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Opioid-Prescribing Trends in San Diego County, 2008-2019
Joshua R Smith1, Sarah Salven, Christian K Beÿ
1Emergency Medical Services (Drs Smith and Koenig and Mr Beÿ) and Public Health Services (Dr Thihalolipavan), Health & Human Services Agency, County of San Diego, San Diego, California; San Diego State University, San Diego, California (Ms Salven); Emergency Department, Scripps Mercy Hospital, San Diego, California (Dr Lev).
Context:
In 2019, drug overdoses accounted for 70 630 deaths in the United States, 70.6% of which involved an opioid. Approximately 28% of these deaths involved prescription medications, representing a significant number nationally. Local, state, and national efforts continue to address the impact of prescription medications within the ongoing opioid epidemic.
Objective:
This study examines trends in opioid prescription patterns from 2008 to 2019 in San Diego County, California, a major metropolitan area and the fifth most populous county in the United States. A timeline of events highlighting local, state, and national milestones is included to better contextualize distinct trends.
Design:
Collection and analysis of annual Prescription Drug Monitoring Program (PDMP) data for San Diego County.
Setting:
San Diego County, California.
Participants:
Prescribing physicians using the Controlled Substance Utilization Review and Evaluation System (CURES 2.0), California's PDMP.
Main Outcome Measures:
Prescribing data for all opioids were aggregated by formulation and strength and then converted into morphine milligram equivalents (MME) per person using CDC (Centers for Disease Control and Prevention) conversion guidelines and local population estimates. Additional outcomes analyzed include the number of prescriptions dispensed, number of pills per prescription, pill strength, and specific drug.
Results:
Total opioids prescribed increased by 29.7% from 2008 (399 MME per person) to 2012 (517 MME per person) and subsequently decreased by 54.4% from 2012 to 2019 (235 MME per person). The annual decrease in total MME from 2012 to 2019 averaged 5.9%. However, the 2-year decrease in MME from 2017 to 2019 was 35.1%, indicating an accelerated reduction in recent years.
Conclusions:
Opioid-prescribing trends in San Diego County from 2008 to 2019 are defined by 2 distinct periods. These trends may serve as an example of how local, state, and national efforts focusing on prescriber outreach, patient education, and regulatory oversight can address the impact of prescription opioids on the ongoing opioid epidemic.
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