Hawaii is the Lowest Opioid Prescribing State
Based on the available evidence, Hawaii is the state with the lowest opioid prescription rate, having approximately one-third the prescription rate of Alabama, which has three times the amount of opioid prescriptions compared to the lowest prescribing state.
Geographic Variation in Opioid Prescribing
The United States shows significant geographic variation in opioid prescribing patterns, with some states having prescription rates up to three times higher than others. This variation persists despite national efforts to control opioid prescribing through various measures including:
- State prescription drug monitoring programs (PDMPs)
- CDC guidelines for opioid prescribing
- State-specific legislation and regulations
State-Level Variations
- States with long-standing prescription monitoring programs tend to have among the lowest rates of opioid prescriptions 1
- Two- to three-fold differences in opioid prescribing measures have been observed across states 2
- Alabama consistently ranks among the states with the highest opioid prescription rates
- Hawaii has maintained the position as the state with the lowest opioid prescription rate
Factors Associated with Lower Prescription Rates
Several factors appear to be associated with lower opioid prescription rates at the state level:
- Presence of a statewide prescription drug monitoring program 1
- Higher proportion of population aged 15-24 and 65+ years (negative association)
- Lower number of surgeons per 1,000 population
- Lower proportion of population reporting illicit drug use
Trends in Opioid Prescribing
Between 2006 and 2017, several national trends were observed in opioid prescribing 2:
- Decrease in the mean amount of opioids prescribed from 628.4 to 543.4 MME per person
- Significant decrease in high daily dosage prescriptions (≥90 MME) in 49 states
- Decrease in short-term prescriptions (≤3 days) in 48 states
- Increase in mean prescription duration from 13.0 to 17.9 days in all states
Implications for Clinical Practice
The CDC guideline for prescribing opioids for chronic pain 3 recommends:
- Starting opioids at the lowest effective dosage
- Using caution when increasing opioid dosages
- Implementing additional precautions when dosages reach or exceed 50 MME per day
- Avoiding increasing dosages to 90 MME or more per day without careful justification
- Prescribing no greater quantity than needed for acute pain (often 3 days or less)
Risk Reduction Strategies
To reduce risks associated with opioid prescribing:
- Use prescription drug monitoring programs to identify potential doctor shopping
- Avoid co-prescribing opioids with benzodiazepines whenever possible 4
- Consider prescribing naloxone for patients on high-dose opioids (>50 MME/day)
- Monitor patients receiving opioids for signs of misuse or abuse
- Be aware that patients with multiple prescribers (≥4) and using multiple pharmacies (≥4) are at higher risk of overdose 4
The significant geographic variation in opioid prescribing highlights the importance of state-level interventions and policies to address the opioid crisis, with Hawaii demonstrating the lowest prescription rates nationally.