Initial Opioid Prescriptions among U.S. Commercially Insured Patients, 2012-2017

Area of Science:

• Public Health
• Epidemiology
• Pharmacology

Background:

• The United States faces a severe opioid epidemic, exacerbated by prescription opioid overuse in adults aged 25-64.
• Long-duration and high-dose initial opioid prescriptions increase risks of long-term use, misuse, overdose, and death.

Purpose of the Study:

• To analyze trends in initial opioid prescription incidence, duration, and dosage in the U.S. from July 2012 to December 2017.
• To identify patterns in high-risk opioid prescribing among healthcare providers.

Main Methods:

• Utilized administrative claims data (Blue Cross-Blue Shield Axis) for U.S. enrollees from July 2012 to December 2017.
• Estimated monthly incidence of initial opioid prescriptions among opioid-naïve enrollees.
• Assessed the proportion of initial prescriptions that were long-duration or high-dose, and tracked the number of prescribers initiating therapy.

Main Results:

• The monthly incidence of initial opioid prescriptions decreased by 54% (1.63% to 0.75%) between July 2012 and December 2017.
• The number of providers initiating opioid therapy also declined significantly during this period.
• However, high-risk prescribing (e.g., >3-day supply or ≥50 MME/day) remained prevalent among a persistent subgroup of prescribers.

Conclusions:

• While many providers ceased initiating opioid therapy during the study period, a concerning number continued to issue high-risk initial prescriptions.
• This persistent high-risk prescribing by a subgroup of providers likely contributes to the ongoing opioid crisis.