Clues to opioid abuse from state prescription drug monitoring programs

Drug overdose is the leading cause of injury death in the United States – mostly due to abuse and misuse of prescription opioid pain relievers, benzodiazepines (sedatives/tranquilizers), and stimulants. Information from state prescription drug monitoring programs (PDMPs) can be used to detect and measure prescribing patterns that suggest abuse and misuse of controlled substances, according to a report released today in the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR) Surveillance Summary.

It is the first multi-state report from the CDC- and FDA-funded Prescription Behavior Surveillance System (PBSS), which analyzes data from state PDMPs. The eight states that submitted 2013 data—California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio and West Virginia—represent about a quarter of the U.S. population.

The study found that prescribing practices varied widely among states despite the fact that states are similar in the prevalence of the conditions these drugs are used to treat. Moreover, differences in population characteristics, such as ethnicity and social status, likely explain only a fraction of the variation in prescribing practices. The findings point to the urgent need for improved prescribing practices, particularly for opioids – which in all eight states were prescribed twice as often as stimulants or benzodiazepines.

"Every day, 44 people die in American communities from an overdose of prescription opioids and many more become addicted," said CDC director Tom Frieden, M.D., M.P.H. "States are on the frontline of witnessing these overdose deaths.  This research can help inform their prescription overdose prevention efforts and save lives."

Study findings underscore need to curb overprescribing

Prescribing rates varied widely by state: twofold for opioids, fourfold for stimulants, and nearly twofold for benzodiazepines. Among the study's other findings:

• A small minority of prescribers are responsible for most opioid prescriptions.
• The top 1 percent of prescribers wrote 1 in 4 opioid prescriptions in Delaware, compared with 1 in 8 in Maine.
• People who receive opioid prescriptions often receive benzodiazepine prescriptions as well, despite the risk for adverse drug interactions.
• The percentage of controlled substance prescriptions paid for in cash – an indicator of abuse – varied almost threefold among five states reporting this measure.

"A more comprehensive approach is needed to address the prescription opioid overdose epidemic, including guidance to providers on the risks and benefits of these medications," said Debra Houry, M.D., M.P.H., director of CDC's National Center for Injury Prevention and Control.