How Opioid Prescriptions Have Changed Recently: New Report

Too many Americans are prescribed too many opioids for too long, according to a new report from the Centers for Disease Control and Prevention (CDC).

Though the rates of doctors prescribing opioids have decreased since 2010, they still remained high in 2015 in the U.S., according to the report. In addition, the amount of opioids prescribed to Americans remained high in 2015, though that also decreased since its peak in 2010.

There were enough prescription opioids in the U.S. in 2015 "for every American to be medicated around the clock for three weeks," Dr. Anne Schuchat, acting director of the CDC, said at a news conference today (July 6). [America's Opioid-Use Epidemic: 5 Startling Facts]

"Higher opioid prescribing practices place residents … at greater risk for opioid addiction, overdose and death," Schuchat said. And the United States is currently experiencing the highest opioid overdose death rates ever recorded in the country, she added. This high death rate is driven by prescription opioids as well as illegal opioids, including heroin and illegally manufactured fentanyl, a particularly powerful form of the drug.

Schuchat said "high opioid prescribing" can be thought of in three parts.

First, too many opioid prescriptions are being written, Schuchat said. The new report found that in 2015, there were 71 opioid prescriptions written for every 100 people in the United States. This rate is down from a high of 81 prescriptions per 100 people in 2010 to 2012, according to the report.

Second, opioids are being prescribed for too many days, Schuchat said. The length of an opioid prescription has increased by about one-third, from 13 days in 2006 to nearly 18 days in 2015, the report found.

Even taking opioids for "just a few days makes a person more likely to take them long term," Schuchat said. And "taking even a low-dose opioid for more than three months increases the risk of addiction by 15 times," she said.

Third, the doses of the drugs that are prescribed are too high, Schuchat said.

To calculate the total amount of opioids prescribed to people, the CDC uses a measure called "morphine milligram equivalents" (MMEs). This measure takes into account the relative strengths of different types of opioids, using morphine as the standard. Some prescription opioids are weaker than morphine (1 milligram of codeine, for example, is equivalent to 0.15 milligrams of morphine), and others are stronger (such as 1 milligram of hydromorphone, which is equal to 4 milligrams of morphine).

Taking higher doses has been linked with an increased risk of dying from an overdose, Schuchat said. People who take a dose of 50 MMEs per day have double the risk of dying from an overdose compared with people who take a dose of 20 MMEs per day or less, Schuchat said. And a dose of 90 MMEs or more per day — which the researchers consider a "high" dose — is associated with a 10-fold greater risk of opioid overdose death compared with 20 MMEs per day. [11 Facts About Heroin]

The report found that about 7 out of 100 opioid prescriptions in 2015 were for 90 MMEs or higher a day.

Rates vary like the weather

Overall, opioid prescribing rates decreased by 18 percent from 2010 to 2015, the report found. But that decrease was limited to about half of the counties in the U.S., and every state has high-prescribing counties, Schuchat said.

There is "tremendous variation between counties," and rates vary "as much from place to place as the weather," Schuchat said. In 2015, for example, six times more opioids were dispensed in the highest-prescribing counties than in the lowest-prescribing counties, the report found.

The researchers noted that several factors were associated with counties that had high opioid prescribing rates. These included having a small city, a greater percentage of white residents, a higher concentration of primary care doctors or dentists, greater rates of people who did not have health insurance or were unemployed, and more people with diabetes, arthritis or a disability.

However, these factors explained only about one-third of the wide variation in opioid prescribing, Schuchat said.

Schuchat also noted that the CDC has released guidelines for doctors about prescribing opioids. But because these guidelines were published in 2016, the data in the new report doesn't reflect what impact, if any, they could have had on prescribing.

Researchers will be able to use the new report as a baseline with which to compare the effects of the CDC's 2016 guidelines, Schuchat said.

Originally published on Live Science.