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Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017.
JAMA Netw Open. 2020 05 01; 3(5):e204514.JN

Abstract

Importance

Although opioids can be effective medications in certain situations, they are associated with harms, including opioid use disorder and overdose. Studies have revealed unexplained prescribing variation and prescribing mismatched with patient-reported pain for many indications.

Objective

To summarize opioid prescribing frequency, dosages, and durations, stratified across numerous painful medical indications.

Design, Setting, and Participants

Retrospective cross-sectional analysis of 2017 US administrative claims data among outpatient clinical settings, including postsurgical discharge. Participants had any of 41 different indications associated with nonsurgical acute or chronic pain or postsurgical pain or pain associated with sickle cell disease or active cancer and were enrolled in either private insurance (including Medicare Advantage) in the OptumLabs Data Warehouse data set (n = 18 016 259) or Medicaid in the IBM MarketScan Multi-State Medicaid Database (n = 11 453 392). OptumLabs data were analyzed from October 2018 to March 2019; MarketScan data were analyzed from January to April 2019.

Exposures

Nonsurgical acute or chronic pain or postsurgical pain; pain related to sickle cell disease or active cancer.

Main Outcomes and Measures

Indication-specific opioid prescribing rates; days' supply per prescription; daily opioid dosage in morphine milligram equivalents; and for chronic pain indications, the number of opioid prescriptions.

Results

During the study period, of 18 016 259 eligible patients with private insurance, the mean (95% CI) age was 42.7 (42.7-42.7) years, and 50.3% were female; of 11 453 392 eligible Medicaid enrollees, the mean (95% CI) age was 20.4 (20.4-20.4) years, and 56.1% were female. A pain-related indication under study occurred in at least 1 visit among 6 380 694 patients with private insurance (35.4%) and 3 169 831 Medicaid enrollees (27.7%); 2 270 596 (35.6% of 6 380 694) privately insured patients and 1 126 508 (35.5% of 3 169 831) Medicaid enrollees had 1 or more opioid prescriptions. Nonsurgical acute pain opioid prescribing rates were lowest for acute migraines (privately insured, 4.6% of visits; Medicaid, 6.6%) and highest for rib fractures (privately insured, 44.8% of visits; Medicaid, 56.3%), with variable days' supply but similar daily dosage across most indications. Opioid prescribing for a given chronic pain indication varied depending on a patient's opioid use history. Days' supply for postoperative prescriptions was longest for combined spinal decompression and fusion (privately insured, 9.5 days [95% CI, 9.4-9.7 days]) or spinal fusion (Medicaid, 9.1 days [95% CI, 8.9-9.2 days]) and was shortest for vaginal delivery (privately insured, 4.1 days [95% CI, 4.1-4.1 days] vs Medicaid, 4.2 days [95% CI, 4.2-4.2 days]).

Conclusions and Relevance

Indication-specific opioid prescribing rates were not always aligned with existing guidelines. Potential inconsistencies between prescribing practice and clinical recommendations, such as for acute and chronic back pain, highlight opportunities to enhance pain management and patient safety.

Authors+Show Affiliations

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

32391892

Citation

Mikosz, Christina A., et al. "Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017." JAMA Network Open, vol. 3, no. 5, 2020, pp. e204514.
Mikosz CA, Zhang K, Haegerich T, et al. Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017. JAMA Netw Open. 2020;3(5):e204514.
Mikosz, C. A., Zhang, K., Haegerich, T., Xu, L., Losby, J. L., Greenspan, A., Baldwin, G., & Dowell, D. (2020). Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017. JAMA Network Open, 3(5), e204514. https://doi.org/10.1001/jamanetworkopen.2020.4514
Mikosz CA, et al. Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017. JAMA Netw Open. 2020 05 1;3(5):e204514. PubMed PMID: 32391892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017. AU - Mikosz,Christina A, AU - Zhang,Kun, AU - Haegerich,Tamara, AU - Xu,Likang, AU - Losby,Jan L, AU - Greenspan,Arlene, AU - Baldwin,Grant, AU - Dowell,Deborah, Y1 - 2020/05/01/ PY - 2020/5/12/entrez PY - 2020/5/12/pubmed PY - 2020/10/27/medline SP - e204514 EP - e204514 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 5 N2 - Importance: Although opioids can be effective medications in certain situations, they are associated with harms, including opioid use disorder and overdose. Studies have revealed unexplained prescribing variation and prescribing mismatched with patient-reported pain for many indications. Objective: To summarize opioid prescribing frequency, dosages, and durations, stratified across numerous painful medical indications. Design, Setting, and Participants: Retrospective cross-sectional analysis of 2017 US administrative claims data among outpatient clinical settings, including postsurgical discharge. Participants had any of 41 different indications associated with nonsurgical acute or chronic pain or postsurgical pain or pain associated with sickle cell disease or active cancer and were enrolled in either private insurance (including Medicare Advantage) in the OptumLabs Data Warehouse data set (n = 18 016 259) or Medicaid in the IBM MarketScan Multi-State Medicaid Database (n = 11 453 392). OptumLabs data were analyzed from October 2018 to March 2019; MarketScan data were analyzed from January to April 2019. Exposures: Nonsurgical acute or chronic pain or postsurgical pain; pain related to sickle cell disease or active cancer. Main Outcomes and Measures: Indication-specific opioid prescribing rates; days' supply per prescription; daily opioid dosage in morphine milligram equivalents; and for chronic pain indications, the number of opioid prescriptions. Results: During the study period, of 18 016 259 eligible patients with private insurance, the mean (95% CI) age was 42.7 (42.7-42.7) years, and 50.3% were female; of 11 453 392 eligible Medicaid enrollees, the mean (95% CI) age was 20.4 (20.4-20.4) years, and 56.1% were female. A pain-related indication under study occurred in at least 1 visit among 6 380 694 patients with private insurance (35.4%) and 3 169 831 Medicaid enrollees (27.7%); 2 270 596 (35.6% of 6 380 694) privately insured patients and 1 126 508 (35.5% of 3 169 831) Medicaid enrollees had 1 or more opioid prescriptions. Nonsurgical acute pain opioid prescribing rates were lowest for acute migraines (privately insured, 4.6% of visits; Medicaid, 6.6%) and highest for rib fractures (privately insured, 44.8% of visits; Medicaid, 56.3%), with variable days' supply but similar daily dosage across most indications. Opioid prescribing for a given chronic pain indication varied depending on a patient's opioid use history. Days' supply for postoperative prescriptions was longest for combined spinal decompression and fusion (privately insured, 9.5 days [95% CI, 9.4-9.7 days]) or spinal fusion (Medicaid, 9.1 days [95% CI, 8.9-9.2 days]) and was shortest for vaginal delivery (privately insured, 4.1 days [95% CI, 4.1-4.1 days] vs Medicaid, 4.2 days [95% CI, 4.2-4.2 days]). Conclusions and Relevance: Indication-specific opioid prescribing rates were not always aligned with existing guidelines. Potential inconsistencies between prescribing practice and clinical recommendations, such as for acute and chronic back pain, highlight opportunities to enhance pain management and patient safety. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32391892/Indication_Specific_Opioid_Prescribing_for_US_Patients_With_Medicaid_or_Private_Insurance_2017_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.4514 DB - PRIME DP - Unbound Medicine ER -