2022 Controlled Substance Prescribing in West Virginia

Furthermore, the WV VIPP and BOP were interested in looking at the average day supply of opioids related to this indicator and sought to understand whether there was a correlation between the number of doses being prescribed and the average day supply. In early 2018, the West Virginia Legislature passed Senate Bill 273 (SB 273), which limits the total number of days for which a prescription for an opioid can be written. Looking at the average day supply will help WV VIPP and BOP to determine if SB 273 has an impact.

Compared to 2021, overall opioid doses prescribed decreased across all counties in West Virginia with an average decrease of 3% in 2022. The overall average day supply for opioid prescriptions decreased by 1% from 2021-2022 and the percentage changes ranged from a 5% decrease to a 2% increase at the county level.

This indicator was modified to present another measure of MME. The CDC recommends a dose <50 MME/day and no more than 90 MME/day. The odds of overdose increase from 1.9 to 4.6 when going from 50 to <100 MME/day. ^[1]  It is important to assess this modified indicator to obtain an accurate picture of what counties are at increased risk of overdose.

There was a 6% decrease in high-risk daily dose prescribing across the state. However, changes varied at the county level, with a range of a 19% decrease to 5% increase from 2021-2022.

[1] Dowell D, Haegerich TM, Chou R.  CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016.  MMWR Recomm Rep 2016; 65:1-46 DOI:http://dx.doi.org/10.15585/mmwr.rr6501e1

The BOP has provided unsolicited reporting of patients with 8 or more prescribers within a 6-month period for the past few years and was interested in comparing this to the CDC guidelines which is 5 or more prescribers within a 6-month period. In December 2016, DHHR, in collaboration with the BOP, produced a report of the 2016 overdose deaths. It was found that the decedents were 3 times more likely to have seen 3 or more prescribers. WV VIPP and BOP were interested in evaluating this measure for the overall CSMP population.

The BOP has provided unsolicited reporting of patients with 5 or more pharmacies within a 6-month period for the past few years, which is the same as the CDC indicators. In December 2016, DHHR, in collaboration with the BOP, produced a report of the 2016 overdose deaths. It was found that the decedents were 70 times more likely to have used 4 or more pharmacies. WV VIPP and BOP were interested in evaluating this measure for the overall CSMP population.

Compared to 2021, the rate of patients seeing 3 or more prescribers increased across all counties in the state with a percentage increase of 7%. However, the rate of patients that went to 4 or more pharmacies decreased by 5% across the state.

The CDC recommends the initial opioid prescription be short-acting/immediate release as a strategy to reduce the risk of overdose. The WV VIPP and BOP chose to review the percent of patients prescribed long-acting opioids when said patients were opioid-naïve (i.e., no opioids in the previous 45 days). The percent of patients who were opioid-naïve and prescribed short-acting opioids were also reviewed.  Even at low doses of immediate release opioids, the potential for misuse and risk of overdose increases if the patient is not counseled on how to take the medication safely. However, it was determined that efforts should be focused on those patients who received long-acting opioids.

There was an overall increase in the percent of patients who were opioid-naïve from 2021 to 2022 with a 7% increase. Percentage changes ranged from a 43% decrease to a 164% increase among counties.