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. 2022 Jan 14;22(1):68.
doi: 10.1186/s12913-022-07477-6.

Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

Daniel M Hartung  1   2 , Jonah Geddes  3 , Sara E Hallvik  4 , P Todd Korthuis  3 , Luke Middleton  5 , Gillian Leichtling  4 , Christi Hildebran  4 , Hyunjee Kim  3
Affiliations

Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

Daniel M Hartung et al. BMC Health Serv Res. .

Abstract

Background: In 2015, Oregon's Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes.

Methods: Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon's high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level.

Results: There was an immediate reduction in high dose opioid prescriptions after the program was implemented (- 1.55 prescription per 1000 enrollee; 95% CI - 2.26 to - 0.84; p < 0.01). Program implementation was also associated with an immediate drop (- 1.29 percentage points; 95% CI - 1.94 to - 0.64 percentage points; p < 0.01) and trend reduction (- 0.23 percentage point per month; 95% CI - 0.33 to - 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program.

Conclusions: Although Oregon's high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

Keywords: Medicaid; Opioids; Overdose.

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Conflict of interest statement

Authors report no relevant financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Interrupted time series regression model of proportion of opioid fills > = 90 MME per day with fitted trend lines before and during performance improvement project. Notes: Dotted line indicates start of performance improvement project
Fig. 2
Fig. 2
Interrupted time series regression models of opioid overdose per 100,000 per month with fitted trend lines before and during performance improvement project. Notes: Dotted line indicates start of performance improvement project
See this image and copyright information in PMC

References

    1. Aitken M. Medicine use and spending in the U.S. A Review of 2018 and Outlook to 2023. 2019.
    1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419–1427. doi: 10.15585/mmwr.mm675152e1. - DOI - PMC - PubMed
    1. Haegerich TM, Jones CM, Cote PO, Robinson A, Ross L. Evidence for state, community and systems-level prevention strategies to address the opioid crisis. Drug Alcohol Depend. 2019;204:107563. doi: 10.1016/j.drugalcdep.2019.107563. - DOI - PMC - PubMed
    1. Mauri AI, Townsend TN, Haffajee RL. The Association of State Opioid Misuse Prevention Policies with Patient- and Provider-Related Outcomes: a scoping review. Milbank Q. 2020;98(1):57–105. doi: 10.1111/1468-0009.12436. - DOI - PMC - PubMed
    1. Oliva EM, Bowe T, Manhapra A, Kertesz S, Hah JM, Henderson P, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ. 2020;368:m283. doi: 10.1136/bmj.m283. - DOI - PMC - PubMed

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