Abstract
Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioid-related harms. To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. 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. 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. 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%. 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.
Highlights
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 milligram equivalents (MMEs) per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. In this cross-sectional study, the opioid prescribing rate in 2009 in the community health centers (CHCs) network was higher than national population estimates but began to decline earlier and more precipitously
We summarized each study year separately, creating 10 cross-sectional assessments of prescribing patterns within OCHIN clinics
Summary
Opioid-related morbidity and mortality in the US have been well documented.[1,2] This problem began with and continues to be propelled by opioid prescriptions from medical settings, with nearly half of these prescriptions generated from primary care clinics.[3,4] opioid prescribing has declined steadily since 2011, prescription rates remain historically high with enough opioids dispensed for 1 in every 2 individuals in the US in 2018.5 the opioid epidemic affects all demographic groups, individuals from low-income communities are at highest risk for opioid-related adverse outcomes, including hospitalization and fatal overdose.[5,6,7,8] Despite this increased risk, less is known about prescribing patterns in these communities. Opioid-related morbidity and mortality in the US have been well documented.[1,2] This problem began with and continues to be propelled by opioid prescriptions from medical settings, with nearly half of these prescriptions generated from primary care clinics.[3,4] opioid prescribing has declined steadily since 2011, prescription rates remain historically high with enough opioids dispensed for 1 in every 2 individuals in the US in 2018.5. Most studies that have described prescribing trends relied on insurance claims data from managed care systems and retail pharmacies,[9,10,11,12,13,14] sources that are likely to undercount unemployed and uninsured individuals, precisely those individuals most likely to have opioid-related adverse outcomes. CHC data are likely an ideal source of information concerning opioid prescribing patterns in low-income populations
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