JULY 2017

The amount of opioids prescribed in the US peaked in 2010 and 

then decreased each year through 2015. However, prescribing 

remains high and vary widely from county to county. Healthcare 

providers began using opioids in the late 1990s to treat chronic 

pain (not related to cancer), such as arthritis and back pain. As 

this continued, more opioid prescriptions were written, for more 

days per prescription, in higher doses. Taking opioids for longer 

periods of time or in higher doses increases the risk of addiction, 

overdose, and death. In 2015, six times more opioids per 

resident were dispensed in the highest-prescribing counties than 

in the lowest-prescribing counties. County-level characteristics, 

such as rural versus urban, income level, and demographics, 

only explained about a third of the differences. This suggests 

that people receive different care depending on where they live. 

Healthcare providers have an important role in offering safer and 

more effective pain treatment.

Healthcare providers can:

■ Follow the CDC Guideline for Prescribing Opioids for Chronic 

Pain, which includes recommendations such as:

` Use opioids only when benefits are likely to outweigh risks.

` Start with the lowest effective dose of immediate-release 

opioids. For acute pain, prescribe only the number of days 

that the pain is expected to be severe enough to require 

opioids. 

` Reassess benefits and risks if considering dose increases. 

■ Use state-based prescription drug monitoring programs 

(PDMPs) which help identify patients at risk of addiction 

or overdose.

6x

Providers in the 

highest prescribing 

counties prescribed 

6 times more opioids 

per person than the 

lowest prescribing 

counties in 2015. 

50% 

Half of US counties 

had a decrease 

in the amount of 

opioids (MME*) 

prescribed per 

person from 

2010 to 2015. 

3x

The MME prescribed 

per person in 2015 

was still more than 

3 times as high as 

in 1999. 

Opioid Prescribing

Where you live matters

Want to learn more? www.cdc.gov/vitalsigns/opioids

* MME, morphine milligram equivalents, 

is a way to calculate the total amount 

of opioids, accounting for differences in 

opioid drug type and strength.
Some characteristics of counties with 

higher opioid prescribing:

MME PER PERSON

Despite recent declines, opioid prescribing 

is still high and inconsistent across the US.

Problem:

SOURCE: CDC Vital Signs, July 2017 2

` Small cities or large towns

` Higher percent of white residents

` More dentists and primary 

care physicians

` More people who are 

uninsured or unemployed

` More people who have diabetes, 

arthritis, or disability

Higher opioid prescribing puts patients at risk for addiction and overdose. The wide variation among counties suggests a lack 

of consistency among providers when prescribing opioids. The 2016 CDC Guideline for Prescribing Opioids for Chronic 

Pain offers recommendations that may help to improve prescribing practices and ensure all patients receive safer, more 

effective pain treatment.

180  MME

1999 | US

640  MME

2015 | US

VS

The amount of opioids prescribed per person was three 

times higher in 2015 than in 1999.

SOURCES: Automation of Reports and Consolidated Orders System (ARCOS) of the Drug 

Enforcement Administration; 1999. QuintilesIMS Transactional Data Warehouse; 2015.

Insufficient data

0.1 - 453

454 - 676

677 - 958

959 - 5,543

The amount of opioids 

prescribed per person varied 

widely among counties in 2015. 
Problem: 

Too many prescriptions 

Solution:

Fewer prescriptions 

Problem: 

Too many days 

Solution:

Fewer days

Problem:

Too high a dose

Solution:

Lower doses

50 MME 

20 MME 

Problem: High prescribing

Solution: Safer prescribing practices

Days 20

15

10

5

0 2006 2015

0

10

20

30

40

50

60

70

2006 2015

Dose (MME)

Promising actions for safer opioid prescribing

3 SOURCE: CDC Vital Signs, July 2017

In 2015, the amount of opioids 

prescribed was enough for every 

American to be medicated around 

the clock for 3 weeks.

Even at low doses, 

taking an opioid for 

more than 3 months 

increases the risk of 

addiction by 15 times.

 A dose of 50 MME or 

more per day doubles the 

risk of opioid overdose 

death, compared to 20 

MME or less per day. At 

90 MME or more, the risk 

increases 10 times.

