Study Finds Wide Geographic Variation in Prescribing For Painkillers

Appalachia, Southern and Western States Have Highest Prescribing Rates

Oct 15, 2012, 08:00 ET from Abt Associates

BETHESDA, Md., Oct.15, 2012 /PRNewswire/ -- Appalachia, Southern and Western states have the highest rates of prescribing for opioids, commonly known as painkillers, a study by Abt Associates researchers published in the Journal of Pain found. The number of physicians in a county was the strongest predictor of the amount of opioids prescribed.

Using data pharmacy records for 135 million opioid prescriptions, Abt researchers studied the differences in opioid prescribing among states and counties, and examined whether these differences were attributable to the population's socioeconomic status, healthcare use, the local availability of prescribers and state policies on prescription monitoring.

An estimated 205 million prescriptions were written for eight opioids nationwide in 2008. Of these, hydrocodone prescriptions accounted for 53 percent, oxycodone prescriptions 21 percent, followed by tramadol, propoxyphene and codeine (10 percent, nine percent, and seven percent respectively).

The counties with the highest prescribing rates were disproportionately found in Appalachia and in Southern and Western states. Those with the lowest rates were generally located in Midwestern states and in Alaska. Nevada has the highest rate, with 1,150 milligrams of painkillers per resident – 603 milligrams more than the average for residents in all states. Other states in the top five include Delaware, Florida, Kentucky and Tennessee. Washington, D.C., Alaska, Hawaii, North Dakota and South Dakota are among those areas with the lowest amounts of opioid prescribing.

Counties varied widely in the amounts of painkillers (measured by weight rather than number of prescriptions) dispensed in 2008. By weight, the most commonly dispensed drug was propoxyphene. The top opioid-prescribing counties used three or four times as much of the most commonly prescribed opioids per resident as counties with lower amounts of opioid prescribing, and seven to 10 times as much oxycodone, methadone, and oxymorphone. The wide variation in oxycodone prescribing and dispensing is perhaps the most significant, given that this drug is almost half of the total amount of opioids dispensed.

"This wide variation suggests that undertreatment of pain is pervasive in some parts of the nation while in other places physicians are overprescribing these drugs, despite the high risk of abuse—which has reached epidemic proportions,"  said Dr. Douglas McDonald, the study's lead author and a principal associate in Abt's U.S. Health division. Kenneth Carlson and David Izrael of Abt Associates co-authored the paper.

This study was supported by a grant awarded to Abt Associates by the National Institutes of Health, National Institute on Drug Abuse.

About Abt Associate
Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Known for its rigorous approach to solving complex challenges, Abt Associates was ranked as one of the top 20 global research firms in 2012 and also named one of the top 40 international development innovators.  The company has multiple offices in the U.S. and program offices in nearly 40 countries.

SOURCE Abt Associates