The Prevalence of Diagnosed Opioid Abuse in Commercial and Medicare Managed Care Populations

Dufour, Robert; Joshi, Ashish V.; Pasquale, Margaret K.; Schaaf, David; Mardekian, Jack; Andrews, Gordon; Patel, Nick C.

doi:10.1111/papr.12148

Cited by 44 publications

(60 citation statements)

References 13 publications

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“…1–3 This epidemic has increasingly affected the elderly Medicare population, among whom rates of hospitalization for opioid overdoses quintupled from 1993 through 2012. 4–6 The risks of opioid use are particularly pronounced among the elderly, who are vulnerable to their sedating side effects, even at therapeutic doses. 7 Multiple studies have shown increased rates of falls, fractures, and death from any cause associated with opioid use in this population.…”

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confidence: 99%

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

2017

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BACKGROUND Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. METHODS We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. RESULTS Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.)

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confidence: 99%

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

2017

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“…1 The population that uses Medicare, the federal insurance program for Americans who have certain disabilities or are 65 years or older, has among the highest and most rapidly growing prevalence of opioid use disorder, with more than 6 of every 1000 patients (more than 300000 of 55 million) diagnosed 2 and with hospitalizations increasing 10% per year. 3 Data on patients with commercial insurance plans (the other likely source for national population data) show just more than 1 of every 1000 patients diagnosed.…”

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confidence: 99%

“…3 Data on patients with commercial insurance plans (the other likely source for national population data) show just more than 1 of every 1000 patients diagnosed. 2 Prevention initiatives are essential for reducing the number of new patients with opioid use disorder, but treatment will be required for those already addicted to opioids. Opioid agonist therapy (OAT), including buprenorphine-naloxone (Suboxone) and methadone, is the most effective pharmacotherapy for opioid addiction.…”

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confidence: 99%

Use of Opioid Agonist Therapy for Medicare Patients in 2013

Lembke

Chen

2016

JAMA Psychiatry

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“…As federal, state, and local governments work to develop and implement policies to address the opioid crisis, targeted efforts may be needed to expand access to OUD prescribers in Medicare. This may be particularly important in areas with large numbers of dually eligible enrollees, in Southern and Midwestern regions, and in rural counties . While expanding OUD treatment is part of Centers for Medicare & Medicaid Services’ (CMS) recently issued Opioid Misuse Strategy, the specific strategies to increase access to medications in Medicare are not clear …”

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confidence: 99%

“…For example, a 2014 study found that the 6‐month prevalence of OUD was 6.35 per 1000 Medicare enrollees, compared with 1.15 per 1000 patients with commercial insurance. The rate of OUD among Medicare enrollees doubled from 2008 to 2010 . A recent report estimated that in 2016 approximately 500 000 Medicare Part D beneficiaries received high amounts of opioids, defined as an average morphine equivalent dose of greater than 120 milligrams a day for at least three months.…”

Section: Introductionmentioning

confidence: 99%

County‐level access to opioid use disorder medications in medicare Part D (2010‐2015)

Abraham

Adams

Bradford

et al. 2019

Health Services Research

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Objective To identify geographic disparities in access to opioid use disorder (OUD) treatment medications and county demographic and economic characteristics associated with access to buprenorphine and oral naltrexone prescribers in Medicare Part D. Data Sources/Study Setting We utilized data from the Medicare Part D Prescription Drug Event Standard Analytic File (2010‐2015). Study Design/Data Collection We used logistic regression to examine county‐level access to OUD medication prescribers. Principal Findings There was a 5.6 percentage point increase in counties with access to an OUD prescriber over the study period. However, in 2015, 60 percent of US counties lacked access to a Medicare Part D buprenorphine prescriber and over 75 percent lacked access to an oral naltrexone prescriber. Increased access to OUD prescribers was largely concentrated in urban counties. Results of logistic regression indicate regional differences and potential racial disparities in access to OUD prescribers. Conclusions To improve access to buprenorphine and naltrexone treatment for Medicare Part D enrollees, CMS may consider implementing educational and training initiatives focused on OUD treatment, offering training to obtain a buprenorphine waiver at no cost to providers, and sending targeted information to providers in low OUD treatment capacity areas.

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The Prevalence of Diagnosed Opioid Abuse in Commercial and Medicare Managed Care Populations

Abstract: Despite a stable rate of prescription opioid use among the observed population, the prevalence of diagnosed opioid abuse is increasing, particularly in the Medicare population.

Cited by 44 publications

References 13 publications

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

Use of Opioid Agonist Therapy for Medicare Patients in 2013

County‐level access to opioid use disorder medications in medicare Part D (2010‐2015)

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