Opioid Prescribing in the 2016 Medicare Fee-for-Service Population

Area of Science:

• Health Services Research
• Pharmacology
• Public Health

Background:

• Opioid misuse and overuse represent a significant national health crisis.
• Understanding patterns of opioid prescription fills and dosing is crucial for public health initiatives.

Purpose of the Study:

• To identify characteristics of Medicare beneficiaries associated with filling opioid prescriptions.
• To analyze variations in opioid dosing, specifically average daily doses (ADDs) of 120 morphine milligram equivalents (MMEs) or more.
• To examine factors influencing the likelihood of high-dose opioid use.

Main Methods:

• A cohort study of the 100% Medicare fee-for-service (FFS) population with 12 months of Medicare Part D coverage in 2016.
• A two-part model was used to examine patient factors associated with opioid prescription fills and ADD variations.
• Logistic regression analyzed the probability of ADDs equal to or exceeding 120 MMEs.

Main Results:

• Approximately 35% of FFS beneficiaries filled at least one opioid prescription in 2016; 1.5% had ADDs of 120 MMEs or more.
• Beneficiaries eligible for disability and those with multiple chronic conditions were more likely to fill opioids and use higher doses.
• Patients with chronic obstructive pulmonary disease (COPD) showed increased odds of filling opioids, higher ADDs, and higher likelihood of exceeding 120 MMEs.
• Black and Hispanic beneficiaries were less likely to fill opioids and had lower overall doses compared to white beneficiaries.

Conclusions:

• Specific beneficiary subgroups, particularly those with COPD, face elevated risks for adverse events from high-dose opioids (≥120 MMEs).
• Opioid optimization interventions are recommended to balance pain management with the risks of adverse events, especially respiratory depression in COPD patients.