Bradley D. Stein, M.D., Ph.D., from the RAND Corporation in Pittsburgh, and colleagues examined changes in the total number of opioid prescriptions filled at retail pharmacies by patient, prescriber, and county characteristics between 2008 through 2009 and 2017 through 2018.

The researchers found that from 2008-2009 to 2017-2018, there was a 21.2 percent decrease in total opioid MME volume per capita by prescriptions filled in retail pharmacies, from 951.4 to 749.3 MME. The greatest decline in MME volume per capita was among persons aged 46 to 55 years (664.6 MME; 33.7 percent decrease), while the greatest percentage decline was seen among persons aged 18 to 25 years (140.2; 66.6 percent). The greatest decline in per-capita MME volume was seen in metropolitan counties (219.8 MME; 22.6 percent) and in counties in the quartile with the highest fatal overdose rate (473.8 MME; 34.6 percent). Both within and across states, there was considerable variation observed. Across most specialties, there was a decrease in opioid MME volume per practicing clinician.

"These results suggest that the effects of clinician and policymaker efforts to reduce opioid prescribing may have differentially affected different populations, and future efforts to enhance clinically appropriate opioid prescribing may need to be more clinically nuanced and targeted for specific populations," the authors write.