SEATTLE — The rate of opioid use varies considerably from state to state, with some of the highest rates found in Indiana and Maine, and the lowest in California and Minnesota, federal prescription claims data show.
That variation is inexplicable medically, and suggests that opioids are being used too liberally in some states, not enough in others, or both, Dr. Judy T. Zerzan said in a poster presentation at the annual research meeting of Academy Health.
Medicare and Medicaid prescribing figures from the start of 1996 to the end of 2002 show a steep national increase in opioid prescribing. The increase coincides with efforts to improve treatment of pain, noted Dr. Zerzan of the division of general internal medicine at the University of Washington, Seattle.
Over the 7 years of the study, opioid prescribing nationally increased a mean of 24% per year. In contrast, there was a mean annual increase of 12% for an index known as the “market basket” that reflects general prescribing.
But only two-thirds of the states had an increase in the opioid prescribing. And some had a greater relative increase than others, Dr. Zerzan said.
The 10 states with the highest rates of opioid prescribing were Alaska, Indiana, Louisiana, Maine, Maryland, Missouri, Mississippi, Montana, North Carolina, and West Virginia, with rates of 87–200 defined daily doses per 1,000 Medicaid beneficiaries.
The eight states with the lowest rates were California, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Tennessee, and Vermont, with rates of 0 to 39 defined daily doses per 1,000 Medicaid beneficiaries.
One possible explanation for the variation in opioid use is differing state prescription benefit policies. Other potential explanations include that marketing of the drugs has been different in different regions, and that physician attitudes toward opioids vary by region, Dr. Zerzan said.