Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions

Abstract Background In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes. Methods Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level. Results There was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program. Conclusions Although Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.

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Opioid dosing among patients with 3 or more years of continuous prescription opioid use before and after the CDC opioid prescribing guideline

International Journal of Drug Policy ◽

10.1016/j.drugpo.2021.103308 ◽

2021 ◽

Vol 97 ◽

pp. 103308

Author(s):

Joanne Salas ◽

Xue Li ◽

Hong Xian ◽

Mark D. Sullivan ◽

Jane C. Ballantyne ◽

...

Keyword(s):

Prescription Opioid ◽

Opioid Use ◽

Opioid Prescribing ◽

Before And After ◽

Prescription Opioid Use

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US Emergency Department Visits for Acute Harms From Prescription Opioid Use, 2016–2017

American Journal of Public Health ◽

10.2105/ajph.2019.305007 ◽

2019 ◽

Vol 109 (5) ◽

pp. 784-791 ◽

Cited By ~ 9

Author(s):

Maribeth C. Lovegrove ◽

Deborah Dowell ◽

Andrew I. Geller ◽

Sandra K. Goring ◽

Kathleen O. Rose ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Prescription Opioid ◽

Opioid Use ◽

Prescription Opioid Use

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Chronic High Risk Prescription Opioid Use Among Persons With HIV

Frontiers in Sociology ◽

10.3389/fsoc.2021.645992 ◽

2021 ◽

Vol 6 ◽

Author(s):

Ana Ventuneac ◽

Gavriella Hecht ◽

Emily Forcht ◽

Bianca A. Duah ◽

Shafaq Tarar ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

High Risk ◽

Substance Use Disorders ◽

Prescribing Patterns ◽

Hiv Care ◽

Prescription Opioid ◽

Opioid Use ◽

Opioid Prescribing ◽

Prescription Opioid Use

Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016–December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.

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Trends in opioid prescribing in Australia: a systematic review

Australian Health Review ◽

10.1071/ah18245 ◽

2020 ◽

Vol 44 (2) ◽

pp. 277

Author(s):

Peter J. Donovan ◽

David Arroyo ◽

Champika Pattullo ◽

Anthony Bell

Keyword(s):

Historical Data ◽

Grey Literature ◽

Risk Of Bias ◽

Prescription Opioid ◽

Opioid Use ◽

Opioid Prescription ◽

Policy Makers ◽

Opioid Prescribing ◽

Prevalence Estimates ◽

Prescription Opioid Use

Objective This review systematically identified studies that estimated the prevalence of prescription opioid use in Australia, assessed the prevalence estimates for bias and identified areas for future research. Methods Literature published after 2000 containing a potentially representative estimate of prescription opioid use in adults, in the community setting, in Australia was included in this review. Studies that solely assessed opioid replacement, illicit opioid usage or acute hospital in-patient use were excluded. Databases searched included PubMed, EMBASE, Web of Science and the grey literature. Results The search identified 2253 peer-reviewed publications, with 34 requiring full-text review. Of these, 20 were included in the final qualitative analysis, in addition to four publications from the grey literature. Most studies included analysed prescription claims data for medicines dispensed via Australia’s national medicines subsidy scheme (the Pharmaceutical Benefits Scheme). Although data sources were good quality, all prevalence estimates were at least at moderate risk of bias, predominantly due to incompleteness of data or potential confounding. Included publications demonstrated a significant rise in opioid use up to 2017 (including a 15-fold increase in prescriptions dispensed over the 20 years to 2015), predominantly driven by a sharp rise in oxycodone use. Although opioid prescription numbers continue to escalate, usage, as measured by oral morphine equivalent per capita, may have plateaued since 2014. Codeine remains the most prevalently obtained opioid, followed by oxycodone and tramadol. There was a substantial delay (median 30 months; interquartile range 20–37 months) to publication of opioid usage data from time of availability. Conclusions Australia has experienced a marked increase in opioid prescribing since the 1990s. Current published literature is restricted to incomplete, delayed and historical data, limiting the ability of clinicians and policy makers to intervene appropriately. What is known about the topic? Opioid prescriptions in Australia have continued to increase since the 1990s and may be mirroring the epidemic being seen in the US. What does this paper add? This paper systematically identifies all publications that have examined the prevalence of prescription opioid use in Australia since 2000, and only identified prevalence estimates that were at moderate or high risk of bias, and found significant delays to publication of these estimates. What are the implications for practitioners? Because published literature on the prevalence of prescription opioid consumption is restricted to incomplete, delayed and historical data, the ability of clinicians and policy makers to appropriately intervene to curb prescription opioid use is limited. A national policy of real-time monitoring and reporting of opioid prescribing may support improvements in practice.

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Opioid Overdose Hospitalization Trajectories in States With and Without Opioid-Dosing Guidelines

Public Health Reports ◽

10.1177/0033354919864362 ◽

2019 ◽

Vol 134 (5) ◽

pp. 567-576

Author(s):

Jeanne M. Sears ◽

Deborah Fulton-Kehoe ◽

Beryl A. Schulman ◽

Sheilah Hogg-Johnson ◽

Gary M. Franklin

Keyword(s):

South Carolina ◽

Negative Binomial ◽

State Level ◽

Healthcare Research ◽

Prescription Opioid ◽

High Dose ◽

Opioid Overdose ◽

Prescribing Practices ◽

Health Crisis ◽

Opioid Prescribing

Objectives: High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids. Methods: We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states. Results: For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations. Conclusions: These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.

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