County-Level Opioid Prescribing in the United States, 2015 and 2017

Guy, Gery P.; Zhang, Kun; Schieber, Lyna Z.; Young, Randall; Dowell, Deborah

doi:10.1001/jamainternmed.2018.6989

Cited by 63 publications

(62 citation statements)

References 11 publications

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“…6 These sensitivity models only cover the years 2007-2017 because of data availability. Data on the prescription opioid rate were accessed from the CDC which acquired prescription data from IQVIA, a health information technology and clinical research company ( Centers for Disease Control and Prevention, 2019 ; Guy et al, 2020 ). Unfortunately, there is no comparable dataset which measures the supply of illegal drugs.…”

Section: Methodsmentioning

confidence: 99%

The economic underpinnings of the drug epidemic

Seltzer

2020

SSM - Population Health

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U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that the deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clear link between changes in labor market dynamics in the U.S. manufacturing sector and drug overdose deaths has been established. Using restricted-use vital registration records between 1999 and 2017 that comprise over 700,000 drug deaths, I test two questions: First, what is the association between manufacturing decline and drug and opioid overdose mortality rates? Second, how much of the increase in these drug-related outcomes can be predicted by manufacturing decline? The findings provide strong evidence that the restructuring of the U.S. labor market has played an important upstream role in the current drug crisis. Up to 92,000 overdose deaths for men and up to 44,000 overdose deaths for women are predicted by the decline of state-level manufacturing over this nearly two-decade period. These results persist in models that adjust for other social, economic, and policy trends changing at the same time. Critically, the findings signal the value of policy interventions that aim to reduce persistent economic precarity experienced by individuals and communities, especially the economic strain placed upon the middle class.

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Section: Methodsmentioning

confidence: 99%

The economic underpinnings of the drug epidemic

Seltzer

2020

SSM - Population Health

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“…However, while opioid prescribing has declined in recent years , opioid overdose death rates have largely continued to rise , leading to concern that efforts to reduce opioid prescribing may be ineffective or even causing harm . However, given the ongoing rise in heroin use, including fentanyl‐tainted heroin , population rates of opioid overdose may obscure trends in incident OUD among the opioid‐naive.…”

Section: Introductionmentioning

confidence: 99%

“…In response, there have been multiple initiatives to limit opioid prescribing [7][8][9][10][11][12], which could reduce the burden of opioid use disorder (OUD) and its associated harms by avoiding initial exposure to prescription opioids among individuals receiving treatment for pain [13][14][15] or by promoting safer treatment regimens for those who do start opioid analgesics [16,17], thus mitigating OUD and overdose risk. Alternatively, these measures may also limit non-medical use of prescription opioids if they reduce diversion of opioid analgesic medication [3,[18][19][20][21] However, while opioid prescribing has declined in recent years [11,22], opioid overdose death rates have largely continued to rise [23], leading to concern that efforts to reduce opioid prescribing may be ineffective or even causing harm [24][25][26][27]. However, given the ongoing rise in heroin use, including fentanyl-tainted heroin [28][29][30], population rates of opioid overdose may obscure trends in incident OUD among the opioid-naive.…”

Section: Introductionmentioning

confidence: 99%

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

et al. 2019

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Aims To examine how the risks of incident opioid use disorder (OUD), non‐fatal and fatal overdose have changed over time among opioid‐naive individuals receiving an initial opioid prescription. Design Retrospective, longitudinal study using the Massachusetts Chapter 55 data set, which linked multiple administrative data sets to study the opioid epidemic. We identified the cumulative incidence of OUD, non‐fatal and fatal overdose among the opioid‐naive initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years to 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. Setting Massachusetts, USA. Participants Massachusetts residents aged ≥ 11 years in 2011–15 who were opioid‐naive (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n = 2 154 426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. Measurements Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and non‐fatal overdose were identified from claims in the All Payer Claims Database (APCD) and hospital encounters in the acute hospital case mix files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. Findings Among opioid‐naive individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1‐year OUD rate was 1.18% in 2011, 1.11% in 2012, 1.26% in 2013 and 0.94% in 2014. Longer therapy duration was associated with higher risk of OUD [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 2.19–2.29 for duration of 3 or more months], non‐fatal (HR = 1.67, 95% CI = 1.53–1.82) and fatal opioid overdose (HR = 2.24, 95% CI = 1.91–2.61). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR = 1.14, 95% CI = 1.12–1.17), non‐fatal (HR = 1.20, 95% CI = 1.10–1.30) and fatal overdose (HR = 1.86, 95% CI = 1.61–2.16). Conclusions Among opioid‐naive individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of opioid use disorder and opioid overdose.

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“…In the United States, the annual opioid prescribing rate reached a high of 81.2 prescriptions per 100 persons in 2010 . This rate decreased to 58.7 per 100 persons in 2017 (Guy et al 2019). While efforts have been made to restructure opioid prescribing, a subset of surgical patients require these medications postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention

Lovett

Miller

Pitruzzello

et al. 2019

Journal of Perioperative Practice

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Purpose Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. Methods Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. Results Retrospective chart reviews and interviews were conducted after the intervention (May–July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. Conclusions Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.

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County-Level Opioid Prescribing in the United States, 2015 and 2017

Abstract: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Cited by 63 publications

References 11 publications

The economic underpinnings of the drug epidemic

The economic underpinnings of the drug epidemic

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention

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