Despite Awareness, US Opioid Use Hasn't Decreased

Molly Jeffery, PhD

Newly published research shows that from 2007 to 2016 opioid prescriptions have remained relatively unchanged, despite the growing awareness of potential dangers of opioid abuse.

Researchers from Mayo Clinic, Yale University, The University of Alabama at Birmingham and Dartmouth College studied data from 48 million US patients with insurance coverage between 2007 and 2016. The study included patients with commercial insurance, Medicare Advantage beneficiaries (aged 65 years and older), and Medicare Advantage beneficiaries under age 65 (generally eligible due to disability).

"Our data suggest not much has changed in prescription opioid use since about 5 years ago," Molly Jeffery, PhD, lead author, scientific director of the Mayo Clinic Division of Emergency Medicine Research, said in a statement.

The main endpoints in this retrospective cohort study were the proportion of beneficiaries with any opioid prescription per quarter, average daily dose in milligram morphine equivalents (MME), and proportion of opioid use episodes that represented long term use.

Researchers found that across the study period, disabled Medicare beneficiaries were most likely to have opioid prescriptions—51.5% of these patients used opioids per year, compared with 14.3% or commercial beneficiaries and 25.7% of Medicare beneficiaries over age 65.

“Despite a deceleration in the growing prevalence of opioid use in the middle of the period, rates of use remained at or above their 2007 level in 2016,” wrote the study authors.

The proportion of patients using opioids in each quarter remained nearly stable for the commercial insurance population, starting at 6%, rising to 7% in Q3 of 2007 through Q4 of 2014, and returning to 6% at that point through the end of the study. For older Medicare recipients, 12% used opioids at the start, this increased to 15% in Q4 of 2010, and the prevalence remained between 14-15% for the remainder of the study.

Much more variability was observed among disabled Medicare recipients. In this population, the prevalence increased from 26% in Q1 of 2007 to a high of 41% between 2012 and 2013, before falling to 39% by the end of 2016.

While other research has pointed to decreases in opioid prescription rates, the current study shows that prescriptions are leveling off, but not decreasing.

"Our research of patient-level data doesn't show the decline that was found in previous research," said Jeffery. "Those declines were seen in the total amount of opioids prescribed across the whole market. We wanted to know how the declines were experienced by individual people. Did fewer people have opioid prescriptions? Did people taking opioids take less over time? When we looked at it that way, we found a different picture."

The study authors noted that this research did not include uninsured people, people with fee-for-service Medicare, or people with Medicaid alone. They additionally noted other limitations, including that their data may have missed people with multiple sources of insurance and people who paid for their own opioid prescriptions (instead of the insurance).

In conclusion, the authors suggested that for patients with long-term opioid use, physicians should reevaluate whether opioids continue to benefit the patient and consider other treatments as additions or alternatives to opioid use.

“Evidence based approaches are needed to improve both the safety of opioid use and patient outcomes including pain management and ability to function,” study authors wrote.

The study, “Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study,” was published August 1, 2018 in The BMJ.