What US state has the lowest opioid prescription rate?

US State with the Lowest Opioid Prescription Rate

Hawaii has the lowest opioid prescription rate among US territories, with Guam having the lowest rate among US territories at 118.9 oral morphine mg equivalent (MME) per capita.

Overview of Opioid Prescription Rates by Region

The opioid prescription landscape varies significantly across the United States, with notable differences between states and territories:

• Hawaii has a significantly lower opioid prescription rate (794.6 MME per capita) compared to mainland states like Florida (1,509.8 MME per capita) 1
• Among US territories, Guam has the lowest rate at 118.9 MME per capita, followed by the Virgin Islands at 139.2 MME per capita 1
• Puerto Rico has the highest territorial rate at 421.5 MME per capita, though still lower than mainland comparison states 1

Factors Influencing Regional Opioid Prescription Variations

Several key factors contribute to the geographic disparities in opioid prescribing patterns:

• Geographic divisions: Counties in the East North Central, Mountain, and South Atlantic divisions have significantly higher odds of being "opioid high-risk" areas (with high overdose mortality and low treatment availability) compared to the West North Central division 2
• Economic factors: A 1% increase in unemployment is associated with 9% higher odds of a county being classified as "opioid high-risk" 2
• Healthcare infrastructure: Counties with an additional 10 primary care clinicians per 100,000 population have reduced risk of being opioid high-risk counties 2
• Demographic factors: Counties with higher percentages of younger populations (under 25 years) have lower risk of being opioid high-risk areas 2

Impact of Prescription Drug Monitoring Programs (PDMPs)

Prescription Drug Monitoring Programs have shown effectiveness in reducing opioid prescribing rates:

• States with PDMPs have significantly lower oxycodone shipments compared to states without such programs 3
• PDMP implementation is associated with less increase in prescription opioid admissions per year (p = 0.063) 3
• Patients admitted to inpatient drug abuse rehabilitation programs in PDMP states are less likely to be admitted for prescription opioid abuse (Odds ratio = 0.775) 3

Trends in Opioid Prescribing and Impact

The opioid landscape has changed dramatically over time:

• From 1997 to 2003, shipments of common opioids increased substantially: oxycodone (479%), morphine (100%), and hydrocodone (148%) 3
• The prevalence of prescription opioids detected in fatally injured drivers increased from 1.0% in 1995 to 7.2% in 2015 4
• Prescription opioid prevalence was higher in female than male drivers (4.4% vs 2.9%) 4
• Racial and ethnic factors correlate with prescribing patterns, with increased opioid prescribing in counties with higher proportions of white residents 5

Clinical Implications

The CDC Guideline for Prescribing Opioids for Chronic Pain emphasizes several key recommendations:

• Nonopioid therapy is preferred for treatment of chronic pain 6
• When opioids are necessary, clinicians should prescribe the lowest effective dosage 6
• Clinicians should use caution when increasing dosage to 50 MME or more per day and avoid increasing to 90 MME or more per day when possible 6
• For acute pain, opioid prescriptions should be limited to the lowest effective dose of immediate-release opioids, typically for 3 days or less 6

Pitfalls and Caveats

When interpreting opioid prescription rate data:

• Low prescription rates don't necessarily indicate lower opioid-related problems, as illicit opioid use may be prevalent
• Data may not capture prescriptions filled across state lines or obtained through illicit means
• Geographic analyses are often limited to county-level data due to irregular entry of zip code information 5
• Prescription rates must be balanced with ensuring appropriate access for patients with legitimate pain needs 1