Trends in Opioid Prescribing by County Following Pennsylvania PDMP Implementation

Background: The opioid epidemic has hit all corners of the United States but has disproportionately affected geographical areas to varying extents over the last thirty years. Rural areas have had higher rates of opioid prescribing than urban areas. However, urban counties have higher rates of opioid overdose deaths than rural counties. This study aims to outline the trends in opioid prescribing between rural and urban counties in the state of Pennsylvania since the implementation of a statewide prescription drug monitoring program (PDMP).Methods: Data pertaining to opioid prescribing habits as listed below were obtained from the Pennsylvania Department of Health who administers the PDMP in Pennsylvania. Study data that were of interest and provided by the PDMP were: Drug name, quantity of prescriptions, average daily morphine milligram equivalents (MME), and days supplied. Urban and Rural categorizations were provided by The Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly. The timeline for this study analyses began from Q1 2017 through Q1 2020. T-tests were used to compare the county informationResults: Opioid prescriptions from 2017 to 2020 decreased on average by 35% (SD= 0.13) in rural counties and 33% (SD= 0.10) in urban counties (P= 0.114). Change in average daily MME was 0.13 (SD=0.06) in the rural group and 0.14 (SD=0.03, p=0.229). Days supplied per prescription showed no significant changes between rural and urban counties with regards to; less than 3 days, 4-7 days, 8-21 days, and 31+ days. A significant decrease was seen in the 22–30-day subgroup between the rural (0.36 SD=0.08) and urban counties (0.31 SD=0.04 p=0.003).Conclusion: No significant changes were seen in the decline of opioid prescribing habits between rural and urban counties in Pennsylvania from 2017 to 2020. This compounds on similar state-specific studies showing no significant difference in the rate of decline between rural and urban counties.