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Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid.
Psychiatr Serv. 2019 08 01; 70(8):681-688.PS

Abstract

OBJECTIVE

Opioid analgesics can be safe and effective when used properly. Reducing prescriptions that increase adverse outcomes is a focus for addressing the opioid crisis. In this study, the rate of potentially problematic opioid prescriptions was examined over 11 years in a large sample of U.S. patients.

METHODS

Claims from the IBM MarketScan commercial database (about 45 million) and multistate Medicaid database (about 7 million) from 2005 to 2015 were used to calculate rates of the following potentially problematic prescription practices: prescriptions for high-dose opioids for 90 days or more, prescriptions from multiple providers, prescriptions of long-acting or extended-release opioids for acute pain, overlap between prescriptions for opioids, and overlap between prescriptions for opioids and benzodiazepines.

RESULTS

Among patients with an opioid prescription, about 8% of those with private insurance and about 14% of those with Medicaid coverage had at least two incidents of potentially problematic prescriptions per year. Over the study period, rates increased for some practices (opioid-benzodiazepine overlap) and decreased for others (prescriptions from multiple providers). Receipt of potentially problematic prescriptions was higher among older patients, female patients with private insurance, and whites and male patients covered by Medicaid.

CONCLUSIONS

A significant percentage of patients who are prescribed opioids experience problematic prescription practices. Targeted policy and clinical interventions that reduce potentially problematic prescription could be a focus for addressing the U.S. opioid crisis.

Authors+Show Affiliations

Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services (DHHS), Washington, D.C. (Ali); Real World Analytics and Alliances, Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Tehrani); Health, Retirement, and Long-Term Analysis Division, Congressional Budget Office (CBO), Washington, D.C. (Mutter); IBM Watson Health, Cambridge, Massachusetts (Henke, O'Brien); U.S. Acute Care Solutions, Canton, Ohio (Pines); MedStar Washington Hospital Center, Washington, D.C. (Mazer-Amirshahi).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31056003

Citation

Ali, Mir M., et al. "Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid." Psychiatric Services (Washington, D.C.), vol. 70, no. 8, 2019, pp. 681-688.
Ali MM, Tehrani AB, Mutter R, et al. Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid. Psychiatr Serv. 2019;70(8):681-688.
Ali, M. M., Tehrani, A. B., Mutter, R., Henke, R. M., O'Brien, M., Pines, J. M., & Mazer-Amirshahi, M. (2019). Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid. Psychiatric Services (Washington, D.C.), 70(8), 681-688. https://doi.org/10.1176/appi.ps.201800555
Ali MM, et al. Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid. Psychiatr Serv. 2019 08 1;70(8):681-688. PubMed PMID: 31056003.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potentially Problematic Opioid Prescriptions Among Individuals With Private Insurance and Medicaid. AU - Ali,Mir M, AU - Tehrani,Ali B, AU - Mutter,Ryan, AU - Henke,Rachel Mosher, AU - O'Brien,Margaret, AU - Pines,Jesse M, AU - Mazer-Amirshahi,Maryann, Y1 - 2019/05/06/ PY - 2019/5/6/pubmed PY - 2020/6/4/medline PY - 2019/5/7/entrez KW - Insurance KW - Medicaid KW - Opioid KW - Opioid analgesic KW - Opioid misuse KW - Problematic opioid prescription SP - 681 EP - 688 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 70 IS - 8 N2 - OBJECTIVE: Opioid analgesics can be safe and effective when used properly. Reducing prescriptions that increase adverse outcomes is a focus for addressing the opioid crisis. In this study, the rate of potentially problematic opioid prescriptions was examined over 11 years in a large sample of U.S. patients. METHODS: Claims from the IBM MarketScan commercial database (about 45 million) and multistate Medicaid database (about 7 million) from 2005 to 2015 were used to calculate rates of the following potentially problematic prescription practices: prescriptions for high-dose opioids for 90 days or more, prescriptions from multiple providers, prescriptions of long-acting or extended-release opioids for acute pain, overlap between prescriptions for opioids, and overlap between prescriptions for opioids and benzodiazepines. RESULTS: Among patients with an opioid prescription, about 8% of those with private insurance and about 14% of those with Medicaid coverage had at least two incidents of potentially problematic prescriptions per year. Over the study period, rates increased for some practices (opioid-benzodiazepine overlap) and decreased for others (prescriptions from multiple providers). Receipt of potentially problematic prescriptions was higher among older patients, female patients with private insurance, and whites and male patients covered by Medicaid. CONCLUSIONS: A significant percentage of patients who are prescribed opioids experience problematic prescription practices. Targeted policy and clinical interventions that reduce potentially problematic prescription could be a focus for addressing the U.S. opioid crisis. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/31056003/Potentially_Problematic_Opioid_Prescriptions_Among_Individuals_With_Private_Insurance_and_Medicaid_ L2 - https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800555?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -