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Prescription Opioid Data

Prescription opioids are often used to treat chronic and acute pain and, when used appropriately, can be an important component of treatment. However, serious risks are associated with their use, and it is essential to carefully consider the risks of using prescription opioids alongside their benefits. These risks include misuse, opioid use disorder (addiction), overdoses, and death.

Millions of Americans suffer from pain and are often prescribed opioids to treat their conditions. However, the dangers of prescription misuse, opioid use disorder, and overdose have been a growing problem throughout the United States.

Since the 1990s, when the amount of opioids prescribed to patients began to grow, the number of overdoses and deaths from prescription opioids has also increased. Even as the amount of opioids prescribed and sold for pain has increased, the amount of pain that Americans report has not similarly changed.

From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.1

Changes in Opioid Prescribing Practices

Taking prescription opioids for longer periods of time or in higher dosages can increase the risk of opioid use disorder (addiction), overdose, and death. It is also important for patients and providers to discuss the risks of opioids, consider alternative therapies, and, if prescribing opioids is appropriate, the provider should offer fewer prescriptions for fewer days and at lower dosages.

The overall opioid prescribing rate in the United States peaked and leveled off from 2010-2012 and has been declining since 2012, but the amount of opioids in morphine milligram equivalents (MME) prescribed per person is still around three times higher than it was in 1999.2 MME is a way to calculate the total amount of opioids, accounting for differences in opioid drug type and strength.

There was a more than 19% reduction in annual prescribing rate from 2006 to 2017. The declines in opioid prescribing rates since 2012 and high-dose prescribing rates (≥90 MME) since 2008 suggest that healthcare providers have become more cautious in their opioid prescribing practices.

In 2017, however, there were still almost 58 opioid prescriptions written for every 100 Americans.

  • More than 17% of Americans had at least one opioid prescription filled, with an average of 3.4 opioid prescriptions dispensed per patient.
  • Per prescription, the average daily amount was more than 45.3 MME.
  • The average number of days per prescription continues to increase, with an average of 18 days in 2017.3

There is wide variability at the county level in the amount of opioids received per resident. Counties with higher prescribing have been shown to have these characteristics:

  • Generally smaller cities or larger towns
  • Higher percentage of white residents
  • Higher number of dentists and primary care physicians per capita
  • More people who are uninsured or unemployed
  • More residents who have diabetes, arthritis, or a disability2

Healthcare providers report concerns about opioid-related risks of addiction and overdose for their patients, as well as insufficient training in pain management. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain offers recommendations that may help to improve prescribing practices and ensure all patients receive safer, more effective pain treatment. Healthcare providers can also earn continuing education through this interactive training series called Applying the CDC Guideline for Prescribing Opioids.

Calculating Prescription Opioid Overdose Deaths

When looking at overdose deaths from prescription opioids, CDC analyzes the following:

  • Natural opioids: Pain medications like morphine and codeine
  • Semi-synthetic opioids: Pain medications like oxycodone, hydrocodone, hydromorphone, and oxymorphone
  • Methadone: A synthetic opioid used to treat pain, but it can also be provided through opioid treatment programs to treat opioid use disorders

Current information reported about overdose deaths does not distinguish pharmaceutical fentanyl from illegally-made fentanyl. In order to account for increases in illicitly manufactured fentanyl, CDC Injury Center separates synthetic opioids (other than methadone) from prescription opioid death calculations.

Overdose Deaths Involving Prescription Opioids

46 people die every day from overdoses involving prescription opioids.4  In 2017, prescription opioids continue to contribute to the epidemic in the U.S. – they were involved in more than 35% of all opioid overdose deaths.

The most common drugs involved in prescription opioid overdose deaths include:

  • Methadone
  • Oxycodone (such as OxyContin®)
  • Hydrocodone (such as Vicodin®)5

For people who died from prescription opioid overdose in 2017:

  • Overdose rates from prescription opioids significantly increased among people more than 65 years of age.
  • Overdose rates from prescription opioids were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.
  • The rate of overdose deaths from prescription opioids among men was 6.1 per 100,000 people and the rate among women was 4.2 in 2017.

The highest overdose death rates from prescription opioids were in West Virginia, Maryland, Kentucky, and Utah.4

Guideline in Practice

Health systems can create Electronic Health Record (EHR) alerts (e.g., for high daily dosage, multiple opioid prescriptions), which allows providers to make informed prescribing decisions within clinical workflow.

In March 2016, CDC released the CDC Guideline for Prescribing Opioids for Chronic Pain to ensure that patients have access to safer, more effective chronic pain treatment, while reducing the number of people who misuse opioids, develop opioid use disorder, or overdose. The Guideline focused on the prescribing of opioid pain medication to patients 18 years and older in primary care settings outside of active cancer treatment, palliative care and end of life care.

