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More strikingly, nearly 20 % of the long-term users consumed an average daily dose of ≥50 morphine milligram equivalents, an amount that was identified by recent guidelines as potentially imparting a high risk of opioid-related harms.

The average percent of long-term opioid users among patients with advanced osteoarthritis varied widely across states, ranging from 8.9% in Minnesota to 26.4% in Alabama.

Access to primary care providers was only modestly associated with rates of long-term opioid use (an average adjusted difference of 1.4% between areas with highest vs lowest concentration of primary care providers), while access to rheumatologists was not associated with long-term opioid use.

“These findings suggest that regional prescribing practices are key determinants of prescription opioid use in chronic pain patients, and geographically targeted dissemination strategies for safe opioid prescribing guidelines may be required to address the high use observed in certain states,” said Dr. Desai.

Reference: http://doi.wiley.com/10.1002/art.40834

SOURCE: Wiley @brownrbjr2002