Despite increased attention to opioid abuse in the past few years, opioid use and average daily dose in individuals who are commercially insured and those who receive Medicare have remained relatively unchanged, according to a retrospective study published in the British Medical Journal.
Investigators examined trends in opioid use between 2007 and 2016 in individuals with commercial insurance and in Medicare/Medicare Advantage beneficiaries who were either age eligible or eligible because of permanent disability, using pharmacy claims from OptumLabs Data Warehouse. They evaluated the insurance claims of 48 million individuals and included all opioids available during the study period. The study’s primary outcomes were the percentage of beneficiaries with any opioid prescription per quarter and average daily dose in milligram morphine equivalents (MME).
On average across the study period, 51.5% of those who were disabled and receiving Medicare were found to use opioids, compared with 14.3% of those with commercial insurance and 25.7% of age-eligible Medicare beneficiaries. Quarterly opioid use prevalence remained relatively stable in the population with commercial insurance, with 7% of patients using opioids per quarter from quarter 3 of 2007 to quarter 4 of 2014.This rate was then reduced to 6% and remained unchanged through 2016. The rate of quarterly opioid use prevalence increased between 2007 and 2016 from 11% to 14% and from 26% to 41% in the age-eligible Medicare population and the disabled Medicare population, respectively.
Those who were disabled and receiving Medicare were found to have the highest rates of use and long-term use, as well as daily dose. On average, this group used 63 MME per day, compared with 17 MME for commercial beneficiaries and 20 MME for age-eligible Medicare beneficiaries. At study’s end, the average daily dose for people with disability receiving Medicare was 56 MME.
Study limitations include an inability to capture other groups of people such as the uninsured, those who use fee-for-service Medicare, and those who have Medicaid.
“In the two Medicare beneficiary groups, prevalence of opioid use was higher in 2016 than in 2007,” the researchers said, “which suggests that there may be opportunities to further optimize opioid prescribing practices to conform to guidelines.”
Jeffery MM, Hooten WM, Henk HJ, et al. Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study. BMJ. 2018;362:k2833.