Use opioids only when benefits are likely 

to outweigh risks. Options other than 

opioids include:

■ Pain medicines like acetaminophen, 

ibuprofen, and naproxen

■ Physical therapy and exercise

■ Cognitive behavioral therapy 

For acute pain, prescriptions should 

only be for the expected duration 

of pain severe enough to need 

opioids. Three days or less is often 

enough; more than seven days is 

rarely needed.

Use the lowest effective dose of 

immediate-release opioids when 

starting, and reassess benefits 

and risks when considering dose 

increases. 

For more recommendations when considering opioids for chronic pain outside of end-of-life care, see The CDC Guideline 

for Prescribing Opioids for Chronic Pain. The Guideline can also be used to inform health systems, states, and insurers 

to ensure appropriate prescribing and improve care for all people.

www.cdc.gov/drugoverdose/prescribing/guideline.html

Average days supply per prescription increased 

from 2006 to 2015.

Average daily MME per prescription declined both 

nationwide and in most counties, but it is still too high. 

Therapies that don’t 

involve opioids may 

work better and have 

fewer risks and side 

effects.

If continuing opioids, 

ask whether benefits 

continue to outweigh 

risks. If not, use other 

treatments and taper 

opioids gradually.

Avoid a daily dose 

of 90 MME or more. 

If already taking 

high doses, offer 

the opportunity to 

gradually taper to 

safer doses.

(640 MME per person, which equals 5 mg of 

hydrocodone every 4 hours)
What Can Be Done?

The Federal Government is

■ Educating healthcare providers and the public about 

pain management, addiction, and opioid overdose 

and providing guidance on safe and effective pain 

management.

■ Equipping states with resources to implement and 

evaluate safe prescribing practices.

■ Improving access to addiction treatment and 

recovery services.

■ Increasing access to overdose-reversing drugs, such 

as naloxone.

■ Tracking opioid-related trends to better understand 

and respond to the epidemic.

■ Supporting cutting-edge research about pain 

management and addiction.

States can 

■ Maximize prescription drug monitoring programs 

(PDMPs) by using near real-time data reporting, 

integrating with electronic health records, and 

promoting routine provider use.

■ Implement and evaluate programs to improve 

prescribing practices.

■ Use data to identify and address high-risk 

prescribing. 

■ Enhance the use of prescribing guidelines based on 

the best available science.

■ Increase access to medication-assisted treatment 

for addiction and naloxone for opioid overdose.

Health insurers can

■ Refer to the Guideline in setting up prescription 

claims review programs to identify and address 

improper prescribing and use of opioids.

■ Increase coverage for other proven treatments to 

reduce pain, such as physical therapy and nonopioid pain medicines.

■ Cover clinicians’ time when they are conducting 

activities that improve quality and safety of pain 

management and addressing addiction. These can 

include patient counseling, coordination of care, 

and checking the patient’s prescription history in 

the PDMP.

■ Reduce barriers (such as prior authorization) to use 

of nonopioid pain medications and medicationassisted treatment for addiction. 

Healthcare providers can:

■ Follow the CDC Guideline for Prescribing Opioids 

for Chronic Pain, which includes recommendations 

such as:

` Use opioids only when benefits are likely to 

outweigh risks.

` Start with the lowest effective dose of immediaterelease opioids. For acute pain, prescribe only the 

number of days that the pain is expected to be 

severe enough to require opioids.

` Reassess benefits and risks if considering dose 

increases. 

■ Use state-based PDMPs which help identify 

patients at risk of addiction or overdose.

Everyone can

■ Consider non-opioid options for pain management.

■ Store prescription opioids in a secure place, out of 

reach of others (including children, family, friends, 

and visitors). 

■ Dispose of medications properly as soon as the 

course of treatment is done. For more information, 

visit FDA at: www.fda.gov/Drugs/ResourcesForYou.

■ Get help if you’re having trouble controlling your 

opioid use, SAMHSA’s National Helpline: 

1-800-662-HELP. 

1-800-CDC-INFO (232-4636) 

TTY: 1-888-232-6348 

www.cdc.gov

Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30329

Publication date: 7/6/2017

CS269641A