Two Utah Cities, 60 Miles Apart, With Very Different Opioid Stories

Two Utah cities. About 60 miles apart as the crow flies. Clinton, a community of about 22,000 in Davis County near Hill Air Force Base, and Hurricane, a fast-growing town of 23,000 in Washington County near St. George.

In Clinton, 9.5% of all Medicare Part D prescriptions in 2023 were for opioids, Hydrocodone, Tramadol, Oxycodone, or Oxycodone combinations. In Hurricane, that number was 1.3%. One in ten prescriptions versus one in seventy-seven.

That gap doesn't have a single clean explanation. But it says something real about how pain is being managed in different corners of Utah.

The four opioids in the data

Medicare Part D covers four main opioids that show up in Utah's top prescriptions. Hydrocodone/Acetaminophen (Vicodin, Norco) is the most prescribed at 146,951 claims. Tramadol comes next at 101,484 claims, technically not a traditional opioid but classified as one, often used for moderate pain. Oxycodone HCl follows at 100,696 claims. Oxycodone/Acetaminophen (Percocet) rounds it out at 81,348.

Together, those four account for 430,479 Medicare prescriptions in Utah in 2023, about 7.9% of all claims in the top 50 drugs. That's a significant number, though it's worth noting that many of these prescriptions are for genuine, chronic pain conditions in older adults.

The rural cluster is worth noting

The cities with the highest opioid shares aren't all big urban centers. Richfield (Sevier County), Price (Carbon County), and Delta (Millard County) all cluster in the 7-8% range. These are small, rural communities in central and eastern Utah, far from major medical centers.

Richfield is a notable case. Gabapentin, a nerve pain drug covered in more detail in a separate article, is actually the single most prescribed drug there, ahead of Atorvastatin. And both Hydrocodone and Oxycodone combinations appear in the top five. The chronic pain burden in rural Sevier County appears to be shaping the entire prescription landscape.

What caregivers should know about opioids and older adults

Opioids affect older adults differently than younger people. The kidneys and liver process drugs more slowly as we age, which means the same dose that was safe at 45 may produce stronger effects at 70. Falls are one of the leading causes of injury and death in people over 65, and opioids increase fall risk.

If you're helping an older parent manage pain, a few questions are worth raising at their next appointment. What's the underlying cause of the pain, and has it been assessed recently? Is there a non-opioid option, physical therapy, anti-inflammatories, nerve blocks, that hasn't been tried? Is the current dose still appropriate given their age and kidney function?

None of this is an argument against opioids. Chronic pain is real, and undertreated pain is its own serious problem. But older adults on opioids benefit from regular check-ins on whether the dose and duration are still the right fit.

What this data can't tell us

Prescription data shows what's being prescribed, not why. A high opioid rate in Clinton could reflect a concentration of providers who manage post-surgical pain, or a patient population with higher rates of certain conditions, or prescribing patterns that have just been the norm for years. This data raises questions. It doesn't assign blame.

The more useful frame for families: use the geographic context to have a better-informed conversation with your doctor. If you're in a high-prescribing area and you're already on an opioid, asking about a medication review isn't confrontational, it's just good practice.

Source: CMS Medicare Part D Prescribers by Provider and Drug, 2023. Utah city-level data. Opioid classification per CMS methodology.