Who Gets Rx Opioids and Who Doesn't
/By Pat Anson, PNN Editor
Although opioid prescriptions in the U.S. have fallen by 40% since 2011 and now stand at their lowest level in 20 years, it’s still common to see claims that opioids are “overprescribed.”
“Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions” was the headline used by National Public Radio for an in-depth look at opioid prescribing practices.
“Public data, including new government studies and reports in medical literature, shows enough prescriptions are being written each year for half of all Americans to have one,” NPR reported in 2020. “Patients still receive more than twice the volume of opioids considered normal.”
A new study by the CDC gives some much-needed context to the myth that opioid prescriptions are flooding America. Over the past decade, the so-called flood has turned into a trickle for the vast majority of chronic pain patients – the people most in need of effective analgesia.
The CDC study, which is based on the 2019 National Health Survey, found that only about one in five chronic pain patients – 22.1 percent – had used a prescription opioid in the past 3 months. In other words, it is “normal” for pain patients not to get opioids.
A previous study that looked at opioid prescriptions in 2010 found that 36.4 percent of patients with chronic non-cancer pain were prescribed an opioid. While there are differences in methodology between the two studies, the data seems to confirm that there has been a shift in prescribing practices over the past decade. Pain patients are significantly less likely to get an opioid prescription today than they were in 2010.
The new CDC study is also the first to take a deep dive into the demographic and socioeconomic characteristics of opioid recipients -- how age, sex, insurance, income, education and other factors make patients more or less likely to take opioid medication. Considering how much attention has been paid to opioid prescribing over the last decade, it’s surprising no one has looked into this before.
Researchers found that you are more likely to use prescription opioids if you are female, aged 45-64, unemployed, live in a rural area, and a Medicaid or Medicare beneficiary. Being Black, White, a non-veteran, and living below the federal poverty level also makes you more likely to take a prescription opioid.
YOU ARE MORE LIKELY TO TAKE Rx OPIOIDS IF YOU ARE ...
Conversely, you are less likely to take prescription opioids if you are male, aged 18-29, employed, a military veteran, privately insured, and live in a household at least 200% above the federal poverty level. Being Hispanic, uninsured, having a college degree, and living in a large metropolitan area also makes you less likely to use opioid medication.
YOU ARE LESS LIKELY TO TAKE Rx OPIOIDS IF YOU ARE ...
The CDC study did not look what type of chronic pain condition a patient had or how long they had it. It’s possible the condition itself led to someone becoming unemployed, disabled and poor, or that some other factor is at work. Military veterans, for example, have high rates of chronic pain but get fewer prescriptions because the Veterans Administration strongly discourages the use of opioids.
Researchers also relied on patient “self reports” and did not compare their answers with prescription records. Given the stigma association with opioids, it’s possible some patients may have answered “no” to opioid use, when in fact they used the drugs.
No study is without limitations, but this one shows some clear disparities between who uses opioid prescriptions and who does not. Poverty, lack of education and unemployment may have more to do with pain, drug use and “overprescribing” than policy makers and anti-opioid zealots have been willing to admit.
