Abstract
Problem/ConditionIn 2017, a total of 70,237 persons in the United States died from a drug overdose, and 67.8% of these deaths involved an opioid. Historically, the opioid overdose epidemic in the United States has been closely associated with a parallel increase in opioid prescribing and with widespread misuse of these medications. National and state policy makers have introduced multiple measures to attempt to assess and control the opioid overdose epidemic since 2010, including improvements in surveillance systems.Period Covered2010–2016Description of SystemThe Prescription Behavior Surveillance System (PBSS) was created in 2011. Its goal was to track rates of prescribing of controlled substances and possible misuse of such drugs using data from selected state prescription drug monitoring programs (PDMP). PBSS data measure prescribing behaviors for prescription opioids using multiple measures calculated from PDMP data including 1) opioid prescribing, 2) average daily opioid dosage, 3) proportion of patients with daily opioid dosages ≥90 morphine milligram equivalents, 4) overlapping opioid prescriptions, 5) overlapping opioid and benzodiazepine prescriptions, and 6) multiple-provider episodes. For this analysis, PBSS data were available for 2010–2016 from 11 states representing approximately 38.0% of the U.S. population. Average quarterly percent changes (AQPC) in the rates of opioid prescribing and possible opioid misuse measures were calculated for each state.Results and InterpretationOpioid prescribing rates declined in all 11 states during 2010–2016 (range: 14.9% to 33.0%). Daily dosage declined least (AQPC: -0.4%) in Idaho and Maine, and most (AQPC: -1.6%) in Florida. The percentage of patients with high daily dosage had AQPCs ranging from -0.4% in Idaho to -2.3% in Louisiana. Multiple-provider episode rates declined by at least 62% in the seven states with available data. Variations in trends across the 11 states might reflect differences in state policies and possible differential effects of similar policies.Public Health ActionsUse of PDMP data from individual states enables a more detailed examination of trends in opioid prescribing behaviors and indicators of possible misuse than is feasible with national commercially available prescription data. Comparison of opioid prescribing trends among states can be used to monitor the temporal association of national or state policy interventions and might help public health policymakers recognize changes in the use or possible misuse of controlled prescription drugs over time and allow for prompt intervention through amended or new opioid-related policies.
Highlights
In 2017, a total of 70,237 persons in the United States died from a drug overdose, and 67.8% of these deaths involved an opioid recognized as a controlled/scheduled* substance by the federal government [1]
Various factors contributed to the increase in opioid prescribing, including changing attitudes toward the role of opioids in chronic pain management, calls for more liberal use of opioids by professional pain management societies, and state regulations that have encouraged the use of opioids for chronic pain management [5]
Surveillance data are critical for addressing the epidemic of drug overdoses in the United States
Summary
In 2017, a total of 70,237 persons in the United States died from a drug overdose, and 67.8% of these deaths involved an opioid recognized as a controlled/scheduled* substance by the federal government [1]. Reasons for this dip and rebound are not well understood This period marked the introduction of mandates requiring physicians to check prescription drug monitoring programs (PDMPs) before prescribing controlled substances in selected states, the implementation of new state opioid prescribing guidelines, the development of reformulated medications designed to reduce misuse, and legislation regulating pain clinics [7]. These policy changes make it important to examine trends in opioid prescribing and possible patient misuse since 2010
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