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New CDC Study Finds Guidelines Help to Decrease Opioid Prescriptions, but Geographic Disparities Remain

January 17, 2019

This week, the U.S. Centers for Disease Control and Prevention (CDC) released a new study about opioid prescribing trends. The study found that physicians have reduced the overall frequency with which they are prescribing opioids following the CDC’s release of its Guideline for Prescribing Opioids for Chronic Pain. The rates of reductions, however, vary between urban and rural areas.

The retroactive study examines electronic health records (EHR) from 17 million deidentified EHR from commercial vendor Athenahealth. The prescribing rates were monitored from January 5, 2014, through March 11, 2017, a duration of 166 weeks. For purposes of benchmarking and comparison, the study’s data was divided into three time periods, and geographic regions were divided into six categories, based on population density (large central metropolitan; large fringe metropolitan; medium metropolitan; small metropolitan; metropolitan; and noncore counties, which represent the most rural areas). The data was adjusted for seasonal and logistical considerations.

The study found that:

  • The overall prescription rates dropped from 7.4 percent during the first time period (the week of January 5, 2014, through January 3, 2015) to 7 percent during the second time period (January 4, 2015 through March 19, 2016)
  • During the third time period (March 20, 2016 through March 11, 2017), following the release of the CDC guidelines during March 2016, the overall prescription rate dropped to 6.4 percent
  • Opioid prescription rates remained higher in nonmetropolitan counties than in metropolitan counties. Researchers pointed to the increased likelihood of patients having personal relationships with physicians as a contributor to the higher prescription rates. They also raised the potential of residents in nonmetropolitan areas experiencing higher rates of chronic pain and misusing opioids at a younger age as possible contributing factors to the higher prescription rates.

This study only examines a single EHR vendor’s data, which can present limitations regarding the types of patients included. The study does, however, provide an additional look into the nationwide progress that hospitals and health care providers are making to reduce opioid prescriptions.

Pennsylvania has been deeply impacted by the opioid crisis. The Drug Enforcement Agency reports that, during 2017, 5,456 Pennsylvanians died from drug-related overdoses, a rate nearly double that of the U.S.

Pennsylvania’s hospital community has been working with state and local governments to address the opioid crisis head on. Hospitals are setting guidelines to limit the quantity and duration of opioid prescriptions, implementing emergency department warm hand-off protocol, utilizing Pennsylvania’s Prescription Drug Monitoring Database, installing drug takeback locations, and engaging in community and patient education about the dangers of opioids and alternative pain management.

Some of the commonwealth’s hospitals and health care providers are leveraging telemedicine technology to help substance use disorder patients access the behavioral health care they need while they receive treatment in inpatient facilities. Especially in rural communities, telemedicine has helped to address behavioral health care provider shortages.

For more information, contact Michael Consuelos, MD, HAP’s senior vice president, clinical integration.

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