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

Area of Science:

• Public Health
• Epidemiology
• Pharmacology

Background:

• Rising opioid-related death rates necessitate understanding the link between prescribing practices and mortality.
• Limited data exist on population-level associations between opioid prescribing and opioid-related deaths.

Purpose of the Study:

• To evaluate population-level associations between five opioid prescribing measures and opioid-related deaths.
• Investigate the relationship between changes in opioid prescribing and changes in opioid-related mortality across US commuting zones.

Main Methods:

• Ecological panel analysis using linear regression models with year and commuting zone fixed effects.
• Utilized IQVIA Real World Longitudinal Prescription Data (76.5%-90.0% of US prescriptions).
• Examined associations between five prescribing measures (per capita, % with prescription, high-dose, long-term, multiple prescribers) and deaths involving various opioid types.

Main Results:

• Increased opioid prescriptions per capita, % with prescription, and % with high-dose prescriptions correlated with increased total opioid-related deaths.
• All five prescribing measures correlated with increased deaths involving prescription opioids.
• Decreased long-term opioid prescriptions and prescriptions from multiple prescribers correlated with increased synthetic opioid deaths, particularly fentanyl.

Conclusions:

• Regional decreases in opioid prescriptions linked to declines in prescription opioid deaths.
• However, these decreases were also associated with increases in synthetic opioid deaths, notably fentanyl.
• Ecological study design limits individual-level inferences.