Patterns in opioid prescription in the United States by region and prescribers over a 4-year period

2019 ◽  
Vol 15 (6) ◽  
pp. 499-506 ◽  
Author(s):  
Luisa M. Bigal, BA ◽  
Kristen Bibeau, PhD ◽  
Stephanie Dumbar, PhD
Keyword(s):  
United States ◽  
The United States ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Physician Specialty ◽  
The South ◽  
Opioid Prescription ◽  
North Central ◽  
Prescription Rates ◽  
Over Time

Background: As determinants of the opioid epidemic are several, describing patterns of opioid prescription over time is of importance.Objective: To characterize the prescribing patterns of opioids per US region and physician specialty from 2012 to 2015.Methods: Truven Health Analytics MarketScan® Databases were used to obtain data on opioid prescription rates per US region and physician specialty for the years 2012-2015. Opioids included in the study are tramadol, hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl.Results: Starting sample consisted of 5,860,096 individuals. An increase in prescriptions was seen for codeine (22.3 percent), oxycodone (22.4 percent), and tramadol (22.4 percent), while other opioids had decreases between 6.5 and 20.2 percent during this period. Family medicine physicians were the most frequent prescriber for all opioids except for oxycodone; nonphysician prescribers’ share of prescriptions nearly doubled for all opioids. The share of oxycodone and of tramadol among all opioids increased in all regions, while the opposite was seen for hydrocodone. Codeine prescription share increased substantially in the South but not in other regions. When comparing the period of 2012-2015, differences were significant for all regions (p 0.0001 for all regions). In 2015, the rate of prescription of oxycodone was nearly twofold higher in the Northeast vs North Central (38 percent vs 18.5 percent, p 0.0001), while tramadol was substantially more frequently prescribed in the South, where it responded to nearly 20 percent of all opioid prescriptions (p 0.0001).Conclusion: Patterns of prescription per opioid vary considerably per physician specialty and per US region. Although an overall decrease in prescriptions was seen, certain opioids were more frequently prescribed in 2015 than in 2012.

scholarly journals Outpatient antifungal prescribing patterns in the United States, 2018

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Kaitlin Benedict ◽  
Sharon V. Tsay ◽  
Monina G. Bartoces ◽  
Snigdha Vallabhaneni ◽  
Brendan R. Jackson ◽  
...  
Keyword(s):  
United States ◽  
Nurse Practitioners ◽  
The United States ◽  
Antifungal Drugs ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
The South ◽  
Antifungal Stewardship ◽  
Prescription Rates

Abstract Background: Widespread inappropriate antibiotic prescribing is a major driver of resistance. Little is known about antifungal prescribing practices in the United States, which is concerning given emerging resistance in fungi, particularly to azole antifungal agents. Objective: We analyzed outpatient antifungal prescribing data in the United States to inform stewardship efforts. Design: Descriptive analysis of outpatient antifungal prescriptions dispensed during 2018 in the IQVIA Xponent database. Methods: Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty. Census denominators were used to calculate prescribing rates among demographic groups. Results: Healthcare providers prescribed 22.4 million antifungal courses in 2018 (68 prescriptions per 1,000 persons). Fluconazole was the most commonly prescribed drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females versus males (110 vs 25 per 1,000 population) and adults versus children (82 vs 27 per 1,000 population). Prescription rates were highest in the South (81 per 1,000 population) and lowest in the West (48 per 1,000 population). Nurse practitioners and family practitioners prescribed the most antifungals (43% of all prescriptions), but the highest prescribing rates were among obstetrician-gynecologists (84 per provider). Conclusions: Prescribing antifungal drugs in the outpatient setting is common, with enough courses dispensed for 1 in every 15 US residents in 2018. Fluconazole use patterns suggest vulvovaginal candidiasis as a common indication. Regional prescribing differences could reflect inappropriate use or variations in disease burden. Further study of higher antifungal use in the South could help target antifungal stewardship practices.

scholarly journals Performance of Landscape Roses Grown with Minimal Input in the North-central, Central, and South-central United States

2017 ◽  
Vol 27 (5) ◽  
pp. 718-730 ◽  
Author(s):  
David C. Zlesak ◽  
Randy Nelson ◽  
Derald Harp ◽  
Barbara Villarreal ◽  
Nick Howell ◽  
...  
Keyword(s):  
United States ◽  
National Level ◽  
The United States ◽  
The South ◽  
Flower Number ◽  
North Central ◽  
The North ◽  
South Central ◽  
Central United States ◽  
Plant Hardiness

