guidelines.