Geographic Variation of Chronic Opioid Use in Fibromyalgia

Jacob T. Painter, Leslie J. Crofford, Jeffery Talbert

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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.

Original languageEnglish
Pages (from-to)303-311
Number of pages9
JournalClinical Therapeutics
Issue number3
StatePublished - Mar 2013

Bibliographical note

Funding Information:
Dr. Crofford serves as consultant for Glenmark Pharmaceuticals Ltd and receives research grant funding from Bioenergy, Inc . Dr. Painter and Dr. Talbert have indicated that they have no conflicts of interest regarding the content of this article.

Funding Information:
The current project was supported by the National Center for Research Resources ( UL1RR033173 ) and the National Center for Advancing Translational Sciences ( UL1TR000117 ) which supports Dr. Crofford and Dr. Talbert. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • Chronic nonmalignant pain
  • FM
  • Fibromyalgia
  • Geographic variation
  • Opioid

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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