Doctors relying less on opiods

But prescriptions still high amid plague of painkiller addiction

Doctors have prescribed fewer opioids in recent years, but the numbers are three times higher than they were in 1999, according to a federal health report released Thursday.

As towns large and small struggle with the opioid epidemic, some counties prescribe six times the amount of painkillers — opioids such as oxycodone and morphine — as others, the report from the Centers for Disease Control and Prevention (CDC) says.

The amount of opioids prescribed in the USA peaked in 2010 and decreased each year through 2015 — from 782 morphine milligram equivalents (MME) per person to 640, according to the report, which examined data from 59,000 pharmacies from 2006 through 2015.

This is three times higher than it was 18 years ago in 1999, when the amount prescribed was 180 MME, the report says.

“The amount of opioids prescribed in the U.S. is still too high, with too many opioid prescriptions for too many days at too high a dosage,” CDC acting Director Anne Schuchat said.

The report found that opioids tend to be prescribed most often in counties with higher rates of unemployment; more uninsured people; a greater prevalence of diabetes, arthritis and disability; more dentists and physicians per capita; and a greater percentage of white residents.

“That may in part be because of limited resources to manage pain (in those areas),” said Eric Weil, the chief medical officer for primary care at the Center for Population Health at Partners Healthcare. “If you’re in an area where there are good pain management alternatives, there may be a decreased chance where you would be prescribed an opioid.”

He speculated that areas with higher unemployment and lack of insurance may have fewer resources than others.

“And if you’re in an area where a physician has less in their toolbox, it is conceivable that you would be more likely to prescribe an opioid because you have fewer options,” he said.

Although those factors are probably important, they can explain only about one-third of the variation across counties, Schuchat said. She and the study au- thors said the variation in prescribing has more to do with a lack of consensus among providers about appropriate opioid use.

In 2015, drug overdoses accounted for 52,404 deaths in the USA, out of which 63.1% involved an opioid, according to the CDC. Among opioid-related deaths, about 15,000 involved a prescription opioid, and about 2 million people had an addiction associated with prescription opioids.

In 2016, the CDC published its Guideline for Prescribing Opioids for Chronic Pain, which gives providers recommendations on prescribing opioid pain medication in primary care settings.

The guide recommends using non-opioid therapies for chronic pain outside active cancer treatment, palliative care and end-oflife care, such as acetaminophen, non-steroidal anti-inflammatory drugs, exercise therapy and cognitive behavioral therapy.

Schuchat said she hopes the guidelines will help continue to bring down opioid prescribing rates, as well as address the variation across counties. “This epidemic is really bigger than all of us,” she said.