There was an 18% decrease in opioid prescriptions from 2010 to 2015, according to Anne Schuchat, MD, principal deputy director of the CDC, but the amount of actual morphine milligram equivalents (MME) of drug prescribed is three times higher than in 1999.

The amount of opioids being prescribed in the United States varies by county. Half of U.S. counties have seen a decrease in the amount of opioids prescribed from 2010 to 2015, but the highest prescribing counties still prescribe six times more than the amounts of the lowest prescribing counties, said Dr. Schuchat during a press conference. Furthermore, the CDC found that prescriptions of opioids vary from county to county based on numerous factors.

In the late 1990s, health care providers began prescribing opioids to treat chronic pain issues, including arthritis and back pain. As time went on, the number of prescriptions written, days per prescription and level of dosage all increased. In 1999, the amount of opioids prescribed per person was 180 MME, but in 2015, the amount of opioids prescribed per person skyrocketed to 640 MME. This rapid increase in the amount of drugs prescribed has taken its toll on Americans. According to Dr. Schuchat, of the 52,000 drug overdose–related deaths in the United States in 2015, about 33,000 involved an opioid and 15,000 of those opioid-related overdoses involved a prescription opioid.

With this significant increase in prescriptions since the 1990s, CDC researchers discovered that the rate of opioid prescriptions varied by county. They found that counties with higher rates of opioid prescriptions included small cities or large towns, a higher percentage of whites, and a larger quantity of dentists and primary care physicians (MMWR Morb Mortal Wkly Rep 2017 Jul 8. [Epub ahead of print]). Unfortunately, these characteristics only explain about one-third of the differences among counties.

Dr. Schuchat said the Appalachian region displayed the highest rates due to fewer programs addressing the issue. But “no part of the country is spared,” she said.

“With opioid medications, we are still seeing too many getting too much for too long,” Dr. Schuchat said.

First, there are too many prescriptions written. According to the report, in 2015, enough opioids were prescribed for every American to be medicated all day for three weeks. The second main problem detailed in the report is that physicians are prescribing very high doses of opioids. The risk for opioid overdose death doubles with a dose of 50 MME or more per day, and at 90 MME or more, the risk rises 10 times. Dr. Schuchat said a common misconception is that higher doses reduce chronic pain better than lower doses, which she states is false. The final problem is that clinicians are prescribing opioids for too many days. The report states that taking an opioid for over three months can increase the risk for addiction by 15 times.

The CDC report also detailed how each sector involved can help end the epidemic. The federal government can educate health care providers and the public about pain management, improve access to treatment and recovery programs, increase access to overdose-reversing drugs, support research and more. States can expand prescription drug monitoring programs (PDMPs), implement and evaluate programs to improve prescribing patterns, enhance the use of prescribing guidelines and more. Health insurers can use the guideline to set up prescription claim review programs, increase coverage of nonopioids and more. Health care providers can reduce the use of opioids by only prescribing when benefits outweigh the risks, start with the lowest effective dose, utilize state-sponsored PDMPs to identify at-risk patients and more. Finally, everyone can consider nonopioid medications for pain relief, store prescriptions in a secure place, and get help through the Substance Abuse and Mental Health Services Administration National Helpline if needed.

Due to the wide variation of prescription patterns, the CDC has called for consistency among health care providers. Dr. Schuchat discussed how important it is for physicians and patients to have an ongoing dialogue about opioid use. Furthermore, she addressed how the CDC is exploring internet-based approaches to pain intervention.

—Aaron Schapiro