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March 28, 2019
David Burda
Outcomes Policy

Opioid Variations and State Interventions

Like companies in any other industry, when providers misbehave, it opens the door to state regulation of their behavior. What’s interesting about a new study in JAMA Open Network is the clear assumption by the authors that state interventions are needed to curb the overprescribing of opioids because self-policing won’t work.

Using prescription drug data from IQVIA, formerly Quintiles and IMS Health, researchers from the Centers for Disease Control and Prevention analyzed state variations in opioid prescribing patterns from 2006 through 2017.  Over that 12-year period, retail pharmacies filled more than 2.8 billion opioid prescriptions, or an average of almost 234 million per year.

The compared states using six measures:

  • The amount of opioids prescribed per person in milligrams
  • The average length of an opioid prescription in days
  • Number of opioid prescriptions of three days or less per 100 persons
  • Number of opioid prescriptions of 30 days or more per 100 persons
  • Number of opioid prescriptions with a high daily dosage per 100 persons
  • Number of prescriptions with extended-release or long-acting opioids per 100 persons

And they compared how those measures changed over time in each state.

On each measure, the researchers found wide variations among the states. For example, in 2017, the average annual amount of opioids prescribed per person in Tennessee was 845.7 milligrams, which was the highest of any state. That compared with 512.6 milligrams nationally and 160.1 milligrams in the District of Columbia, which had the lowest average annual amount per person.

Nevada and West Virginia had the longest average length of an opioid prescription in 2017 at 20.8 days and 20.7 days, respectively. The shortest were in South Dakota and Nebraska at 15.4 days and 15.6 days, respectively. The national average was 18.3 days in 2017.

The rate of three-day-or-less prescriptions dropped 61.5 percent in Maine from 2006 through 2017 compared with 18.7 percent in South Dakota. It declined 45.2 percent nationally.

“These data may indicate high-potential areas for opioid use prevention and intervention,” the researcher said, citing the following possibilities:

  • Program interventions
  • Regulation
  • State-based reimbursement systems
  • Required opioid education for prescribers and pharmacists
  • Enhanced prescription drug monitoring programs

“States are well-suited to respond to the opioid crisis through legislation, regulations, enforcement, surveillance and other interventions,” they said.

I guess the researchers think that that’s the only way to stop providers from overprescribing opioids and causing more opioid abuse and deadly overdoses. Maybe they’re predisposed to that view because they work for a federal agency. Who knows? Maybe they’re right. Maybe they’re wrong.

Either way, the lesson for healthcare is clear. Unwanted variation in outcomes leads to suspicion, and suspicion often leads to regulation. So if you don’t want someone regulating your business, clean it up. Do what’s right for patients and maybe someone will stop telling you what to do.

For another take on this topic, please read “Crony Capitalism Has Consequences: Opioid Distribution Destruction and Death” on 4sighthealth.com.


David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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