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  • The Good With the Bad: Reports Show a Drop in Opioid Prescriptions and Dosage Strength, Rise in Prescription Duration and Opioid Hospitalizations

    The latest news on the opioid crisis is decidedly mixed. Reports show some reduction in prescription rates and dosages, but an overall increase in prescription length, wide variation in prescribing across the US, and prescription prevalence in 2015 that was 3 times as high as it was in 1999 and 4 times higher than in Europe in 2015. CDC Acting Director Anne Schuchat told National Public Radio that the 2015 per capita prescription opioid rates are enough for "every American [to] be medicated around the clock for 3 weeks."

    The analysis, from the US Centers from Disease Control and Prevention (CDC), came on the heels of another report from the Agency for Healthcare Quality and Research (AHRQ) showing that opioid-related inpatient stays and emergency department (ED) visits more than doubled between 2005 and 2014.

    The CDC report analyzed retail prescription data from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. The analysis also included a county-by-county look at prescription data in 2010 and 2015. Here's what researchers found:

    The good news: overall prescribing rates have dropped by 13% since 2010 peak levels.
    From 2006 to 2010, opioid prescribing rates increased from 72.4 per 100 persons to an all-time high of 81.2 per 100. By 2015, that rate had dropped to 70.6 per 100 persons. The amount of opioids also dropped from the 2010 peak of 782 morphine milligram equivalents (MMEs) per capita to the 2015 rate of 640 MMEs per capita—still 3 times higher than 1999's rate of 180 MMEs per capita.

    More good news: the drop includes a decrease in prescription of high-dose opioids.
    High-dose prescriptions (daily dosages of 90 or more MMEs) mostly were stable between 2006 and 2010, at 11.4 per 100 persons, then dropped to a rate of 6.7 per 100 by 2015.

    The bad news: prescription duration times have increased since 2006.
    While fewer people may be prescribed opioids, and while those opioids may be at lower strength, the rate of prescription supplies of 30 days or more jumped by 58% between 2006 and 2015, rising from 17.6 per 100 persons to about 28 per 100. The overall average days' supply also rose during that time period, from 13.3 days in 2006 to 17.7 by 2015—a 33% increase.

    More bad news: the positive trends aren't consistent across the US.
    A county-by-county comparison of opioid prescriptions in 2010 and 2015 revealed wide variations among counties, ranging from an average 203 MMEs per capita in the lowest-quartile counties to 1,319 MMEs per capita or more for counties in the highest quartile.

    The highest-prescribing areas tended to share certain characteristics.
    Researchers found several characteristics of the high-prescribing counties including larger percentages of non-Hispanic whites, higher rates of uninsured or Medicaid enrollment, lower education levels, higher rates of unemployment, "micropolitan" (small cities and towns) status, more dentists and physicians per capita, higher suicide rates, and a higher prevalence of diagnosed diabetes, arthritis, and disability.

    The CDC report was released not long after AHRQ published an analysis of opioid-related inpatient hospital stays and ED visits from 2005 to 2014. That report found that inpatient stays increased by 64% during the time period, with opioid-related ED visits doubling. The news was worse for women: between 2005 and 2014, inpatient rates that were historically lower than males caught up, so that by 2014, opioid-related inpatient rates for both sexes were roughly equal. The report was produced by AHRQ's Healthcare Cost and Utilization Project.

    While not directly citing the AHRQ report, authors of the CDC report did acknowledge rising overdose rates, defining the increases as "largely driven by use of illicit fentanyl and heroin" and adding that "there is no evidence that policies designed to reduce inappropriate opioid prescribing are leading to these increases."

    When it comes to the differences between counties, authors speculate that the higher prescription rates in micropolitan counties and counties with a higher prevalence of arthritis and diabetes might be related to access to nondrug pain treatments.

    "There are effective nonopioid treatments for pain whose benefits outweigh the harms," CDC authors write. "Reasons for higher opioid use in micropolitan counties might include less access to quality health care and other treatments for pain, such as physical therapy."

    Ultimately, they write, "this variation suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use, and demonstrates the need for better application of guidance and standards around opioid prescribing practices." Among those standards: CDC's own guidelines for pain management, which urge the use of nonopioid approaches such as physical therapy as a first-line treatment for chronic pain.

    APTA's award-winning #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, #ChoosePT includes a video public service announcement, as well as other targeted advertising and media outreach. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

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