Population-Based Opioid Prescribing and Overdose Deaths in the USA: an Observational Study

Abstract

Background: Rising opioid-related death rates have prompted reductions of opioid prescribing, yet limited data exist on population-level associations between opioid prescribing and opioid-related deaths. Objective: To evaluate population-level associations between five opioid prescribing measures and opioid-related deaths. Design: An ecological panel analysis was performed using linear regression models with year and commuting zone fixed effects. Participants: People ≥10 years aggregated into 886 commuting zones, which are geographic regions collectively comprising the entire USA. Main Measures: Annual opioid prescriptions were measured with IQVIA Real World Longitudinal Prescription Data including 76.5% (2009) to 90.0% (2017) of US prescriptions. Prescription measures included opioid prescriptions per capita, percent of population with ≥1 opioid prescription, percent with high-dose prescription, percent with long-term prescription, and percent with opioid prescriptions from ≥3 prescribers. Outcomes were age- and sex-standardized associations of change in opioid prescriptions with change in deaths involving any opioids, synthetics other than methadone, heroin but not synthetics or methadone, and prescription opioids, but not other opioids. Key Results: Change in total regional opioid-related deaths was positively correlated with change in regional opioid prescriptions per capita (β=.110, p