Variation among states in prescribing of opioid pain relievers and benzodiazepines — United States, 2012

• Opioid pain relievers and benzodiazepine sedatives are commonly prescribed in the United States. They are frequently prescribed to the same patient.
• Overprescribing of opioid pain relievers can result in multiple adverse health outcomes, including fatal overdoses.
• Wide variation exists from one state to another in prescribing rates for these drugs. For states that prescribe well above the national rate, the need for a change in prescribing practices is urgent.
• CDC recommends that states make active use of their prescription drug monitoring programs to calculate current rates of prescribing, examine variations within the state, and track the impact of safer prescribing initiatives.

IntroductionOverprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.MethodsCDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.ResultsIn 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.ConclusionsFactors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.Implications for Public HealthState policy makers might reduce the harms associated with the abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations.