Plan Type and Opioid Prescriptions for Children in Medicaid

Area of Science:

• Pediatric pharmacology
• Health services research
• Public health

Background:

• Opioids pose risks for diversion, misuse, and abuse in children, making them generally unsuitable for acute pain management.
• Understanding variations in pediatric opioid prescribing is crucial for patient safety and public health.

Purpose of the Study:

• To investigate the association between Medicaid plan types—coordinated care organization (CCO), managed care (MC), and fee-for-service (FFS)—and the likelihood of children receiving opioid prescriptions.
• To identify potential disparities in pediatric opioid prescribing patterns based on insurance plan structure.

Main Methods:

• Secondary analysis of Oregon Medicaid data from January 1, 2016, to December 31, 2017.
• Inclusion of 200,169 Medicaid-enrolled children aged 0-17.
• Examined opioid prescription receipt from any provider and from dental visits, controlling for age, sex, race, and ethnicity.

Main Results:

• Approximately 6.7% of children received an opioid from any provider, and 1.2% from a dental visit.
• Children enrolled in CCO plans were significantly more likely to receive an opioid prescription from any health provider compared to those in MC or FFS plans (P<0.01).
• Similarly, CCO enrollees showed a significantly higher likelihood of receiving opioids from dental visits than MC or FFS enrollees (P<0.01).

Conclusions:

• Pediatric opioid prescription rates differ significantly based on Medicaid plan type.
• Medicaid-enrolled children in CCO plans exhibit a higher propensity for receiving opioid prescriptions.
• Further investigation is warranted to elucidate the underlying reasons for these prescribing variations and to mitigate potential risks associated with pediatric opioid use.