County-level opioid dispensing rate affects individual-level misuse

Researchers found a direct association between county-level opioid dispensing rate and individual-level prescription opioid misuse, misuse frequency and dependence, according to study results published in American Journal of Psychiatry.

“Relying on national data from the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA), this study builds on previous research to examine directly the relationship between opioid dispensing rates at the county level and individual-level pharmaceutical opioid misuse and heroin use as well as dependence,” Mike Vuolo, PhD, of the department of sociology at Ohio State University, and Brian C. Kelly, PhD, of the department of sociology at Purdue University, wrote. “The findings may have implications not only for prevention and intervention but also for clinical practice.”

Specifically, Vuolo and Kelly analyzed data from the restricted-access National Survey on Drug Use and Health, the CDC’s retail opioid prescription database, the Prescription Drug Abuse Policy System and the U.S. Census. They used fixed-effect models to examine whether county-level dispensing rates impacted prescription opioid outcomes as intended and whether rate changes had adverse effects on heroin use outcomes. They included 748,000 participants aged 12 years or older between 2006 and 2016.

Results showed increased risk for prescription opioid misuse, increased frequency of misuse and dependence of 7.2%, 3.5% and 10.4%, respectively, per standard deviation increase in the county-level opioid dispensing rate per 100 individuals. The researchers observed no evidence for any link between opioid dispensing rates and the three heroin outcomes.

“Institutionally driven changes among prescribers, potentially shaped by both professional recognition of the problem and policy implementation, may have helped curb the prescription opioid crisis; however, these changes do not appear to have altered heroin use (in either direction) following shifts in dispensing at the county level,” Vuolo and Kelly wrote. “We recommend that medical providers continue to monitor patterns of prescribing and dispensing and that states continue to pursue policies that temper unnecessary opioid prescriptions.”