Nationwide, County-Level Analysis of the Patterns, Trends, and System-Level Predictors of Opioid Prescribing in Surgery in the US: Social Determinants and Access to Mental Health Services Matter.
Journal
Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305
Informations de publication
Date de publication:
01 Mar 2024
01 Mar 2024
Historique:
medline:
15
2
2024
pubmed:
15
2
2024
entrez:
15
2
2024
Statut:
ppublish
Résumé
The diversion of unused opioid prescription pills to the community at large contributes to the opioid epidemic in the US. In this county-level population-based study, we aimed to examine the US surgeons' opioid prescription patterns, trends, and system-level predictors in the peak years of the opioid epidemic. Using the Medicare Part D database (2013 to 2017), the mean number of opioid prescriptions per beneficiary (OPBs) was determined for each US county. Opioid-prescribing patterns were compared across counties. Multivariable linear regression was performed to determine relationships between county-level social determinants of health (demographic, eg median age and education level; socioeconomic, eg median income; population health status, eg percentage of current smokers; healthcare quality, eg rate of preventable hospital stays; and healthcare access, eg healthcare costs) and OPBs. Opioid prescription data were available for 1,969 of 3,006 (65.5%) US counties, and opioid-related deaths were recorded in 1,384 of 3,006 counties (46%). Nationwide, the mean OPBs decreased from 1.08 ± 0.61 in 2013 to 0.87 ± 0.55 in 2017; 81.6% of the counties showed the decreasing trend. County-level multivariable analyses showed that lower median population age, higher percentages of bachelor's degree holders, higher percentages of adults reporting insufficient sleep, higher healthcare costs, fewer mental health providers, and higher percentages of uninsured adults are associated with higher OPBs. Opioid prescribing by surgeons decreased between 2013 and 2017. A county's suboptimal access to healthcare in general and mental health services in specific may be associated with more opioid prescribing after surgery.
Sections du résumé
BACKGROUND
BACKGROUND
The diversion of unused opioid prescription pills to the community at large contributes to the opioid epidemic in the US. In this county-level population-based study, we aimed to examine the US surgeons' opioid prescription patterns, trends, and system-level predictors in the peak years of the opioid epidemic.
STUDY DESIGN
METHODS
Using the Medicare Part D database (2013 to 2017), the mean number of opioid prescriptions per beneficiary (OPBs) was determined for each US county. Opioid-prescribing patterns were compared across counties. Multivariable linear regression was performed to determine relationships between county-level social determinants of health (demographic, eg median age and education level; socioeconomic, eg median income; population health status, eg percentage of current smokers; healthcare quality, eg rate of preventable hospital stays; and healthcare access, eg healthcare costs) and OPBs.
RESULTS
RESULTS
Opioid prescription data were available for 1,969 of 3,006 (65.5%) US counties, and opioid-related deaths were recorded in 1,384 of 3,006 counties (46%). Nationwide, the mean OPBs decreased from 1.08 ± 0.61 in 2013 to 0.87 ± 0.55 in 2017; 81.6% of the counties showed the decreasing trend. County-level multivariable analyses showed that lower median population age, higher percentages of bachelor's degree holders, higher percentages of adults reporting insufficient sleep, higher healthcare costs, fewer mental health providers, and higher percentages of uninsured adults are associated with higher OPBs.
CONCLUSIONS
CONCLUSIONS
Opioid prescribing by surgeons decreased between 2013 and 2017. A county's suboptimal access to healthcare in general and mental health services in specific may be associated with more opioid prescribing after surgery.
Identifiants
pubmed: 38357977
doi: 10.1097/XCS.0000000000000920
pii: 00019464-202403000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
280-288Informations de copyright
Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000-2014. Morb Mortal Wkly Rep. 2016;64:1378–1382.
Wilson N, Kariisa M, Seth P, et al. Drug and opioid-involved overdose deaths—United States, 2017–2018. Morb Mortal Wkly Rep. 2020;69:290–297.
The White House. Council of economic advisers report: the underestimated cost of the opioid crisis. Available at: https://trumpwhitehouse.archives.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/. Accessed January 8, 2024.
Manchikanti L, Helm S II, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. 2012;15:ES9–E38.
Schuchat A, Houry D, Guy GPJ. New data on opioid use and prescribing in the United States. JAMA. 2017;318:425–426.
Phillips DM. JCAHO pain management standards are unveiled Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000;284:428–429.
Mandell BF. The fifth vital sign: a complex story of politics and patient care. Cleve Clin J Med. 2016;83:400–401.
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015;49:409–413.
Kaafarani HMA, Han K, El Moheb M, et al. Opioids after surgery in the United States versus the rest of the world: the international patterns of opioid prescribing (iPOP) multicenter study. Ann Surg. 2020;272:879–886.
Eid AI, Depesa C, Nordestgaard AT, et al. Variation of opioid prescribing patterns among patients undergoing similar surgery on the same acute care surgery service of the same institution: time for standardization? Surgery. 2018;164:926–930.
Bartels K, Mayes LM, Dingmann C, et al. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One. 2016;11:e0147972.
Bateman BT, Cole NM, Maeda A, et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130:29–35.
Bicket MC, Long JJ, Pronovost PJ, et al. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152:1066–1071.
Hasak JM, Roth Bettlach CL, Santosa KB, et al. Empowering post-surgical patients to improve opioid disposal: a before and after quality improvement study. J Am Coll Surg. 2018;226:235–240.e3.
Kaafarani HMA, Eid AI, Antonelli DM, et al. Description and impact of a comprehensive multispecialty multidisciplinary intervention to decrease opioid prescribing in surgery. Ann Surg. 2019;270:452–462.
Frazee R, Garmon E, Isbell C, et al. Postoperative opioid prescription reduction strategy in a regional healthcare system. J Am Coll Surg. 2020;230:631–635.
Kutzler HL, Gannon R, Nolan W, et al. Opioid avoidance in liver transplant recipients: reduction in postoperative opioid use through a multidisciplinary multimodal approach. Liver Transplant. 2020;26:1254–1262.
Howard R, Waljee J, Brummett C, et al. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. 2018;153:285–287.
Remington PL, Catlin BB, Gennuso KP. The county health rankings: rationale and methods. Popul Health Metr. 2015;13:11.
Kaafarani HMA. Surgeons as part of the solution: changing the culture of opioid prescribing. Ann Surg. 2018;267:e48.
Guy GP, Zhang K, Bohm MK, et al. Vital signs: changes in opioid prescribing in the United States, 2006–2015. Morb Mortal Wkly Rep. 2017;66:697–704.
Zhu W, Chernew ME, Sherry TB, Maestas N. Initial opioid prescriptions among US commercially insured patients, 2012–2017. N Engl J Med. 2019;380:1043–1052.
Wilson MN, Hayden JA, Rhodes E, et al. Effectiveness of prescription monitoring programs in reducing opioid prescribing, dispensing, and use outcomes: a systematic review. J Pain. 2019;20:1383–1393.
Jones MR, Novitch MB, Sarrafpour S, et al. Government legislation in response to the opioid epidemic. Curr Pain Headache Rep. 2019;23:40.