Prescription Opioid Use Among Disabled Medicare Beneficiaries

Abstract

Background Prescription opioid use and overdose deaths are increasing in the U.S. Among under-age-65, disabled Medicare beneficiaries, the rise in musculoskeletal conditions as qualifying diagnoses suggests opioid analgesic use may be common and increasing, raising safety concerns. Methods From a 40% random-sample Medicare denominator, we identified fee-for-service beneficiaries under-age-65 and created annual enrollment cohorts 2007-2011 (6.4 million person-years). We obtained adjusted, annual opioid use measures: any use, chronic use (≥6 prescriptions), intensity of use (daily morphine equivalent dose (MED)), opioid prescribers per user. Geographic variation was studied across Hospital Referral Regions (HRRs). Results Most measures peaked in 2010. The adjusted proportion with any opioid use was 43.9% in 2007, 44.7% in 2010 and 43.7% in 2011. The proportion with chronic use rose from 21.4% in 2007 to 23.1%, in 2011. Among chronic users: mean MED peaked at 81.3 mg in 2010, declining to 77.4 mg in 2011; in 2011, 19.8% received ≥ 100 mg MED; 10.4% received ≥200 mg. In 2011 HRR-level measures varied broadly (5th to 95th percentile): any use: 33.0% to 58.6%, chronic use: 14.0% to 36.6%; among chronic users, mean MED ranged from 45 mg to 125 mg; mean annual opioid prescribers from 2.4 to 3.7. Conclusions Among these beneficiaries, opioid use was common. While intensity stabilized, the population using opioids chronically grew. Variation shows a lack of standardized approach and reveals regions with mean MED at levels associated with overdose risk. Future work should assess outcomes, chronic use predictors and policies balancing pain control and safety.

Losing ground at midlife in America

“…The share of Social Security Disability Insurance Medicare beneficiaries age 21-64 y who fill six or more prescriptions annually is 30% higher for whites than for blacks (8), and rates of prescription opioid use disorders are also somewhat lower for blacks (9). These differences seem too modest to explain the reversal in mortality rates, because one would require changes over time in the ratio of black-white opioid use to explain the large differential growth in black-white mortality rates.…”

Prescription Opioids and Labor Market Pains: The Effect of Schedule II Opioids on Labor Force Participation and Unemployment

“…Previous research has shown that adverse labor market conditions may contribute to higher disability rates (Black et al, 2002;Autor and Duggan, 2003;Erceg and Levin, 2014;Hall, 2015). Similarly, as chronic diagnosed pain is by itself grounds for disability, the direction of causation between opioid use and disability may run in either direction (GAO, 2011;Morden et al, 2014;Meara et al, 2016;Buchmueller and Carey, 2017;Song, 2017).…”

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

“…The rates we found in a veteran population not defined by chronic pain can be contextualized by studies in a 5 % sample in VHA that saw an increase in annual-period prevalence from 17.4 % to 24.1 % between FY2001 and FY2009, 3 in a national sample of veterans with chronic non-cancer pain reporting that 50 % received opioids in 2011, 22 and in a sample of disabled Medicare beneficiaries under 65 years of age with a 43.7 % rate of any opioid use and 23.1 % rate of chronic use in 2011. 23 Facilities with the highest prevalence of opioid prescribing in FY2004 tended to have declining rates of incident prescribing over the time period measured. This finding suggests the possibility of a saturation effect: as prevalent prescribing increases, fewer unexposed patients are available for incident prescription.…”