Landscape roses (Rosa sp.) are popular flowering shrubs. Consumers are less willing or able to maintain landscape beds than in years past and require plants that are not only attractive, but well-adapted to regional climatic conditions, soil types, and disease and pest pressures. Marketing and distribution of rose cultivars occurs on a national level; therefore, it is difficult for U.S. consumers in the U.S. Department of Agriculture (USDA) Plant Hardiness Zones 3 to 5 to identify well-adapted, cold-hardy cultivars. Identifying suitable cultivars that have strong genetic resistance to pests and disease and that will tolerate temperature extremes without winter protection in the USDA Plant Hardiness Zones 3 to 5 is of tremendous value to consumers and retailers in northern states. Twenty landscape rose cultivars, primarily developed in north-central North America, were evaluated at five locations in the United States (three in the north-central United States, one in the central United States, and one in the south-central United States) using the low-input, multiyear Earth-Kind® methodology. Six roses had ≥75% plant survival at the end of the study and were in the top 50% of performers for overall mean horticultural rating at each of the three north-central U.S. sites: ‘Lena’, ‘Frontenac’, ‘Ole’, ‘Polar Joy’, ‘Sunrise Sunset’, and ‘Sven’. Five of these six roses met the same criteria at the central United States (exception ‘Lena’) and the south-central United States (exception ‘Polar Joy’) sites. Cultivar, rating time, and their interaction were highly significant, and block effects were not significant for horticultural rating for all single-site analyses of variance. Significant positive correlations were found between sites for flower number, flower diameter, and overall horticultural rating. Significant negative correlations were found between flower number and diameter within each site and also between black spot (Diplocarpon rosae) lesion size from a previous study and overall horticultural rating for three of the five sites. Cane survival ratings were not significantly correlated with overall horticultural rating, suggesting some cultivars can experience severe winter cane dieback, yet recover and perform well. Data from this study benefit multiple stakeholders, including nurseries, landscapers, and consumers, with evidence-based regional cultivar recommendations and breeders desiring to identify regionally adapted parents.

Family Affairs, Part II

2018 ◽  
Author(s):  
Mark Burford
Keyword(s):  
United States ◽  
The United States ◽  
The South ◽  
South Side ◽  
National Convention ◽  
Black Christians ◽  
Set Up ◽  
Local Buzz ◽  
Over Time ◽  
Musical Activities

In Chicago, the resourceful Jackson established a livelihood on the South Side, initiated a lifelong involvement in political causes, and generated local buzz as a church singer. In the 1930s and 1940s, she also furthered her career through the pioneering Chicago organizers who founded the National Convention of Gospel Choirs and Choruses (NCGCC) and through the National Baptist Convention (NBC), the largest aggregation of black Christians in the United States. Founded by gospel songwriter Thomas A. Dorsey along with Magnolia Lewis Butts and Theodore Frye, the NCGCC set up the infrastructure for the modern gospel movement while growing Dorsey’s fame. Even more significant was Jackson’s exposure to black Baptists nationwide through the musical activities of the NBC, overseen by Lucie Campbell. Though she gained visibility through these two institutions, over time Jackson built a reputation increasingly independent of both.

scholarly journals The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada: Le rôle de la formation à la faculté de médecine à l’égard des pratiques de prescription d’opioïdes des médecins: données probantes d’Ontario, Canada

2020 ◽  
Vol 65 (10) ◽  
pp. 710-720
Author(s):  
Claire de Oliveira ◽  
Tomisin Iwajomo ◽  
Tara Gomes ◽  
Paul Kurdyak
Keyword(s):  
United States ◽  
Medical School ◽  
Medical Schools ◽  
The United States ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Opioid Prescribing ◽  
Medical School Training ◽  
School Training

Background: Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada. Methods: We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking. Results: Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions. Conclusion: The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.

scholarly journals Trends in Twentieth-Century U.S. Extreme Snowfall Seasons

2009 ◽  
Vol 22 (23) ◽  
pp. 6204-6216 ◽  
Author(s):  
Kenneth E. Kunkel ◽  
Michael A. Palecki ◽  
Leslie Ensor ◽  
David Easterling ◽  
Kenneth G. Hubbard ◽  
...  
Keyword(s):  
United States ◽  
El Niño ◽  
El Nino ◽  
The United States ◽  
La Niña ◽  
The South ◽  
North Central ◽  
La Nina ◽  
Central United States ◽  
Highly Correlated

