More Opioids Being Prescribed in Rural America

January 28, 2019, 11:58 am News Staff – The CDC analyzed patient opioid prescription data from Athenahealth, a national electronic health record (EHR) vendor, during 2014-2017 and found that the percentage of patients prescribed an opioid was higher in rural areas than in urban settings.

This finding could correlate with the fact that higher rates of opioid-related deaths have been recorded in rural areas than in urban areas. In 2017, 14 rural counties were among the 15 counties with the highest opioid prescribing rates.

This is according to a Morbidity and Mortality Weekly Report (MMWR) that the CDC released on Jan. 18.

Report Details

Using deidentified data from Athenahealth's EHR system, the CDC analyzed opioid prescribing rates among 31,422 primary care physicians in the United States.

Data were stratified by providers' counties according to CDC's National Center for Health Statistics urban-rural classification scheme. From most to least densely populated, the six categories are: large central metropolitan, large fringe metropolitan, medium metropolitan, small metropolitan, micropolitan and noncore counties.

The CDC found that patients in noncore (the most rural) counties had an 87 percent higher chance of receiving an opioid prescription compared with those in large central metropolitan counties during the study period.

Story Highlights

By county classification, the overall percentage of patients with opioid prescriptions ranged from 5.2 percent in large central metropolitan counties to 9.6 percent in noncore counties during the study period.

Buprenorphine prescribed for pain and opioid use disorder treatment represented only 0.02 percent of all opioid prescriptions.

This analysis also assessed how prescribing practices varied among the six urban-rural classification categories of counties before and after the March 2016 release of the CDC Guideline for Prescribing Opioids for Chronic Pain, which the AAFP gave its designation of "affirmation of value" at the time.

"Across all six county groups, the odds of receiving an opioid prescription decreased significantly after March 2016," the agency said. "This decrease followed a flat trend during the preceding period in micropolitan and large central metropolitan county groups; in contrast, the decrease continued previous downward trends in the other four county groups."

Additional MMWR Notes

In drawing conclusions from its research, the CDC said the higher odds of opioid prescribing in rural counties could be partially attributed to "prescription drug use and misuse at an earlier age, as well as higher prevalences of chronic pain among persons living in rural areas."

The agency added that rural counties also tend to have larger populations of older adults who have higher prevalences of conditions associated with pain.

The CDC additionally noted that opioid prescribing in rural areas is strongly influenced by prescribers' relationships with their patients and can be inconsistent with opioid prescribing guidelines; access to medication-assisted treatment facilities and alternative therapies are also limited in rural areas.

Furthermore, the MMWR said "variations in the implementation of state-run prescription drug monitoring programs and state-based laws, such as the regulation of pain-management clinics, might also differ in urban and rural communities."

While it's good news that opioid prescribing has been declining in recent years, overdose deaths involving opioids have increased, which the CDC attributed largely to an uptick in use of heroin and illicitly manufactured fentanyl.

The agency said many people who self-report heroin use also have a history of misusing prescription opioids. So, it's still important to continue to address prescription opioid use to help curb opioid-involved overdose deaths, the MMWR said.

The CDC noted that this and other data from EHRs can be used to "effectively supplement traditional surveillance methods for monitoring trends in opioid prescribing and other areas of public health importance, with minimal lag time under ideal conditions."

"As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction, community health care practices and intervention programs must continue to be tailored to community characteristics," the MMWR said.

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