Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

Abstract

IMPORTANCE Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioidrelated harms. OBJECTIVE To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis. MAIN OUTCOMES AND MEASURES The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users. RESULTS The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.

Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study

“…Opioid use at initiation has been shown to affect downstream consequences such as long-term use [ 22 ] and unintentional overdoses, underscoring the importance of commencing on low potency and dose on first prescription. Recent studies beyond 2015 have demonstrated a decline or a plateauing of opioid prescribing across a number of jurisdictions, especially of high-dose use and of high-strength opioids such as oxycodone [ 22 , 41 , 42 ]. In all populations, the decline in such prescribing reflects national, regulatory, federal, statewide, and local efforts, especially as portrayals related to opioid-related harms become more prevalent via the media.…”

Characterizations of Opioid Prescribing in Community Health Centers in 2018

“…Chronic opioid use : patients who, within calendar quarter, were prescribed ≥160 opioid pills (short- or long-acting), ≥90 long-acting pills, or any methadone pills or fentanyl patches. 9 …”

“…High-dose use : chronic users who averaged more than 90 morphine milligram equivalents (MMEs) per day through any quarter in 2018. 9 …”

“…8 Recent evidence shows a precipitous decline in opioid prescribing between 2009 and 2018 in CHCs, citing the importance of federal, state, and local efforts in curtailing prescribing patterns and CHCs’ heightened quality improvement initiatives to reduce overprescribing. 9 …”

Untitled

“…Opioid use at initiation has been shown to affect downstream consequences such as longterm use [22] and unintentional overdoses, underscoring the importance of commencing on low potency and dose on first prescription. Recent studies beyond 2015 have demonstrated a decline or a plateauing of opioid prescribing across a number of jurisdictions, especially of high-dose use and of high-strength opioids such as oxycodone [22,41,42]. In all populations, the decline in such prescribing reflects national, regulatory, federal, statewide, and local efforts, especially as portrayals related to opioid-related harms become more prevalent via the media.…”