Geospatial and Temporal Patterns of Opioid Prescribing in California Before and After COVID-19: Insights from a 2017–2022 Analysis and Interactive Dashboard

Opioid prescribing has declined in the United States over the past decade, yet concerns about high-risk prescribing behaviors remain, particularly in the context of the COVID-19 pandemic. This study examined geospatial and temporal patterns of opioid prescribing in California from 2017 to 2022 using statewide prescription drug monitoring program data. We evaluated four indicators of high-risk prescribing: multiple provider episodes, overlapping opioid prescriptions, concurrent opioid and benzodiazepine use, and high-dose opioid prescriptions. Interrupted time series analyses were conducted to assess changes before and after the onset of the COVID-19 pandemic. While overall opioid prescribing and the number of patients receiving opioids continued to decline over time, several high-risk behaviors showed concerning trends during the pandemic period. Specifically, multiple provider episodes and overlapping opioid prescriptions increased following March 2020, while concurrent opioid and benzodiazepine use plateaued and reductions in high-dose prescribing did not fully return to pre-pandemic levels. To support interpretation and public health use, we developed an interactive dashboard enabling dynamic exploration of county-level trends. These findings suggest that the pandemic disrupted prior progress in reducing high-risk opioid prescribing and highlight the need for targeted interventions to address persistent and emerging risks in opioid use.