Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

Abstract

Background: There is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults.

Methods: We used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics.

Results: The percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low income, living in a lower-education area, and comorbidity of drug abuse, rheumatoid arthritis, and depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%.

Conclusions: Analyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.

Keywords: Medicare; Opioid; Overdose; Regulations.

Figure 1

Percent of Medicare patients in the U.S. who received prolonged opioid prescriptions for schedule II or schedule III or combination schedule II/III, from 2007 through 2012.

Figure 2

Proportions of Part D Medicare patients who received prolonged prescriptions for schedule II vs. schedule III opioid in 2012, controlling for patient characteristics, for each state. Patients with a cancer diagnosis were excluded. States colored as red had adjusted rates of schedule II opioid prescription significantly higher or lower than the average. States colored as blue had adjusted rates of schedule III opioid prescription significantly higher or lower than the average. States colored as green had both adjusted rates of schedule II and adjusted rates of schedule III opioid prescriptions significantly higher or lower than the average. States colored as black had adjusted rates of schedule II and adjusted rates of schedule III opioid prescriptions similar to the average. These adjusted rates were estimated from hierarchical generalized linear models that included all variables listed in Table 1.