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Key Points Question What are the characteristics of US counties with high rates of opioid overdose mortality and low capacity to deliver medications for opioid use disorder? Findings In this cross-sectional study of data from 3142 US counties, counties in the South Atlantic, Mountain, and East North Central divisions had more than twice the odds of being at high risk for opioid overdose mortality and lacking in capacity to deliver medications for opioid use disorder. Higher density of primary care clinicians, a younger population, micropolitan status, and lower rates of unemployment were associated with lower risk of opioid overdose and lower risk of lacking in capacity to deliver medications for opioid use disorder. Meaning Strategies to address mortality from opioid overdose by increasing treatment for addiction should target urban counties in Appalachia, the Midwest, and the Mountain division and include efforts to increase primary care clinicians and employment opportunities.

This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The United States is in the midst of a prescription opioid overdose and abuse epidemic. The rate of fatal prescription drug overdoses involving opioids almost quadrupled from 1.4 deaths/100 000 people in 1999 to 5.4 deaths/100 000 people in 2011. 1 The rate of emergency department visits involving prescription drug misuse-primarily of opioid, antianxiety, and insomnia medications-more than doubled from 214 visits/100 000 people in 2004 to 458 visits/100 000 people in 2011. 2 Forty-nine states have responded by developing prescription drug monitoring programs (PDMPs), which digitally store controlled substance dispensing information and make those data accessible to prescribers, pharmacies, and law enforcement officials. Although PDMPs are designed to curb opioid overprescribing, prescriber utilization is low. The median PDMP registration rate among licensed prescribers who issue at least 1 controlled substance prescription is 35%. 3 Furthermore, not all enrolled prescribers regularly use PDMPs.Consequently, 22 of the 49 states with PDMPs now legally mandate prescribers to query the system before writing for controlled substances with recognized potential for abuse or dependence. 4 These requirements face pushback from prescribers, many of whom consider them to be burdensome incursions into clinical practice. 5 For example, physician and dentist group challenges to the breadth of circumstances proposed for PDMP checks have contributed to a 2-year delay in the final implementation of a legally required mandate in

The evidence for cannabis’s treatment efficacy across different conditions varies widely, and comprehensive data on the conditions for which people use cannabis is lacking. We analyzed state registry data to provide nationwide estimates characterizing the qualifying conditions for which patients are licensed to use cannabis medically. We also compared the prevalence of medical cannabis qualifying conditions to recent evidence from the National Academies of Sciences, Engineering, and Medicine report on cannabis’s efficacy in treating each condition. Twenty states and Washington DC had available registry data on patient number, and fourteen states had data on patient-reported qualifying conditions. Chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients (67.5% in 2016). 85.5% of patient-reported qualifying conditions had either substantial or conclusive evidence of therapeutic efficacy. As medical cannabis use continues to increase, creating a nationwide patient registry will facilitate better understanding of use trends and potential effectiveness.

State prescription drug monitoring programs (PDMPs) aim to reduce risky controlled-substance prescribing, but early programs had limited impact. Several states implemented robust features in 2012-13, such as mandates that prescribers register with the program and regularly check its registry database. Some states allow prescribers to fulfill the latter requirement by designating delegates to check the registry. The effects of robust PDMP features have not been fully assessed. We used commercial claims data to examine the effects of implementing robust PDMPs in four states on overall and high-risk opioid prescribing, comparing those results to trends in similar states without robust PDMPs. By the end of 2014 the absolute mean morphine-equivalent dosages that providers dispensed declined in a range of 6-77 mg per person per quarter in the four states, relative to comparison states. Only in one of the four states, Kentucky, did the percentage of people who filled opioid prescriptions decline versus its comparator state, with an absolute reduction of 1.6 percent by the end of 2014. Robust PDMPs may be able to significantly reduce opioid dosages dispensed, percentages of patients receiving opioids, and high-risk prescribing.

IMPORTANCE Since the Centers for Disease Control and Prevention published opioid prescribing guidelines in March 2016, 31 states have implemented legislation to restrict the duration of opioid prescriptions for acute pain. However, the association of these policies with the amount of opioid prescribed following surgery remains unknown. OBJECTIVE To examine the association of opioid prescribing duration limits with postoperative opioid prescribing in Massachusetts and Connecticut, the first 2 states to implement limits after March 2016. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis and cross-sectional study examined immediate level and slope changes in monthly outcomes after prescribing limit implementation in Massachusetts and Connecticut. These states implemented 7-day limits on initial