Co-morbidity and utilization of medical services by pain patients receiving opioid medications: data from an insurance claims database

Abstract

We used a large medical insurance claims database to identify three groups: chronic opioid use (>180 therapeutic days, N=3726); acute opioid use (<10 therapeutic days, N=37,108); and a non-opioid group (N=337,366) who filed at least one insurance claim but none for opioids. Our results showed that although chronic opioid users represented only 0.65% of the total population, they filed 4.56% of all insurance claims, used 45% of all opioid analgesics and had much more physical and psychiatric co-morbidity than the acute opioid or non-opioid samples. Women were substantially over-represented (>63%) in the chronic pain group and used a much greater share of all medical services than males, especially as they grew older. Although our data suggest that chronic pain is optimally managed in a multidisciplinary patient- and gender-specific treatment plan, this was rarely the case with internists being the primary, and often only, physician seen. Moreover, our data suggest that opioids were often used for conditions in which they are generally not indicated (e.g. arthritis and headaches) or contraindicated by co-existing physical ailments (COPD). Finally, we conclude that adherence to the WHO analgesic ladder and other pain treatment guidelines was relatively infrequent: first, opioid extended release preparations which are ideally suited for chronic pain were used only in one in four patients; and, second, the selection of a weak (propoxyphene, codeine, and tramadol) or strong opioid (e.g. morphine and oxycodone) seemed to be driven by numerous factors not necessarily related to the intensity or duration of pain.

Figure 1

The percent of the total males (left panel) and females (right panel) in the chronic opioid, acute opioid, and non-opioid control as a function of the age brackets shown.

Figure 2

The distribution, by percent, of the immediate release (IR) and extended release (ER) weak and strong opioids used by those in chronic pain (left panel) and acute pain (right panel)

Figure 3

The percent of the total females males (left panel) and males females (right panel) in the chronic opioid, stratified by the use of weak opioids, strong opioids, or both acute opioid, and non-opioid control as a function of the age brackets shown.