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Observational Study
. 2023 Feb;38(2):390-398.
doi: 10.1007/s11606-022-07686-z. Epub 2022 Jun 3.

Population-Based Opioid Prescribing and Overdose Deaths in the USA: an Observational Study

Mark Olfson  1   2 , Timothy Waidmann  3 , Marissa King  4 , Vincent Pancini  3 , Michael Schoenbaum  5
Affiliations
Observational Study

Population-Based Opioid Prescribing and Overdose Deaths in the USA: an Observational Study

Mark Olfson et al. J Gen Intern Med. 2023 Feb.

Abstract

Background: Rising opioid-related death rates have prompted reductions of opioid prescribing, yet limited data exist on population-level associations between opioid prescribing and opioid-related deaths.

Objective: To evaluate population-level associations between five opioid prescribing measures and opioid-related deaths.

Design: An ecological panel analysis was performed using linear regression models with year and commuting zone fixed effects.

Participants: People ≥10 years aggregated into 886 commuting zones, which are geographic regions collectively comprising the entire USA.

Main measures: Annual opioid prescriptions were measured with IQVIA Real World Longitudinal Prescription Data including 76.5% (2009) to 90.0% (2017) of US prescriptions. Prescription measures included opioid prescriptions per capita, percent of population with ≥1 opioid prescription, percent with high-dose prescription, percent with long-term prescription, and percent with opioid prescriptions from ≥3 prescribers. Outcomes were age- and sex-standardized associations of change in opioid prescriptions with change in deaths involving any opioids, synthetics other than methadone, heroin but not synthetics or methadone, and prescription opioids, but not other opioids.

Key results: Change in total regional opioid-related deaths was positively correlated with change in regional opioid prescriptions per capita (β=.110, p<.001), percent with ≥1 opioid prescription (β=.100, p=.001), and percent with high-dose prescription (β=.081, p<.001). Change in total regional deaths involving prescription opioids was positively correlated with change in all five opioid prescribing measures. Conversely, change in total regional deaths involving synthetic opioids was negatively correlated with change in percent with long-term opioid prescriptions and percent with ≥3 prescribers, but not for persons ≥45 years. Change in total regional deaths in heroin was not associated with change in any prescription measure.

Conclusions: Regional decreases in opioid prescriptions were associated with declines in overdose deaths involving prescription opioids, but were also associated with increases in deaths involving synthetic opioids (primarily fentanyl). Individual-level inferences are limited by the ecological nature of the analysis.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Fig. 1.
Fig. 1.
Total opioid-related deaths per 100,000 persons by quintiles in 882 commuting zones, USA 2009 and 2017.
Fig. 2.
Fig. 2.
Overdose deaths involving synthetic opioids per 100,000 persons by quintiles in 882 commuting zones, USA 2009 and 2017.
See this image and copyright information in PMC

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References

    1. National Institute on Drug Abuse, Overdose death rates. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-r...
    1. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital signs: trends in emergency department visits for suspected opioid overdoses—United States, July 2016–September 2017. MMWR Morb Mortal Wkly Rep. 2018;67(9):279–85. - PMC - PubMed
    1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49. - PubMed
    1. Hartung DM, Kim H, Ahmed SM, et al. Effect of high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes. Subst Abuse 2017;39(2):239-246. - PMC - PubMed
    1. Schuchat A, Houry D, Guy GP Jr. New data on opioid use and prescribing in the United States. JAMA 2017;318(5):425-6. - PMC - PubMed

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