AHRQ Data Reveal Wider Impact of Opioid Overuse
It's probably not news to you that opioid overuse is a problem in the United States. What is news is evidence of the breadth and depth of this problem and the growing impact it is having on people and on our health care system.
Between 1993 and 2012, the hospitalization rate for overuse of opioids—prescription painkillers such as morphine, codeine, fentanyl and oxycodone—has more than doubled, according to the most recent data from the Agency for Healthcare Research and Quality (AHRQ). In 2012, there were a total of 709,500 U.S. hospitalizations among adults for opioid overuse. In addition, the problem has become much broader, with hospitalizations increasing at particularly alarming rates among middle aged and older age groups.
Commonly used to manage pain that occurs with illness, injury or after surgery, opioids can be overused for a variety of reasons. They include accidental and deliberate misuse of a prescription, such as taking more doses than prescribed; taking medication prescribed for someone else or combining opioids with other substances such as alcohol.
The populations affected by opioid overuse have changed and expanded over time, AHRQ data show.
In 1993, hospitalization rates for opioid overuse were relatively concentrated in certain subsets of the population. Rates were much higher among young adults than among older adults (189 per 100,000 people age 25 to 44 compared with 67 per 100,000 for adults age 45 to 64, and 46 per 100,000 for 65- to 85-year-olds); much higher among men than among women (144 per 100,000 men compared with 92 per 100,000 women) and much higher among people living in the Northeast than in the rest of the country (264 per 100,000 in the Northeast, 3 to 4 times the rate in other regions).
By 2012, not only had rates of hospitalization for opioid overuse more than doubled, but the fastest rates of increase were in groups with relatively lower rates in 1993. Hospitalization rates increased by approximately five-fold among 45- to 64-year-olds and for 65- to 84-year-olds, much more quickly than for younger adults; and by 2012, hospitalization rates were higher for 45- to 64-year-olds than for 25- to 44-year-olds. Similarly, rates increased much more quickly for women than for men; and by 2012, hospitalization rates were very similar by gender. Further, hospitalization rates increased more slowly in the Northeast than in the rest of the country; in 2012, rates in the Northeast were still somewhat higher than in other regions, but the differences in 2012 were much smaller than in 1996.
Our data also shed light on the evolving nature of insurance coverage for opioid overuse hospitalizations. In 1993, Medicaid was billed for more than twice as many hospital stays involving opioid overuse than any other payer (private insurance, Medicare, uninsured and other). By 2012, Medicare joined Medicaid as a top payer for opioid overuse diagnoses, with each paying for about one-third of these hospitalizations.
Interestingly, hospitalizations for the uninsured decreased over this two-decade time period. In 1993, 20 percent of hospitalizations for opioid overuse were among the uninsured; by 2012, this population accounted for 12 percent of the total.
These data come from AHRQ's Healthcare Cost and Utilization Project, or HCUP; the infographic is from AHRQ's Medical Expenditure Panel Survey, or MEPS. HCUP is the most comprehensive source of state-level inpatient and outpatient data, capturing information from many types of insurers. HCUP enables researchers to study and compare health care delivery and patient outcomes over time at the national, regional, state and local level. MEPS is the only national data source that measures how Americans use and pay for medical care, health insurance and out-of-pocket spending. It measures changes in access to health services for patients according to factors such as health status, income and employment.
While these data provide multifaceted evidence that opioid overuse is having a growing impact on our health care system, they can't tell us why these trends are taking place. What the data can tell us is that it's a problem that needs attention.
The U.S. Department of Health and Human Services has been paying close attention and taking aggressive action to reduce opioid overuse, with the goal of saving lives. HHS actions are multipronged and target both prescribers and individuals and incorporate ongoing research and evaluation with efforts that aim to reduce opioid abuse, while also safeguarding legitimate and appropriate access to these drugs (see Addressing Prescription Drug Abuse in the United States:Current Activities and Future Opportunities). As one example, HHS provides educational programs in a variety of formats for clinicians on appropriate opioid prescribing. More than 50,000 health providers have already completed courses offered through the National Institutes of Health in partnership with the Office of National Drug Control Policy and Medscape, an online physician educational web portal. And the Substance Abuse and Mental Health Services Administration offers a continuing education course to primary care physicians to enhance their skills in safe prescribing of opioids for patients with chronic pain.
In addition, at the Centers for Medicare & Medicaid Services (CMS), efforts are under way to ensure that sponsors of Medicare Part D plans, which provide prescription drug coverage to seniors, have put safeguards into place to prevent overuse of certain prescribed medications. CMS' Overutilization Monitoring System, which took effect in July 2013, notifies plan sponsors of beneficiaries who have a potential opioid or acetaminophen overuse issue through data analytics. Plan sponsors are required to respond to CMS within 30 days on whether the patient will be referred for case management. An initial comparison with data from 2011 shows a substantial reduction in the number of acetaminophen and opioid overusers in the Part D program.
Multiple efforts by both the public and private sectors will be required to make significant progress, as well as ongoing monitoring and evaluation. Data from HCUP will contribute to the monitoring and evaluation effort.
Richard Kronick, Ph.D., is Director of the Agency for Healthcare Research and Quality.
Page originally created October 2014