County-Level Opioid Dispensation Directly Associates With Individual Opioid Misuse, Dependence

Hiding drugs
By using data from the Centers for Disease Control and Prevention’s retail opioid prescription database, the National Survey on Drug Use and Health, the Prescription Drug Abuse Policy System, the Centers for Disease Control and Prevention’s retail opioid prescription database, the Prescription Drug Abuse Policy System, and the US Census, researchers investigated if county level changes in opioid dispensing rates affect dependence, frequency of use, as well as individual level prescription opioid misuse.

A national survey found the county level opioid dispensing rate in the United States was directly related with individual level prescription opioid misuse and dependence. These findings were published in the American Journal of Psychiatry.

Data were sourced from the National Survey on Drug Use and Health (NSDUH) which has been collecting data annually since 1971 as well as census data from the US Census Bureau Research Data Center. Individual-level use, frequency of use, and dependence of prescription opioids and heroin were assessed among individuals aged ≥12 years between 2006 and 2016 and compared with county-level opioid dispensing data from the Centers for Disease Control and Prevention retail opioid prescription databased during the same time period.

In all years, 4.6% of the 748,800 respondents reported prescription opioid misuse, of whom 2.3% were infrequent misusers, 1.3% intermittent misusers, 0.5% regular but not daily misusers, and 0.3% daily misusers. For heroin, only 0.3% reported any use.

The average county-level opioid dispensing rate across all years and respondents was 78.4 per 100 persons. The rate of dispensing increased from 80.5 in 2006 to 96.1 per 100 persons in 2012, thereafter declining until 2016.

Accounting for opioid-related policies, county-level sociodemographics, individual-level correlates, and state; increased county-level opioid dispensing rates associated with past-year prescription opioid misuse (adjusted odds ratio [aOR], 1.002; 95% CI, 1.001-1.002; P <.001), frequency of past-year prescription opioid misuse (aOR, 1.001; 95% CI, 1.001-1.002; P <.01), and prescription opioid dependence (aOR, 1.003; 95% CI, 1.001-1.004; P <.001).

These findings indicated that for every one1-standard-deviation increase in dispensation, the past-year prescription misuse increased by 7.2% and the odds of dependence was 10.4% higher.

No significant relationship was observed for county-level opioid dispensing rates and past-year heroin use (aOR, 0.999; 95% CI, 0.996-1.001), frequency of past-year heroin use (aOR, 0.998; 95% CI, 0.994-1.002), or heroin dependence (aOR, 0.999; 95% CI, 0.996-1.003).

This study may be limited by using county-level data because important within-county differentiation may have been missed, and county size and number vary substantially across and within states.

This study found evidence to suggest that county-level opioid prescription dispensation rates associated directly with individual-level misuse and dependence but had little effect on heroin use or dependence. These data should be considered in the formulation of policies which aim at curbing the prescription opioid crisis in the US.


Vuolo M, Kelly BC. Effects of county-level opioid dispensing rates on individual-level patterns of prescription opioid and heroin consumption: evidence from national US data. Am J Psychiatry. Published online December 8, 2021. doi:10.1176/appi.ajp.2021.21060602