title: Geographic variation of chronic opioid use in fibromyalgia.
abstract: BACKGROUND
  Opioid use for the treatment of chronic nonmalignant pain has increased drastically over the past decade. Although no evidence of efficacy exists supporting the treatment of fibromyalgia (FM) with chronic opioid therapy, a large number of patients are receiving this therapy. Geographic variation in the use of opioids has been demonstrated in the past, but there are no studies examining variation of chronic opioid use.
  
  
  OBJECTIVE
  This study examines both the extent of geographic variation and the factors associated with variation across states of chronic opioid use among patients with FM.
  
  
  METHODS
  Using a large, nationally representative dataset of commercially insured individuals, the following characteristics were examined: sex, disease prevalence, physician prevalence, illicit drug use, and the prescence of a prescription monitoring program. Other contextual and structural characteristics were also assessed.
  
  
  RESULTS
  The analysis included 245,758 patients with FM; 11.3% received chronic opioid therapy during the study period. There was a 5-fold difference between the states with the lowest rate of use (~4%) and those with the highest (~20%). The weighted %CV was 36.2%. Percent female and previous illicit opioid use rates were associated with higher rates of chronic opioid use, and FM prevalence and physician prevalence were associated with lower rates. The presence of a prescription monitoring program was not significantly correlated.
  
  
  CONCLUSIONS
  Geographic variation in chronic opioid use among patients with FM exists at rates similar to those seen in other studies examining opioid use. This large level of geographic variation suggests that the prescribing decision is not based solely on physician-patient interaction but also on contextual and structural factors at the state level. The level of physician and condition prevalence suggest that information dissemination and peer-to-peer interaction may play a key role in adopting evidence-based medicine for the treatment of patients suffering from FM and related conditions. Level of diagnosis prevalence as a predictor of evidence-based practice has not been reported in the literature and is an important contribution to research on geographic variation.
authors.affiliation: Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA. jtpainter@uams.edu
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Painter
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Crofford
authors.forename: Jeffery
authors.initials: J
authors.lastname: Talbert
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy*; D005843:Geography; D006801:Humans; D008297:Male
chemical_list: D000701:Analgesics, Opioid