The opioid epidemic in the United States has hit communities disproportionately, differing based on geography, race, sex, gender, and age. As opioid prescription rates have been declining in the past few years, more data is needed to outline the effect of certain policies in targeting the problem effectively. This study aimed to outline the demographical changes taking place in Pennsylvania, one of the hardest-hit states in the opioid epidemic. In 2018, Pennsylvania was one of the states with the highest age-adjusted drug overdose death rate.17 No significant change was found between urban and rural communities in the rate of decline of overall opioid prescriptions in Pennsylvania. Very little variation existed between the groups with regards to the number of pills prescribed, MMEs, and days supplied.
Although opioid prescriptions have been declining nationally since the early 2010’s,18 few studies have analyzed the trends of decline in opioid prescribing on a geographical basis. A study done in Kentucky showed significant downward trends in residents with an opioid prescription from 2012–2015, however, no significant change was seen between geographical settings.19
The availability of prescription and semi-synthetics opioids (hydromorphone, hydrocodone, and oxycodone) as well as deaths related to these opioids is a problem that has been associated primarily with rural communities. Factors that are hypothesized to be contributing to this include the higher availability of prescription narcotics, less developed social networks, unique provider relationships with their patients, and the rapid succession of stable financial opportunities.20,21 Federal resources have been lacking as well. Drive times to federal Opioid Treatment Centers (OTC) are significantly higher in rural areas.22
Urban counties also face unique challenges addressing the opioid epidemic. Drug overdose deaths were higher in urban counties than rural counties in 2017, mostly due to the disproportionate use of heroin and synthetic opioids.23 Urban counties suffer from similar issues as the remote rural counties such as lower family income, education level, unemployment rate, and mental health disorders. The availability and inexpensive cost of synthetic opioids provide a unique challenge to policymakers aimed at combating the opioid crisis in urban communities.
The Health Resources and Services Administration (HRSA) is a prime example of the federal Government supporting rural communities to fight the opioid epidemic. Millions of dollars have been allocated to address the need for stronger health care resources in rural counties including over eleven million in Pennsylvania alone.24 Other initiatives of HRSA include increasing telehealth availability for those seeking treatment remotely, increasing funding for poison control centers, and increasing education among prescribers and consumers alike.
Other significant measures placed in Pennsylvania over the last decade have impacted opioid prescribing in the state. The implementation of a statewide PDMP showed prescribers and law enforcement agencies patients who were at risk of opioid use disorders. Alongside the 2016 CDC report, which updated its policy on opioid prescribing, the PA Department of Health (PA-DOH) created a series of prescribing guidelines for target audiences including, but not limited to: dentists, emergency departments, providers of treatment for non-chronic cancer pain, and Obstetrician/Gynecologists.25 Various public health measures were implemented in the mid-2010s which included the DEA 360 program. MAT was advanced in the hospital setting as well, where physicians were allowed to begin methadone/buprenorphine treatment for patients hospitalized for opioid-related or non-opioid-related issues.
Included in these measures are targeted programs aimed at reducing the supply of heroin and synthetic drugs, especially in urban areas. One of which was the DEA’s 15th Take-Back Day. This took place at 217 collection sites across Pennsylvania and collected 37,290 pounds of prescription drugs. Approximately half of the total was collected in the Philadelphia metropolitan area and surrounding counties.26 The DEA also increased the intensity of their physician investigations, as Pennsylvania ranked second among the highest number of physician arrests in opioid related cases.27