Abstract Temporal variability in the occurrence of the most extreme snowfall years, both those with abundant snowfall amounts and those lacking snowfall, was examined using a set of 440 quality-controlled, homogenous U.S. snowfall records. The frequencies with which winter-centered annual snowfall totals exceeded the 90th and 10th percentile thresholds at individual stations were calculated from 1900–01 to 2006–07 for the conterminous United States, and for 9 standard climate regions. The area-weighted conterminous U.S. results do not show a statistically significant trend in the occurrence of either high or low snowfall years for the 107-yr period, but there are regional trends. Large decreases in the frequency of low-extreme snowfall years in the west north-central and east north-central United States are balanced by large increases in the frequency of low-extreme snowfall years in the Northeast, Southeast, and Northwest. During the latter portion of the period, from 1950–51 to 2006–07, trends are much more consistent, with the United States as a whole and the central and northwest U.S. regions in particular showing significant declines in high-extreme snowfall years, and four regions showing significant increases in the frequency of low-extreme snowfall years (i.e., Northeast, Southeast, south, and Northwest). In almost all regions of the United States, temperature during November–March is more highly correlated than precipitation to the occurrence of extreme snowfall years. El Niño events are strongly associated with an increase in low-extreme snowfall years over the United States as a whole, and in the northwest, northeast, and central regions. A reduction in low-extreme snowfall years in the Southwest is also associated with El Niño. The impacts of La Niña events are strongest in the south and Southeast, favoring fewer high-extreme snowfall years, and, in the case of the south, more low-extreme snowfall years occur. The Northwest also has a significant reduction in the chance of a low-extreme snowfall year during La Niña. A combination of trends in temperature in the United States and changes in the frequency of ENSO modes influences the frequency of extreme snowfall years in the United States.

scholarly journals The Opioid Epidemic and the Labor Market

2017 ◽  
pp. 1-6
Author(s):  
Dionissi Aliprantis ◽  
Anne Chen
Keyword(s):  
United States ◽  
Labor Market ◽  
Drug Use ◽  
Labor Force ◽  
The United States ◽  
Opioid Epidemic ◽  
Drug Overdoses ◽  
Prescription Pain Relievers ◽  
Overdose Deaths ◽  
Over Time

Drug overdoses now account for more deaths in the United States than traffic deaths or suicides, and most of the increase in overdose deaths since 2010 can be attributed to opioids--a class of drugs that includes both prescription pain relievers and illegal narcotics. We look at trends in drug use and overdose deaths to document how the opioid epidemic has evolved over time and to determine whether it could be large enough to impact the labor force.

scholarly journals Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 12 (6) ◽  
pp. 528-533 ◽  
Author(s):  
Majd Marrache ◽  
Matthew J. Best ◽  
Micheal Raad ◽  
Jacob D. Mikula ◽  
Raj M. Amin ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Geographic Variation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
The United States ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Anterior Cruciate

Introduction: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction. Hypothesis: Regional differences in opioid prescribing patterns after ACL reconstruction are present. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed. Results: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present ( P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017). Conclusion: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing. Clinical Relevance: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.

Opioids and Teenagers

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Addiction ◽  
Prescription Medications ◽  
Opioid Epidemic ◽  
Opioid Prescription

How has the opioid epidemic in the United States affected teenagers? From 1991 to 2012, the misuse of opioid prescription medications among teenagers more than doubled.1 So did the rate of opioid addiction,2 the rate of hospitalizations for overdose,3...

Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States

2021 ◽  
pp. 193864002110433
Author(s):  
Daniel J. Cunningham ◽  
Nicholas F. Kwon ◽  
Nicholas B. Allen ◽  
Andrew M. Hanselman ◽  
Samuel B. Adams
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Foot And Ankle ◽  
Opioid Prescription ◽  
State Legislation ◽  
Filling Volume ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
The Impact

Background Legislation in the United States has been enacted to reduce opioid overuse and abuse in the setting of the opioid epidemic, and a notable target has been opioid overprescription. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid-limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods The 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients 18 years of age and older undergoing nontrauma, nonarthroplasty foot and ankle surgery from 2010 to 2019 using a commercial database. States with and without legislation were identified, and opioid prescription filling before and after the legislation were tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared with states without legislation over similar time frames (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative prescription filling volume). Conclusion State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling, although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the opioid epidemic. Levels of Evidence: Level III: Retrospective, prognostic cohort study

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