Opioid Prescriptions

Prescriptions Dispensed

A large number of patients are prescribed opioids, and many are prescribed in high dosages. In 2010-2018, about 400 opioid prescriptions were filled per 1,000 residents in LAC each year (Figure 1), which is enough to supply a bottle of opioids to over half of all adults in LAC, though the rate has been steadily declining since 2014. 

The Antelope Valley region (SPA 1) had the highest rates of opioid prescriptions filled, while the Metro region (SPA 4) had the lowest rates of opioid prescriptions filled in 2018 (Figure 2).

Figure 1. Opioid prescriptions (excl. buprenorphine) per 1,000 residents, LAC and CA
Source: CDPH CURES

Figure 2. Opioid prescriptions (excl. buprenorphine) per 1,000 residents by SPA, LAC, 2018
Source: CDPH CURES

About 10 per 1,000 LAC residents were on high-dose opioids (more than 90 mg MME daily) in 2018, which has steadily decreased from about 25 per 1,000 residents in 2009 (Figure 3). 

The number of morphine milligram equivalents (MME) per resident per year in LAC was 245 in 2018, which has steadily decreased from 388 in 2012 (Figure 4). 

Figure 3. Residents on more than 90 mg MME daily per 1,000 residents, LAC and CA
Source: CDPH CURES

Figure 4. Morphine milligram equivalents (MME) (excl. buprenorphine), per resident per year, LAC and CA
Source: CDPH CURES

Overlapping Prescriptions

The rate of LAC residents who had two or more overlapping opioid prescriptions increased from about 8 in 2008 to about 12 in 2014, then decreased to about 7 in 2018 per 1,000 LAC residents (Figure 5). 

The rate of LAC residents who had overlapping opioid and benzodiazepine prescriptions increased from about 11 in 2008 to about 17 in 2014, then decreased to about 11 in 2018 per 1,000 LAC residents (Figure 6). 

Figure 5. Residents per 1,000 with at least two overlapping opioid prescriptions (for at least 30 days in the quarter), LAC and CA, 2008-2018
Source: CDPH CURES

Figure 6. Residents per 1,000 with overlapping opioid and benzodiazepine prescriptions (for at least 30 days in the quarter), LAC and CA, 2008-2018
Source: CDPH CURES

Diversion

Some of the prescriptions are obtained by patients who use five or more prescribers at five or more pharmacies in six months (i.e. "Doctor shoppers"), which may indicate addiction or diversion. Prescribers and pharmacies may not be aware of their patients use of multiple prescribers and pharmacies, contributing to the large supply of prescription drugs in the community. 

This large supply of prescription opioids is often easily and widely available, and over half of individuals who misuse/abuse prescription opioids obtain them from a friend or relative (Figure 8).

Figure 7. Residents per 1,000 using 5+ prescribers at 5+ pharmacies in 6 months ("doctor shoppers"), LAC and CA, 2008-2017
Source: CDPH CURES

Figure 8. Source of prescription opioids (number in thousands), US, 2017
Source: NSDUH

CURES Registrants

Starting in 2016 in California, all licensed prescribers authorized to prescribe scheduled drugs, and all licensed pharmacists authorized to dispense scheduled drugs, are required to register for access to the Controlled Substance Utilization Review and Evaluation System (CURES), California's Prescription Drug Monitoring Program (PDMP). CURES is a secure statewide electronic database that allows for licensed prescribers and licensed pharmacists to access their patients' controlled substances (Schedule II, III, and IV) history, and is designed to identify and deter drug abuse, fraud, and diversion of prescription drugs without affecting legitimate medical practice and patient care. 

In LAC, the number of prescribers and dispensers registered for access to CURES has generally been increasing in recent months, with 35,081 prescribers and 10,172 dispensers registered as of February 2019 (Figure 9). 

Figure 9. Number of prescribers and dispensers registered for access to CURES, Los Angeles County, August 2017 - February 2019
Source: California Department of Justice, CURES program

References

Figures 1-7. California Department of Public Health (CDPH). Controlled Substance Utilization Review and Evaluation System (CURES). https://pdop.shinyapps.io/ODdash_v1/ 

Figure 8. Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health (NSDUH). Table 6.5. https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2018-NSDUH  

Figure 9. California Department of Justice. Controlled Substance Utilization Review and Evaluation System (CURES).