Increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse. A team from the University of Kentucky College of Public Health (CPH) studied regional and rural-urban variations in OAP trends in Kentucky, from 2012 to 2015, and examined potential county-level risk and protective factors. Their findings appear in The Journal of Rural Health as the publication “Trends and Patterns of Opioid Analgesic Prescribing: Regional and Rural‐Urban Variations in Kentucky from 2012 to 2015.” Dr. Huong Luu, a doctoral student in epidemiology and biostatistics, is lead author. Co-authors include Dr. Svetla Slavova, associate professor of biostastics, CPH; Dr. Patricia R. Freeman, associate professor of pharmacy practice and science, UK College of Pharmacy; Dr. Michelle Lofwall, associate professor of pyschiatry, UK College of Medicine; Dr. Steven Browning, associate professor of epidemiology, CPH; and Dr. Heather Bush, associate professor of biostatistics, CPH.
[Photo: Dr. Huong Luu]
The study used prescription drug monitoring data. Marginal models employing generalized estimating equations were used to model repeated counts of residents with opioid analgesic prescriptions within county-quarter, 2012-2015, with offset for resident population, by rural-urban classification exposure, and adjusting for time-varying socioeconomic and relevant health status measures.
There were significant downward trends in rates of residents receiving dispensed opioid analgesic prescriptions, with no regional or rural/urban differences in the degree of decline over time. The adjusted models showed the Kentucky Appalachian region retained a significantly higher rate of residents with opioid analgesic prescriptions per 1,000 residents (30 percent higher than Central Kentucky and 19 percent higher than Kentucky Delta regions). Residents of nonmetropolitan not adjacent-to-metropolitan counties had significantly higher adjusted rates of OAP (33 percent higher than metropolitan counties and 17 percent higher compared to nonmetropolitan adjacent-to-metropolitan counties). The rate of OAP was significantly positively associated with emergency department visit injury rates and negatively associated with buprenorphine/naloxone prescribing rates.
Information on OAP trends and patterns will be used by Kentucky stakeholders to inform targeted interventions. Further research is needed to evaluate the availability and accessibility of nonopioid pain treatment in rural counties and the role of geography and time/distance traveled as risk factors for increased OAP.