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Despite Crisis, U.S. Prescription Opioid Use Remains High

Pills and capsules

(stevepb, Pixabay)

2 August 2018. A review of insurance claims over a 10-year period shows prescription opioid use in the U.S. remains at a high level with few signs of declining, despite repeated and vocal public concerns about these drugs. A report of these findings by a research team from the Mayo Clinic and other institutions appears in yesterday’s issue of the journal The BMJ.

Researchers led by health economist Molly Jeffrey at the Mayo Clinic investigated trends in opioid prescriptions filled by individuals in recent years. Abuse of prescription opioid drugs, as well as heroin and fentanyl sold on the street, has become a serious national public health emergency, with overdose deaths from these drugs in 2018 numbering more than 115 per day, according to National Institute of Drug Abuse. A report by the National Academies of Sciences, Engineering, and Medicine in July 2017 spells out the full scope of the crisis beyond overdose deaths, with some 2 million Americans age 12 and older addicted to prescription opioid drugs and another 600,000 addicted to heroin.

Jeffrey and colleagues — from Yale University, Dartmouth College, University of Alabama in Birmingham, and Mayo Clinic — sought to document overall trends in opioid use by Americans in recent years, as well as any changes in these prescriptions among different groups of recipients, including the type of insurance coverage. The team reviewed insurance claims stored in OptumLabs databases from 2007 through 2016, which includes 20 percent of all commercially-insured people in the U.S. and nearly 1 in 4 (24%) of individuals covered by Medicare Advantage, a hybrid Medicare-commercial insurance program. Mayo Clinic is one of the founders and a current partner in OptumLabs.

The researchers analyzed some 48 million records during this period, looking primarily at individuals with commercial insurance, Medicare Advantage beneficiaries age 65 and over, and Medicare Advantage participants under the age of 65 who qualify for the program because of disabilities. To compare various drugs prescribed over time, the team converted the drug compounds and dosages into standard milligram morphine equivalents, or MMEs.

The results show that in any year more than half (52%) of people with disabilities covered by Medicare Advantage use prescription opioids, twice the rate of older Medicare Advantage customers (26%), and nearly 4 times the rate of people with commercial insurance (14%). Rates of opioid use among people with disabilities covered by Medicare Advantage rose from 26 percent in 2007 to 41 percent in 2013, where the rate remained largely unchanged through 2017. Opioid use rates for older Medicare Advantage participants also rose but more slowly, beginning at 11 percent in 2007 to 15 percent in 2010, and leveling off after that. Among commercial insurance beneficiaries, opioid use remained largely stable at 6 or 7 percent each year.

In addition, Medicare Advantage recipients with disabilities used more opioid drugs than individuals in other insurance categories. People with disabilities under Medicare Advantage used the MME equivalent of 7 to 9 opioid pills in 5 milligram dosages per day over the 10 year period, compared to the equivalent of 3 pills per day for older Medicare Advantage participants, and 2 pills per day of 5 milligrams each for people covered by commercial insurance.

While other reports suggest the overall quantity of prescription opioid drugs consumed is decreasing, the researchers believe those calculations may be misleading. “Our research of patient-level data doesn’t show the decline that was found in previous research,” says Jeffrey in a Mayo Clinic statement. “Those declines were seen in the total amount of opioids prescribed across the whole market. We wanted to know how the declines were experienced by individual people.” Jeffrey tells more about the study in the following video.

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