Opioid Prescribing Patterns by Drug Type: The Pennsylvania Experience.

Brock K. Bakewell, MPH

Chaim Miller, BA

Matthew B. Sherman, BS

Asif M. Ilyas, MD, MBA

SUMMARY POINTS:

• In 2016 nearly 2 million opioid prescriptions were given to patients in Pennsylvania, that number decreased by 38% in 2020.

• The opioids that were most frequently prescribed in Pennsylvania from 2017 to 2020 were oxycodone, hydrocodone, and morphine.

• The highest absolute rates of decrease during this period were from Oxycodone and Hydrocodone.

INTRODUCTION:

From 1999 – 2018, nearly 450,000 people have died from an overdose involving opioids, including both prescription and illicit opioids.1 In 2018, nearly 70% of all overdose deaths involving drugs were due to opioids specifically.2 At the same time, opioid prescribing increased 350%, from 180 to 640 morphine milligram equivalents (MME) per capita, during 1999 – 2015.3 A prominent way states are tackling this crisis is by implementing strategies involving opioid education and drug disposal events which have shown some promise addressing the opioid epidemic.4-8 In addition, states have implemented programs such as the Prescription Drug Monitoring Program (PDMP). State PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances and allow physicians the ability to access that information before prescribing. Pennsylvania’s PDMP was established in August of 2016 and was mandated for use in specific situations on January 1st, 2017.9 This study builds on a previous research analysis published by Miller and Ilyas (2021) which outlines the overall trends in opioid prescribing from 2017 to 2020. This brief takes more microlens and aims to describe the specific trends in types of opioids over the same timeline.

METHODS:

Data pertaining to opioid prescribing habits as listed below were obtained from the Pennsylvania Department of Health (PA DOH) who administers the PDMP in Pennsylvania. As of January 1, 2017, all prescribers who are licensed, registered, or otherwise lawfully authorized to distribute, dispense or administer a controlled substance, other drugs, or device in the course of professional practice or research in the Commonwealth are required to register with and query the PDMP in certain situations. Data provided by the PA DOH is categorized by quarters, each equaling 3 months of the year. Since the PA PDMP was implemented later in August of 2016, the fourth quarter of 2016 was ignored due to low-quality data, and the study analyses began from Q1 (Jan, Feb, Mar) 2017 through Q1 (Jan, Feb, Mar) 2020. Percent changes from the two time points were used for statistical analysis.

RESULTS:

The total number of opioid prescriptions prescribed in Q1 2017 was 1,800,123, which decreased to 1,197,959 in Q1 2020. (Figure 1) This 33% decrease from 2016 to 2020 represents an absolute decrease of 602,164. The greatest decrease in opioid prescription by percentage change was Meperidine (Demerol) at 89% and Fentanyl at 51%. The greatest absolute decrease in opioids prescribed was Oxycodone and Hydrocodone, which decreased by 300,284 and 295,729 prescriptions respectively.

CONCLUSION:

This study depicted the changes in opioid type from mid-2016 until early 2020, during the implementation of a statewide PDMP. Most interestingly, the highest rates of decrease during this period were from Oxycodone and Hydrocodone, two of the most frequently prescribed opioid medications. This study shows promising trends in decreasing the number of opioids prescribed to patients that could lead to misuse and abuse.

References

1. Centers for Disease Control. Wide-ranging online data for epidemiologic research (WONDER). 2020; Available at: http://wonder.cdc.gov. Accessed 12/3/, 2020.

2. Wilson N, Kariisa M, Seth P, Smith 4, Herschel, Davis NL. Drug and Opioid-Involved Overdose Deaths - United States, 2017-2018. MMWR. Morbidity and mortality weekly report 2020 Mar 20,;69(11):290-297.

3. Guy GP, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR. Morbidity and mortality weekly report 2017 Jul 7,;66(26):697-704.

4. Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. StatPearls Treasure Island (FL): StatPearls Publishing LLC; 2020.

5. Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of DrugpRelated Risks and Outcomes. 2018.

6. Reisman RM, Shenoy PJ, Atherly AJ, Flowers CR. Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacy. Subst Abuse 2009 May 1;3:41-51.

7. Surratt HL, O'Grady C, Kurtz SP, Stivers Y, Cicero TJ, Dart RC, et al. Reductions in prescription opioid diversion following recent legislative interventions in Florida. Pharmacoepidemiology and drug safety 2014 Mar;23(3):314-320.

8. Reifler LM, Droz D, Bailey JE, Schnoll SH, Fant R, Dart RC, et al. Do Prescription Monitoring Programs Impact State Trends in Opioid Abuse/Misuse? Pain medicine (Malden, Mass.) 2012 Mar 1,;13(3):434-442.

9. Prescription Drug Monitoring Program. https://www.health.pa.gov/topics/programs/PDMP/Pages/PDMP.aspx. Accessed December 23, 2020.