Welcome to Kenny-s Blog

Opioid prescribing practices update from CDC

By Dr Ananya Mandal, MDJuly 6, 2017

According to the latest Vital Signs reports issued by the Centers for Disease Control and Prevention (CDC), the number of prescriptions containing an opioid was at its highest in 2010 and since then has decreased every year until 2015. The numbers are still high says the report and the variations are also noticeable between counties.

In 2015 the counties where prescriptions of opioids were highest at least six times more number of opioids were prescribed per resident compared to those counties where rates were lowest. This shows that the healthcare providers differ in their prescribing practices of opioids in different locations and thus patients receive non-uniform care.

According to Anne Schuchat, M.D., acting director of the CDC, the numbers of prescriptions with opioids in United States is still too high for comfort. The drugs re prescribed is higher doses and for too long she added. It is the responsibility of the healthcare providers to provide effective as well as safer pain management to all patients she emphasized. This would reduce risks of overdose of opioids as well as dependence and addictions liabilities.

For the report analysts looked at yearly prescribing practices between 2006 and 2015. They calculated the opioid prescription burden using a measure called morphine milligram equivalents (MME) per person standardizing it across the different types and strengths of opioids that were used. They noted that in 2006, 782 morphine milligram equivalents (MME) per person were prescribed and it declined to 640 MME in 2015. This was an encouraging trend. Daily MME was also calculated and it showed that between 2006 and 2010 it remained similar and declined by 17% between 2010 and 2015 from 58 MME to 48 MME. Duration of opioid prescription has been linked as directly correlated with addition liability to these drugs. Results show that the average days’ supply per prescription was 13 days in 2006 and has risen to 18 days in 2015. This is a 33% rise. The amount of opioids prescribed per capita in 2015 is three times higher than 1999 found the report.

The report went on to analyze the retail prescription data from QuintilesIMS. This gave a clear picture of the rates, dosages, number of days for which the prescriptions were made in each of the counties of the country. The reports revealed that non-Hispanic white residents were more likely to be prescribed higher opioid numbers. Those with diabetes and arthritis received most prescriptions understandably. Those living in micropolitan areas or non-metro small cities and big towns and with higher levels of unemployment received a greated percentage of opipids in their prescriptions. According to Deborah Dowell, M.D., M.P.H., chief medical officer in the Division of Unintentional Injury Prevention at CDC’s National Center for Injury Prevention and Control, pain relief requirements vary and that could account for some of the variations in opioid prescribing practices. However the variations are too great to be explained completely by this she added. This variation points at the fact that all healthcare providers need to be brought under an umbrella of uniform and “evidence-based” practice guidelines for better patient care she explained.

In 2016 the CDC came up with “CDC Guideline for Prescribing Opioids for Chronic Pain”. This gives clear cut guidelines for opioid prescribing practices for patients 18 and older in primary care settings. Opioid use apart from cancer pain and palliative care pain is outlined in details. Opioids are to be used for chronic pain which lasts for three months or more says the guidelines. It suggests that opioids are to be opted for only when their benefits outweigh their risks. The lowest effective opioid which acts for a short duration should always be the first choice in order to reduce risk of addiction. Immediate-release forms of opioids that acts fast and whose actions are abated faster should be preferred. Any dose change or rise would again follow the “benefit-risk assessment” protocol according to the guidelines. The healthcare providers are asked to use the state-based prescription drug monitoring programs (PDMPs) to provide data about opioid use in all regions. These guidelines are applicable for health systems, states, and insurers as well says the CDC.

Have something to add? Share it in the comments.

Your email address will not be published. Required fields are marked *