Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Abstract

Purpose High‐risk opioid prescribing is a critical driver of prescription opioid‐related morbidity and mortality. This study explored opioid prescribing patterns across urban‐rural and economic distress classifications. Secondarily, this study explored the urban‐rural distribution of relevant health services, economic factors, and population characteristics. Methods County‐level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012‐2017). Counties were classified using the 2013 National Center for Health Statistics Urban‐Rural Classification Scheme for Counties, and Washington State unemployment‐based distressed areas. County‐level measures from Area Health Resources Files were used to describe the urban‐rural continuum. Findings Persistent economic distress was associated with higher‐risk opioid prescribing. The large central metropolitan category had lower‐risk opioid prescribing metrics than the other 5 urban‐rural categories, which were similar to each other and not ordered by degree of rurality. High‐risk prescribing declined over time, without notable trend divergence by either urban‐rural or economic distress classifications. Conclusions The most striking urban‐rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban‐rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban‐rural continuum. Finally, the multiple intertwined burdens faced by rural communities—higher‐risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment—must be addressed as an urgent public health priority.

Opioid use trends in Spain: the case of the island of La Gomera (2016–2019)

“…Other studies have shown that there are considerable differences in opioid-related measurements between rural and urban areas. The rural areas were found to have higher rates of opioid prescription, higher rates of high-dose opioid prescription, or fewer resources for inpatient and outpatient opioid treatment, etc., in comparison to urban areas (Keyes et al 2014 ; Sears et al 2020 ; Shoff et al 2021 ). Serdarevic et al ( 2017 ) suggest that older women, especially, those living alone, have higher rates of prescription opioid use.…”

Broadband internet subscription rates and opioid prescribing via telemedicine during the COVID‐19 pandemic

“…It is noteworthy, but not surprising, that opioid dispensing in LBBA counties was higher at baseline and remained higher throughout all time periods when compared to HBBA counties. Overall opioid prescribing rates are commonly higher in rural counties, 22 , 23 , 24 , 25 , 26 which made up 80.85% of LBBA counties versus 34.62% of HBBA counties in this study. This may be influenced by a higher prevalence of pain, specifically chronic and high‐impact chronic pain, in rural communities; 27 lower availability of other pain treatment modalities; 28 or other factors.…”

<p>Regional Differences in Opioid Prescribing in Germany – Results of an Analysis of Health Insurance Data of 57 Million Adult People</p>

“…We used data for all persons insured with an SHI for at least 180 days in 2010 and who were 18 years or older in the respective year. On a state level, the number of all insured persons was provided by age group (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), 50-69 and ≥70 years) and sex whereas on the district level only the overall numbers, the mean age and sex ratio per district were available.…”

“…When exploring reasons for regional variations of opioid use, several factors come into play including (a) patients' characteristics such as demographics or burden of pain, (b) physicians' attitude or schools of thinking with respect to opioids but also (c) the health care system including access to specialized care, availability of services and the possibility of reimbursement for alternative treatments. 33 In contrast to the US where for instance prescription drug monitoring programs can be regulated via state-level policies and thereby contribute to regional variations of opioid use, opioid prescribing and dispensing in Germany is subject to national regulations.…”