Despite all the attention given to the opioid overdose epidemic in recent years — including the fact that the epidemic began with an increase in the prescribing of opioid drugs in the late 1990s — opioid prescription rates have remained flat among commercially insured patients for the past 10 years, according to a study published this week in the BMJ.
And among some groups of Medicare patients, the rate at which opioid prescriptions are being handed out by doctors is actually higher than it was 10 years ago, the study reports.
“Our data suggest not much has changed in prescription opioid use since about five years ago,” said Molly Jeffery, the study’s lead author and a health economist and health services researcher at the Mayo Clinic, in a released statement.
That’s a deeply worrisome finding, given the substantial role that legally prescribed drugs have played in the opioid overdose epidemic.
An average of 40 people die each day in the U.S. from a prescription opioid overdose — a number four times higher than in 1999.
The United States has the highest rate of opioid use in the world, according to background information in the study. The U.S. rate is 88 percent higher than in second-place Germany and seven times higher than in Great Britain.
Tens of millions of claims
For the study, Jeffery and her colleagues analyzed anonymous health insurance claims made by 48 million Americans from 2007 through 2016. The participants were covered by both commercial insurance and by Medicare Advantage insurance, which are Medicare plans offered by private insurers. Some of the Medicare Advantage beneficiaries were aged 65 and older, while others were younger than 65 but qualified for a Medicare Advantage plan due to a permanent disability.
To be able to compare doses across different drugs, the researchers converted the prescriptions of each drug into milligram morphine equivalents (MME).
The analysis found that the average annual opioid prescription rate during the study period was 14 percent among commercial beneficiaries, 26 percent among the Medicare beneficiaries aged 65 and older, and 51 percent among the younger Medicare beneficiaries with disabilities.
The researchers then looked to see if the frequency or the amount of opioids being prescribed had changed during the 10 years of the study. What they found was troubling.
The quarterly prevalence of opioid use (the proportion of people who were being prescribed opioids in a given quarter of the year) changed little between 2007 and 2016 for those who were commercially insured. That rate started and ended at 6 percent. The average daily dose of opioids prescribed to this group — 17 MMEs, or the equivalent of about two pills of 5-milligram oxycodone — also remained unchanged.
The quarterly prevalence of opioid use for the Medicare Advantage beneficiaries aged 65 and older, on the other hand, actually increased, rising from 11 percent in 2007 to 15 percent in 2010, before declining slightly to 14 percent by 2016. The average daily dose of opioids prescribed to this group — 20 MMEs, or the equivalent of about three pills of 5-milligram oxycodone — remained unchanged, however.
The findings regarding the disabled Medicare Advantage beneficiaries were even more disturbing. The quarterly prevalence of opioid use in this group jumped from 26 percent in 2007 to 41 percent in 2016, before decreasing to 39 percent in 2016. The average daily dose for this group also rose over the course of the study, from the equivalent of seven 5-milligram oxycodone pills (53 MME) in 2007 to about 8 pills (56 MME) in 2016.
Problem not solved
In 2017, the CDC reported that the national opioid prescription rate had declined between 2010 and 2016, reaching its lowest rate in more than 10 years.
Jeffery and her Mayo Clinic colleagues were skeptical of that finding — which is why they decided to undertake their current study.
“The big difference here is that we’re able to look at an individual level,” she explains in a video released with the study. “Prior studies have used market-level data. And what that means is that they know all of the prescriptions that were filled by everybody, but they don’t know about the people who actually filled them.”
“The hole that we were able to fill,” she adds, “is that, because we have claims data for a large population, we were able to go in and say people of this age, people of this sex or gender, people of this race or ethnicity, people who have this kind of insurance — what did their opioid use patterns look like? That additional information actually caused us to have somewhat different results than what you see on a market level.”
Jeffery and her colleagues believe their findings demonstrate that much more needs to be done to find evidence-based approaches that will help patients manage their pain and maintain their ability to function while also improving the safety of opioid use.
“This problem isn’t solved yet,” Jeffery says in the video. “I think that if you’re hearing the message that prescription opioid use is starting to decline, I think we need to counter that message and say that maybe in most populations it really isn’t moving very much.”
FMI: The study can be read in full at the BMJ website.