Thursday, February 13, 2020

Latest data shows Alabama has the nation's highest rates of opioid prescriptions, with Blue Cross and Blue Shield's virtual monopoly playing a contributing factor

Alabama leads the nation in opioid prescriptions, according to recent data from the U.S. Center for Disease Control and Prevention (CDC) -- and residents probably can thank Blue Cross and Blue Shield's virtual monopoly on health insurance for that distinction. From a report at on the latest findings:

Alabamians received more prescribed opioids per person than residents of any other state in 2018, according to data recently released by the U.S. Centers for Disease Control and Prevention.

Patients in Alabama received 97.5 prescriptions per 100 people. The national average was 51.4 prescriptions per 100 people, according to the most recent surveillance data.

Overall, prescription rates have fallen since 2012. That year, residents of Alabama received 143 prescriptions per 100 people, enough to supply every person in the state with one and a half bottles of painkillers.

The nation's highest opioid-prescription rates tend to be in the South, and medical professionals in the region are struggling to get the problem under control:

“The Medical Association is keenly aware of the high number of opioid prescriptions written in Alabama and has undertaken several initiatives to address the problem,” said Mark Jackson, executive director of the Medical Association of the State of Alabama. “Beginning in 2009 the Medical Association has put on education courses for physicians, nurse practitioners, and physician assistants to make them aware of the dangers and addictive nature of opioids. This past year, we had over 550 providers attend those courses and we have had 5,000 attend since 2009.”

Other states with high rates of opioid prescriptions included Arkansas (93.5), Tennessee (81.8) and Kentucky (79.5). The District of Columbia had the lowest rate at 25 prescriptions per 100 people, roughly one quarter of Alabama’s rate, according to the CDC.

Opioids are commonly prescribed to control pain, but can also be abused, which can lead to addiction and death. Drug overdose deaths in the United States have more than tripled since 1999, and the majority include opioids, a class of drugs that includes everything from prescription OxyContin and fentanyl to illicit heroin sold on the street.

How does Blue Cross and Blue Shield of Alabama (BCBSAL) enter the picture? We addressed that question in a September 2019 post, borrowing from a 2017 report at

Alabama members of Blue Cross Blue Shield receive more opioids for longer periods of time and report higher rates of substance- abuse disorder than patients in almost every other state, according to a report released Thursday.

An analysis of claims filed by Blue Cross members ranked Alabama in the top three for opioid prescriptions filled, long-term painkiller use and diagnoses of opioid-abuse disorder. More than 26 percent of Blue Cross Blue Shield members in the Yellowhammer State filled prescriptions for opioids in 2015, compared to the national average of 21.4 percent.

The study follows recent reports showing the death toll from opioid use topping 33,000 in 2015 and continuing to rise. Many of the deaths in recent years have been caused by heroin and illicit fentanyl - a powerful substance that has infiltrated the drug supply and caused a spike in overdoses. Deaths from prescription opioids have plateaued, but still account for the majority of fatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC).

Details about Alabama's opioid problem are sobering:

According to the report, the number of substance-abuse disorder diagnoses for Blue Cross members increased almost 500 percent from 2010 to 2016. Women age 45 and older have higher rates of substance abuse than men, and men have higher rates of abuse among younger members. Less than a third of members diagnosed with opioid use disorder in Alabama received medication to treat the condition.

The CDC identified Alabama as the state with the highest number of prescribed opioids per capita in 2015, with physicians writing 5.8 million prescriptions that year. State regulators have adopted some rules to curb high rates of prescriptions. Recently, the Alabama Board of Medical Examiners adopted a rule requiring doctors to check the prescription drug database for certain patients.

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