Prescribing Practices

Changes in Opioid Prescribing Practices

Taking prescription opioids for longer periods of time or in higher dosages can increase the risk of opioid use disorder (addiction), overdose, and death. It is also important for patients and providers to discuss the risks of opioids, consider alternative therapies, and, if prescribing opioids is appropriate, the provider should offer fewer prescriptions for fewer days and at lower dosages.

The overall opioid prescribing rate in the United States peaked and leveled off from 2010-2012 and has been declining since 2012, but the amount of opioids in morphine milligram equivalents (MME) prescribed per person is still around three times higher than it was in 1999.¹ MME is a way to calculate the total amount of opioids, accounting for differences in opioid drug type and strength.

There was a more than 19% reduction in annual prescribing rate from 2006 to 2017. The declines in opioid prescribing rates since 2012 and high-dose prescribing rates (≥90 MME) since 2008 suggest that healthcare providers have become more cautious in their opioid prescribing practices.

In 2017, however, there were still almost 58 opioid prescriptions written for every 100 Americans.

• More than 17% of Americans had at least one opioid prescription filled, with an average of 3.4 opioid prescriptions dispensed per patient.
• Per prescription, the average daily amount was more than 45.3 MME.
• The average number of days per prescription continues to increase, with an average of 18 days in 2017.²

There is wide variability at the county level in the amount of opioids received per resident. Counties with higher prescribing have been shown to have these characteristics:

• Generally smaller cities or larger towns
• Higher percentage of white residents
• Higher number of dentists and primary care physicians per capita
• More people who are uninsured or unemployed
• More residents who have diabetes, arthritis, or a disability¹

Healthcare providers report concerns about opioid-related risks of addiction and overdose for their patients, as well as insufficient training in pain management. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain offers recommendations that may help to improve prescribing practices and ensure all patients receive safer, more effective pain treatment. Healthcare providers can also earn continuing education through this interactive training series called Applying the CDC Guideline for Prescribing Opioids.

References

1. Centers for Disease Control and Prevention. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR 2017; 66(26):697-704.
2. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.