Despite payer and provider efforts to reduce opioid prescribing, a new report from researchers at the Mayo Clinic published in the BMJ found that prescription rates remained level for commercially insured patients between 2007 and 2016.
Researchers found that over the course of one year, 14% of commercially insured patients, 26% of Medicare Advantage senior patients and 52% of disabled MA patients received an opioid prescription.
They also discovered that disabled MA recipients had the highest rates of use and the largest daily dose.
Health officials and policy leaders have increasingly turned their attention the opioid crisis in recent years, which has not shown signs of abating despite a variety of interventions. This study is disappointing for those pushing to move the needle on prescriptions as a way of tamping down the epidemic.
The CDC reports that overdose deaths increased by 200% between 1999 and 2014 and another 28% between 2015 and 2016 alone.
President Donald Trump declared the opioid crisis a public health emergency and the administration unveiled plans to address the crisis. That proposal included developing non-addictive pain treatments, a national prescription drug monitoring program and a public-private initiative to create a vaccine to prevent opioid addiction.
Critics argue, however, that the administration hasn't put forward enough money to adequately address the issue.
Meanwhile, providers, payers, lawmakers and community groups are putting limits on opioid prescriptions, offering alternative treatments and using principles of population health — namely social determinants of health data — to find at-risk people. Several states have pointed the finger at drugmakers and filed lawsuits against the companies.
For this study, researchers from Mayo Clinic, Yale University, the University of Alabama at Birmingham and Dartmouth College studied 48 million U.S. patients with insurance between 2007 and 2016, comparing commercially-insured patients and MA beneficiaries.
The researchers found that the quarterly opioid prescriptions for people with commercial plans remained flat at 6% to 7% and the daily dose of about two pills of 5 mg oxycodone remained the same.
For the disabled MA patient population the quarterly opioid use started at 26% in 2007, spiked to 41% in 2013 and dipped slightly to 39% in 2016. The average daily dose increased from the equivalent of seven pills of 5 mg oxycodone to nine pills in 2012 and then down to about eight pills in 2016.
The quarterly opioid use for seniors with MA was 11% in 2007, 15% in 2010 and 14% in 2016. That patient group's average daily dose was roughly three pills of 5 mg oxycodone, which was about the same at the beginning of the study.
Long-term opioid use was most common in disabled MA recipients (14%) and lowest in commercial patients (3%). Patients taking opioids long-term make up a large percentage of total prescribed opioids. The report found long-term opioid users accounted for 62% of commercial opioid prescriptions, 70% for senior MA recipients and 65% disabled MA members.