The opioid epidemic began more than two decades ago and continues to increase in severity with the rate of overdose death increasing steadily. The epidemic was born in problematic claims about opioids and aggressive prescribing. After initial analysis of the first decade of the epidemic it became clear that actions would need to be taken to curtail overprescribing and many states passed legislation tracking and limiting opioid prescribing. Since then opioid prescribing has declined, but overdose has continued to increase at an alarming rate. This analysis is focused on evaluating more recent trends in opioid prescribing and overdose to see if the close positive correlation that existed between these values prior to 2010 holds true for the following decade. My findings indicate that between 2013 and 2019 that there is no relationship, or possibly a negative relationship, between opioid prescribing and overdose. Between 2013 and 2019 there was a 25% decrease in opioid prescribing rate yet a 96% increase in opioid overdose deaths. The close relationship that existed between prescribing and overdose appears to have diverged to the point where overdose increases as prescribing decreases. Linear regression on both national and state data revealed a significant negative relationship between overdose and prescribing for national data between 2013 and 2019 (R2 value of 0.84 and a p-value of 0.003) and no relationship between overdose and prescribing for state data between 2014 and 2019 (R2 value of 0.04 and a p-value of < 0.001). This questions the value of further efforts to reduce prescribing in preventing overdose and supports the hypothesis that restriction of prescription opioids can contribute to increased use of dangerous illicit opioids.

The authors have declared no competing interest.

This study did not receive any funding

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