Opioids, Benzodiazepines Overprescribed Across the United States

In 2012 alone, US health care providers wrote 82.5 opioid and 37.6 benzodiazepine prescriptions per 100 persons.

In the United States, 46 people die each day from prescription painkiller overdoses, according to a research published in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC).

To evaluate prescribing practices for opioid pain relievers and benzodiazepines across the country, CDC researchers analyzed prescribing data from IMS Health's National Prescription Audit.

Overall, they found health care providers wrote 259 million prescriptions for painkillers in 2012, providing 82.5 opioid and 37.6 benzodiazepine prescriptions per 100 persons in the United States. According to the CDC researchers, extended-release/long-acting (ER/LA) opioids accounted for 12.5% of the total estimated amount of opioid prescriptions written nationwide in 2012, while high-dose opioids accounted for 5.1%.

Prescribing rates, however, varied significantly by state. Both opioid and benzodiazepine prescribing rates were higher in the South compared to other regions. Alabama, Tennessee, and West Virginia were the top 3 prescribing states for both opioid painkillers and benzodiazepines. In fact, prescribing rates for both opioids and benzodizapines were 2 or more standard deviations above the national average for these 3 states. For instance, the prescribing rate for all opioid types in Alabama was 2.7 times the rate in Hawaii.

The Northeast, however, had the highest prescribing rates for high-dose and ER/LA opioids. In this region, 17.8% of all opioids prescribed were ER/LA formulations, and prescribing rates for this type of painkiller were 2 or more standard deviations above the average in Maine and Delaware. For high-dose opioids, Delaware, Tennessee, and Nevada had prescribing rates at least 2 standard deviations above the mean.

Although the researchers did not know what factors influenced the regional variations, they suggested the health issues of each state were most likely not different enough to cause such wide disparities in prescribing.

“One possible explanation for the results of this study is the lack of consensus among health care providers on whether and how to use [opioid pain relievers] for chronic noncancer pain,” the authors of the report noted.

According to the CDC researchers, the high opioid prescribing rates observed in some states suggest a need to identify and modify prescribing practices that might not balance patient care and safety appropriately. The researchers recommended that developing guidelines for prescribing opioids and other controlled substances might help to align local prescribing rates with current best practices. Reducing prescribing, however, will require education for patients and prescribers, in addition to careful consideration of all available treatment options.

“Patients in all states deserve access to safe and effective, evidence-based medical care, and prescribers should carefully consider the balance between risks and benefits in any pharmacotherapy,” the authors concluded.