Journal of Rural Health Volume: 35 Issue: 1 Dated: 2018 Pages: 97-107
Since increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse, the current study examined regional and rural urban variations in OAP trends in Kentucky from 2012 to 2015, and examined potential county level risk and protective factors.
The study used prescription drug monitoring data. Marginal models that used 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. The study found that 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 assess 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. (publisher abstract modified)
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