Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC

Most Counties See Opioid Prescription Rates Falling Interview with:

Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC

Dr. Gery Guy

Gery Guy, PhD, MPH
Injury Center
CDC What is the background for this study?

Response: This study examined opioid prescribing at the national and county-level in 2015 and 2017.

During 2015 to 2017, the amount of opioids prescribed decreased 20.1% in the United States. The amount of opioids prescribed per person varies substantially at the county-level. The average amount of opioids prescribed in the highest quartile of counties was nearly 6 times the amount in the lowest quartile. Reductions in opioid prescribing could be related to policies and strategies aimed at reducing inappropriate prescribing, increased awareness of the risks associated with opioids, and release of the CDC Guideline for Prescribing Opioids for Chronic Pain. What are the main findings?

  • From 2015 to 2017, the amount of opioids prescribed in the U.S. decreased by 20.1%
  • Opioid prescribing rates decreased 16.9%
  • High-dose prescribing rates decreased by 25.3%
  • The average and median duration of opioid prescriptions increased by 3.4% and 33.3% respectively during 2015 to 2017.
  • Substantial variation between the highest and lowest prescribing counties was observed for overall prescribing rates (4.6 times higher) and high-dose prescribing rates (7.1 times higher).
  • From 2015 to 2017, the majority of counties experienced a reduction in the amount of opioids prescribed (74.7%), overall prescribing rates (76.3%) and high-dose prescribing rates (76.6%).
  • The duration of opioid prescriptions continues to increase nationally, likely due to greater decreases in shorter-term opioid prescriptions (<30 days) than in longer-term prescriptions. What should readers take away from your report?

Response: Although the amount of opioids prescribed has decreased across most of the United States, the amount prescribed remains substantially elevated compared to years prior to 2000, putting the U.S. population, especially those in high prescribing counties, at continued risk for opioid use disorder and overdose. What recommendations do you have for future research as a result of this work?

Response: In this study we observed reductions in all opioid prescribing measures except one, the duration of prescriptions. The duration of opioid prescriptions continues to increase. Future research could explore what is driving the increase in prescription duration. Is there anything else you would like to add?

Response: Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. CDC has two resources that can help both prescribers and patients weigh the benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce the risk associated with long-term opioid therapy.

CDC’s Guideline for Prescribing Opioids for Chronic Pain

  1. This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use.
  2. Clinical tools, videos, posters, mobile app, training, and patients materials are available to help improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain.

Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain

  1. This resource is intended to help healthcare systems integrate the Guideline and associated quality improvement (QI) measures into their clinical practice.
  2. Fact sheets and other tools supplement the QI-CC resource.

No disclosures


Guy GP, Zhang K, Schieber LZ, Young R, Dowell D. County-Level Opioid Prescribing in the United States, 2015 and 2017. JAMA Intern Med. Published online February 11, 2019. doi:10.1001/jamainternmed.2018.6989 

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Last Updated on February 12, 2019 by Marie Benz MD FAAD