Prescription Practices involving Opioid Analgesics among Americans with Medicaid, 2010

Recent state-based studies have shown an increased risk of opioid overdose death in Medicaid populations. To explore one side of risk, this study examines indicators of potential opioid inappropriate use or prescribing among Medicaid enrollees. We examined claims from enrollees aged 18–64 years in the 2010 Truven Health MarketScan® Multi-State Medicaid database, which consisted of weighted and nationally representative data from 12 states. Pharmaceutical claims were used to identify enrollees (n=359,368) with opioid prescriptions. Indicators of potential inappropriate use or prescribing included overlapping opioid prescriptions, overlapping opioid and benzodiazepine prescriptions, long acting/extended release opioids for acute pain, and high daily doses. In 2010, Medicaid enrollees with opioid prescriptions obtained an average 6.3 opioid prescriptions, and 40% had at least one indicator of potential inappropriate use or prescribing. These indicators have been linked to opioid-related adverse health outcomes, and methods exist to detect and deter inappropriate use and prescribing of opioids.

[1]  M. Valenstein,et al.  Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths , 2012 .

[2]  N. J. Williams,et al.  Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain , 2010, Journal of pain & palliative care pharmacotherapy.

[3]  Susan S. Kim,et al.  Identifying suboptimal management of persistent pain from integrated claims data: a feasibility study. , 2003, Managed care.

[4]  Ying Liu,et al.  Potential misuse and inappropriate prescription practices involving opioid analgesics. , 2013, The American journal of managed care.

[5]  C. Rutter,et al.  Trends in long‐term opioid therapy for chronic non‐cancer pain , 2009, Pharmacoepidemiology and drug safety.

[6]  M. Glass,et al.  Occupational medicine practice guidelines : Evaluation and management of common health problems and functional recovery in workers , 2003 .

[7]  A. Mailis-Gagnon,et al.  Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population. , 2011, Canadian family physician Medecin de famille canadien.

[8]  B. Martin,et al.  Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study. , 2008, The journal of pain : official journal of the American Pain Society.

[9]  C. Rutter,et al.  De Facto Long-term Opioid Therapy for Noncancer Pain , 2008, The Clinical journal of pain.

[10]  Bradley C. Martin,et al.  Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study , 2008, PAIN.

[11]  Leonard J. Paulozzi,et al.  Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women — United States, 1999–2010 , 2013, MMWR. Morbidity and mortality weekly report.

[12]  M. Cullen,et al.  Further validation that claims data are a useful tool for epidemiologic research on hypertension , 2013, BMC Public Health.

[13]  Leonard J. Paulozzi,et al.  Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. , 2011, MMWR. Morbidity and mortality weekly report.

[14]  Bradley C Martin,et al.  Emergency department visits among recipients of chronic opioid therapy. , 2010, Archives of internal medicine.

[15]  J David Haddox,et al.  Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data. , 2004, The American journal of managed care.

[16]  L. Paulozzi.  Prescription drug overdoses: a review. , 2012, Journal of safety research.

[17]  P. K. Adelmann.  Mental and Substance Use Disorders Among Medicaid Recipients: Prevalence Estimates from Two National Surveys , 2003, Administration and Policy in Mental Health and Mental Health Services Research.

[18]  J. Whitmire,et al.  Unintentional Overdose Deaths in the North Carolina Medicaid Population: Prevalence, Prescription Drug Use, and Medical Care Services , 2010 .

[19]  G. Pasternak,et al.  Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. , 2009, The journal of pain : official journal of the American Pain Society.

[20]  B. Psaty,et al.  Opioid Prescriptions for Chronic Pain and Overdose , 2010, Annals of Internal Medicine.

[21]  Matt Schiller,et al.  Analytic models to identify patients at risk for prescription opioid abuse. , 2009, The American journal of managed care.

[22]  L. Leresche,et al.  Age and gender trends in long-term opioid analgesic use for noncancer pain. , 2010, American journal of public health.

[23]  Karin A Mack,et al.  Pharmaceutical overdose deaths, United States, 2010. , 2013, JAMA.

[24]  Hans Hansen,et al.  American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2--guidance. , 2012, Pain physician.

[25]  Thomas R. Frieden,et al.  Overdose deaths involving prescription opioids among Medicaid enrollees - Washington, 2004-2007. , 2009, MMWR. Morbidity and mortality weekly report.

[26]  C. McAdam-Marx,et al.  Costs of Opioid Abuse and Misuse Determined From a Medicaid Database , 2010, Journal of pain & palliative care pharmacotherapy.