WASHINGTON – Despite recent declines in the number of opioids prescribed in the U.S., prescriptions are still three times higher than they were in 1999 – and most Arizona counties are prescribing at rates well above the national average.
Those numbers were included in a Centers for Disease Control and Prevention report released Thursday, “Where You Live Matters: How Does Opioid Prescribing Vary Across the U.S.?” It said that Appalachian states were hardest hit by the drug crisis, but the West was also affected.
The report said the amount of drugs prescribed per person peaked in 2010 and fell through 2015. While Arizona saw similar declines, the report said more than half of its counties exceeded the national average for the amount of opioids prescribed in both years, with some counties at two and three times the national rate.
The CDC measured prescriptions in morphine milligram equivalents, or MMEs. The per capita national average for prescriptions was 768 MMEs in 2010, but dropped to 640 MMEs in 2015.
Arizona dosages fell, but the state was not able to keep pace with the national average drop. Nine counties were prescribing at a rate above the national average in 2010 but that number grew to 11 counties at or above U.S. levels in 2015.
Greenlee County did not report its numbers and was not included in the CDC study.
For most Arizona counties, the rates were well above the national average. Gila, Graham and Mohave counties prescribed at more than twice the national average in both years – Graham at more than three times the U.S. level in 2010. In 2015, when the national rate was 640 MMEs, seven Arizona counties were above 1,000.
“We need public health intervention that will result in much more cautious prescribing of opioids if we hope to end the epidemic,” said Dr. Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing.
-Cronkite News graphic by Joe Gilmore
Kolodny and the CDC both said evidence suggests there is no link between higher opioid dosages and greater pain relief, yet doctors continue to prescribe at dosage levels shown to put patients at the most risk of opioid dependency.
The CDC says that any dose of 50 MMEs or above doubles the likelihood that a patient will become dependent on the drug. The agency also warns that opioid dependency can lead to heroin addiction as a substitute once the prescription ends.
The CDC estimates 2 million Americans suffer from opioid addiction. Since 1999, there has been a rise in prescriptions treating chronic non-cancer pain and the chronic nature extends the “average length of time for which opioids were prescribed,” said the CDC.
The average dosage also tends to be higher for those suffering over an extended period of time. The CDC claims this leads to a greater amount of opioids per prescription putting a person at risk for opioid abuse and overdose.
Counties most likely to be hit hardest with opioid overdoses are those with a large percentage of non-Hispanic whites and a higher prevalence of diabetes and arthritis, unemployment and Medicaid enrollment. Rural counties are also statistically at risk.
Acting CDC Director Anne Schuchat said in a conference call to release the report Thursday that data for rural counties is difficult to reliably interpret because while overdosing is high, prescription numbers aren’t.
Most rural patients will drive into more populated towns to pick up prescriptions, but take the medication at home, Schuchat said. And if someone overdoses in a remote location, emergency help can be difficult to come by.
-Cronkite News video by Alex Valdez
The top three Arizona counties for MMEs prescribed, according to the report, have a combined population under 300,000.
Opioid addiction is one of the deadliest issues currently facing the United States, with more than 90 Americans dying per day from opioid overdoses in June, according to the National Institute on Drug Abuse.
In Arizona, the epidemic is so bad that Gov. Doug Ducey declared a state of emergency last month. He cited the deaths of 790 Arizonans from opioid abuse in 2016 as proof of a public health emergency that requires a new focus on solutions to the crisis.