Dec. 27 (UPI) — The volume of prescription opioid pain medications dispensed by retail pharmacies in the United States has declined over the past decade, with larger drops seen in urban areas, a study published Monday by Annals of Internal Medicine found.
Prescription opioid painkillers distributed to consumers by retail pharmacies, including chains such as CVS and Walgreens, fell by 21% between 2008 and 2018, the most recent 10-year period with figures available, the data showed.
Metropolitan counties saw the steepest declines, at more than 22%, while those with higher rates of fatal opioid overdoses had a 35% drop in prescriptions dispensed, the researchers said.
“These results suggest the effects of clinician and policymaker efforts to reduce opioid prescribing have affected populations differently,” study co-author Dr. Bradley D. Stein said in a press release.
“Future efforts to enhance clinically appropriate opioid prescribing may need to be more clinically nuanced and targeted for specific populations,” said Stein, a senior physician researcher at the RAND Corporation, a nonprofit research organization.
From May 2020 through April of this year, more than 100,000 drug overdose deaths were reported in the United States, with 64% of them involving synthetic opioids such as illicitly manufactured fentanyl, according to the Centers for Disease Control and Prevention.
Although prescription opioid pain relievers are legal, their widespread overprescribing nationally is considered a key factor in the ongoing opioid crisis across the country, which has led to widespread addiction — with some users turning to “street” opiates, such as heroin, research suggests.
In the early 2000s, opioid-based medications were the most commonly prescribed painkillers in the United States, but their use peaked in 2011, an earlier study found.
For this study, Stein and his colleagues at RAND examined differences in opioid prescriptions filled at pharmacies during the periods of 2008 through 2009 and 2017 through 2018.
The prescription information came from IQVIA Prescription data, which captures about 90% of prescriptions filled at retail pharmacies across the country, the researchers said.
They used days’ supply and total daily opioid dose to calculate per capita morphine milligram equivalents for opioid prescriptions filled during the study periods, they said.
Morphine milligram equivalent is a commonly used measure for comparing the potencies of opioids, or the amount of drug required to create an analgesic, pain relieving effect, according to the CDC.
Because opioids are available in different forms, this measurement provides a better assessment of the total amount of opioids filled by patients as compared to just the number of pills dispensed, Stein and his colleagues said.
Over the study period, per capita morphine milligram equivalent volume declined by more than 22% in metropolitan counties across the country and by 35% in those with higher rates of fatal opioid overdoses, the data showed.
The greatest decrease in morphine milligram equivalent volume per practicing clinician was 40%, among adult primary care physicians, and 15%, in pain specialists, who had the highest volume per clinician in 2008-2009.
The greatest percentage decrease, 71%, was in prescriptions written occurred among emergency physicians, clinicians who are likely prescribing opioids predominantly to patients experiencing acute pain, according to the researchers.
“The findings do not provide concrete answers about how much of the unnecessary prescribing of opioids has been eliminated,” Stein said.
“But the work demonstrates that there is a lot more nuance in the changes in opioid prescribing than we previously understood,” he said.