Opioid Prescribing Varies Widely By Region, Study Shows

By Kelly Burch 07/27/18

In some states, patients were up to three times more likely to be prescribed opioids.

doctor writing out prescription

Whether or not patients are prescribed opioids in the emergency room and how many of the pills they get varies widely by region, according to a new study, suggesting that despite increased awareness about the dangers of opioids there is still plenty of room to cut down on unnecessary prescribing. 

According to Science Daily, researchers from the University of Pennsylvania School of Medicine examined insurance claims to see how patients presenting with sprained ankles were treated for pain.

In some states, patients were up to three times more likely to be prescribed opioids. Researchers also found that people who received more opioid pills were five times more likely to fill an additional opioid prescription over the following six months. 

"Although opioids are not—and should not—be the first-line of treatment for an ankle sprain, our study shows that opioid prescribing for these minor injuries is still common and far too variable," said M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn who led the study

"Given that we cannot explain this variation after adjusting for differences in patient characteristics, this study highlights opportunities to reduce the number of people exposed to prescription opioids for the first time and also to reduce the exposure to riskier high-intensity prescriptions,” Delgado said. 

The study examined more than 30,000 patient records and found that 25% were given opioids. 

"Although prescribing is decreasing overall, in 2015 nearly [25%] of patients who presented with an ankle sprain were still given an opioid, a modest decrease from 28% in 2011," Delgado said. "By drilling down on specific common indications as we did with ankle sprains, we can better develop indicators to monitor efforts to reduce excessive prescribing for acute pain."

Researchers found that there was a huge variation between states in the percentage of patients given opioids. For example, only 3% of patients received an opioid prescription in North Dakota, compared to 40% in Arkansas. If states with above-average prescribing were reduced to the average amount, 18,000 fewer opioids pills would be prescribed each year. 

In addition, if all patients were given the smallest supply of opioids, usually 10-12 pills, there would be a significant reduction in the number of pills distributed. 

"Simply making these amounts the default setting electronic medical record orders could go a long way in reducing excessive prescribing as our previous work has shown," Delgado said, noting that the concept could be expanded to other areas of care.

"It would be great to see analyses such as ours replicated in other settings, such as post-operative prescribing, where prescriptions are higher intensity. In these settings there may be greater opportunities to decrease transitions to prolonged opioid use by reducing excessive prescribing."

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.