CDC is evaluating implementation of the Guideline by providers, health systems, and insurers with the goal of identifying how the recommendations are being applied, and potential barriers to implementation.

As of April 2018:

Statistically significant changes in drug overdose death* rates involving prescription opioids§ by select states,¶ United States, 2016 to 2017.** Note: Rate comparisons between states should not be made due to variations in reporting across states.

*Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14.

† Rates shown are for the number of deaths per 100,000 population. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.

§ Drug overdose deaths, as defined, that have natural and semi-synthetic opioids (T40.2) and methadone (T40.3) as contributing causes.

Analyses were limited to states meeting the following criteria: For states with very good to excellent reporting, ≥90% of drug overdose deaths mention at least one specific drug in 2016, with the change in drug overdose deaths mentions of at least one specific drug differing by no more than 10 percentage points (pp) between 2016 and 2017. States with good reporting had 80% – <90% of drug overdose deaths mention of at least one specific drug in 2016, with the change in the percentage of drug overdose deaths mentioning at least one specific drug differing by no more than 10 percentage points between 2016 and 2017. States included also were required to have stable rate estimates, based on ≥20 deaths, in at least two drug categories (i.e., opioids, prescription opioids, synthetic opioids other than methadone, heroin).

**Absolute rate change is the difference between 2016 and 2017 rates. Percent change is the absolute rate change divided by the 2016 rate, multiplied by 100. Statistically significant at p<0.05 level. Nonoverlapping confidence intervals based on the gamma method were used if the number of deaths was <100 in 2016 or 2017, and z-tests were used if the number of deaths was ≥100 in both 2016 and 2017. Note that the method of comparing confidence intervals is a conservative method for statistical significance; caution should be observed when interpreting a nonsignificant difference when the lower and upper limits being compared overlap only slightly.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov/.

2015-2016 Overdose Map

  • Large central metro—Counties in metropolitan statistical areas of 1 million or more population that:
    • Contain the entire population of the largest principal city
    • Have their entire population contained in the largest principal city
    • Contain at least 250,000 inhabitants of any principal city
  • Large fringe metro—Counties of 1 million or more population that did not qualify as large central metro counties.
  • Medium metro—Counties of populations of 250,000 to 999,999.
  • Small metro—Counties of populations less than 250,000.
  • Micropolitan—Counties in micropolitan statistical areas that have a population of at least 10,000 but less than 50,000.
  • Noncore—Nonmetropolitan counties that did not qualify as micropolitan.

Categories of 2013 NCHS Urban-Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm)

Age-adjusted death rates for prescription opioids are plotted above by urbanization classification of residence for 2016 to 2017.  The rates remained stable for all urbanization level. The prescription opioid overdose death rate also remained stable in the United States overall from 2016 to 2017, with a total of 17,029 deaths in 2017. Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths, as defined, that have prescription (natural and semi-synthetic) opioids (T40.2) or methadone (T40.3) as a contributing cause. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.1

Data Table

County Urbanization Level 2016 Rate 2017 Rate
United States 5.2 5.2
Large Central Metro 4.7 4.7
Large Fringe Metro 5.2 5.2
Medium Metro 6 5.9
Small Metro 5.2 5.2
Micropolitan 5.7 5.6
Noncore 5.7 5.3

2015-2016 Urbanicity

  • Large central metro—Counties in metropolitan statistical areas of 1 million or more population that:
    • Contain the entire population of the largest principal city
    • Have their entire population contained in the largest principal city
    • Contain at least 250,000 inhabitants of any principal city
  • Large fringe metro—Counties of 1 million or more population that did not qualify as large central metro counties.
  • Medium metro—Counties of populations of 250,000 to 999,999.
  • Small metro—Counties of populations less than 250,000.
  • Micropolitan—Counties in micropolitan statistical areas that have a population of at least 10,000 but less than 50,000.
  • Noncore—Nonmetropolitan counties that did not qualify as micropolitan.

Categories of 2013 NCHS Urban-Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm)

Age-adjusted death rates for prescription opioids are plotted above by urbanization classification of residence for 2015 to 2016. Rates increased significantly for large central metro (14.6%), large fringe metro (23.8%), and medium metro (7.1%) areas. The prescription opioid overdose death rate also increased in the United States overall—a statistically significant 10.6% increase from 2015 to 2016, with a total of 17,087 deaths in 2016. Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths, as defined, that have prescription (natural and semi-synthetic) opioids (T40.2) or methadone (T40.3) as a contributing cause. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.1

References

  1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
  2. Centers for Disease Control and Prevention. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR 2017; 66(26):697-704.
  3. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
  4. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. Morb Mortal Wkly Rep. ePub: 21 December 2018
  5. Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018.
  6. Kaiser Family Foundation, Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018, (Washington, DC: Kaiser Family Foundation, October 2017).
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