TY - JOUR
T1 - Opioid Prescribing in the 2016 Medicare Fee-for-Service Population
AU - Maciejewski, Matthew L.
AU - Zepel, Lindsay
AU - Hale, Sarah L.
AU - Wang, Virginia
AU - Diamantidis, Clarissa J.
AU - Blaz, Jacquelyn W.
AU - Olin, Serene
AU - Wilson-Frederick, Shondelle M.
AU - James, Cara V.
AU - Smith, Valerie A.
N1 - Funding Information:
The coauthors reported receiving institutional grants from the Department of Veterans Affairs HSR&D (MLM, VW, VS), the National Institute for Drug Abuse (MLM, VS) the National Institute of Diabetes and Digestive and Kidney Diseases (CJD, MLM, VW), the National Cancer Institute (MLM), and an institutional contract from the Centers for Medicare and Medicaid Services (CJD, SLH, MLM, VW, VS). Dr. Maciejewski reported ownership of Amgen stock due to his spouse's employment.
Funding Information:
This work was presented at AcademyHealth's 2019 Annual Research Meeting. Helpful comments from Christine Goertz, DC, PhD are acknowledged. The research in this article was supported by the Centers for Medicare & Medicaid Services under Contract Number HHSM-500-2014-00442G with the National Committee for Quality Assurance. This work was also supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs and the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13-410) at the Durham VA Health Care System. Dr. Maciejewski was supported by a Research Career Scientist award from the Department of Veterans Affairs (RCS 10-391). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veteran Affairs, Duke University, the National Committee for Quality Assurance, the Centers for Medicare & Medicaid Services, or the U.S. Department of Health and Human Services. The coauthors reported receiving institutional grants from the Department of Veterans Affairs HSR&D (MLM, VW, VS), the National Institute for Drug Abuse (MLM, VS) the National Institute of Diabetes and Digestive and Kidney Diseases (CJD, MLM, VW), the National Cancer Institute (MLM), and an institutional contract from the Centers for Medicare and Medicaid Services (CJD, SLH, MLM, VW, VS). Dr. Maciejewski reported ownership of Amgen stock due to his spouse's employment. Conceived the project: MLM, VW, CJD, VAS, LZ, SO; Performed analyses: LZ, VAS, JWB; Interpreted and discussed results: All authors; Drafted the manuscript: MLM, VW, CJD, VAS, LZ. Substantially contributed to the final version and approved the submission: All authors. The sponsors had no role in the design, methods, data collections, analysis, or preparation of the article.
Funding Information:
The research in this article was supported by the Centers for Medicare & Medicaid Services under Contract Number HHSM‐500‐2014‐00442G with the National Committee for Quality Assurance. This work was also supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs and the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13‐410) at the Durham VA Health Care System. Dr. Maciejewski was supported by a Research Career Scientist award from the Department of Veterans Affairs (RCS 10‐391). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veteran Affairs, Duke University, the National Committee for Quality Assurance, the Centers for Medicare & Medicaid Services, or the U.S. Department of Health and Human Services.
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2021/2
Y1 - 2021/2
N2 - BACKGROUND AND OBJECTIVES: Opioid use and misuse are prevalent and remain a national crisis. This study identified beneficiary characteristics associated with filling opioid prescriptions, variation in opioid dosing, and opioid use with average daily doses (ADDs) equal to 120 morphine milligram equivalents (MMEs) or more in the 100% Medicare fee-for-service (FFS) population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In a cohort of FFS beneficiaries with 12 months of Medicare Part D coverage in 2016, we examined patient factors associated with filling an opioid prescription (n = 20,880,490) and variation in ADDs (n = 7,325,031) in a two-part model. Among those filling opioids, we also examined the probability of ADD equal to 120 MMEs or more via logistic regression. RESULTS: About 35% of FFS beneficiaries had one or more opioid prescription fills in 2016 and 1.5% had ADDs equal to 120 MMEs or more. Disability-eligible beneficiaries and beneficiaries with multiple chronic conditions were more likely to fill opioids, to have higher ADDs or were more likely to have ADD equal to 120 MMEs or more. Beneficiaries with chronic obstructive pulmonary disease (COPD) were more likely to fill opioids (odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.46–1.47), have higher ADDs (rate ratio = 1.06, 95% CI = 1.06–1.06) when filled and were more likely to have ADD equal to 120 MMEs or more (OR = 1.23, 95% CI = 1.21–1.24). Finally, black and Hispanic beneficiaries were less likely to fill opioids, had lower overall doses and were less likely to have ADDs equal to 120 MMEs or more compared to white beneficiaries. CONCLUSION: Several beneficiary subgroups have underappreciated risk of adverse events associated with ADD equal to 120 MMEs or more that may benefit from opioid optimization interventions that balance pain management and adverse event risk, especially beneficiaries with COPD who are at risk for respiratory depression.
AB - BACKGROUND AND OBJECTIVES: Opioid use and misuse are prevalent and remain a national crisis. This study identified beneficiary characteristics associated with filling opioid prescriptions, variation in opioid dosing, and opioid use with average daily doses (ADDs) equal to 120 morphine milligram equivalents (MMEs) or more in the 100% Medicare fee-for-service (FFS) population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In a cohort of FFS beneficiaries with 12 months of Medicare Part D coverage in 2016, we examined patient factors associated with filling an opioid prescription (n = 20,880,490) and variation in ADDs (n = 7,325,031) in a two-part model. Among those filling opioids, we also examined the probability of ADD equal to 120 MMEs or more via logistic regression. RESULTS: About 35% of FFS beneficiaries had one or more opioid prescription fills in 2016 and 1.5% had ADDs equal to 120 MMEs or more. Disability-eligible beneficiaries and beneficiaries with multiple chronic conditions were more likely to fill opioids, to have higher ADDs or were more likely to have ADD equal to 120 MMEs or more. Beneficiaries with chronic obstructive pulmonary disease (COPD) were more likely to fill opioids (odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.46–1.47), have higher ADDs (rate ratio = 1.06, 95% CI = 1.06–1.06) when filled and were more likely to have ADD equal to 120 MMEs or more (OR = 1.23, 95% CI = 1.21–1.24). Finally, black and Hispanic beneficiaries were less likely to fill opioids, had lower overall doses and were less likely to have ADDs equal to 120 MMEs or more compared to white beneficiaries. CONCLUSION: Several beneficiary subgroups have underappreciated risk of adverse events associated with ADD equal to 120 MMEs or more that may benefit from opioid optimization interventions that balance pain management and adverse event risk, especially beneficiaries with COPD who are at risk for respiratory depression.
KW - Medicare
KW - opioid
KW - prescription
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U2 - 10.1111/jgs.16911
DO - 10.1111/jgs.16911
M3 - Article
C2 - 33216957
AN - SCOPUS:85096648894
VL - 69
SP - 485
EP - 493
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 2
ER -