Dataset Information

National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013-2018.

ABSTRACT:

Objective

To understand the changes in opioid cessation surrounding the release of CDC guidelines and changes in state Medicaid coverage at the individual patient level.

Methods

This study used a 20% national sample of Medicare beneficiaries between 2013 and 2018 with at least 90 days of consecutive opioid use in the first year of either of 2 study periods (2013-2015 or 2016-2018). Cessation of opioid use was assessed in year 3 of each period by generalized linear mixed models.

Results

Opioid cessation rates were higher in period 2 (11.2%) compared to period 1 (10.1%). Adjusted for beneficiary characteristics, those in period 2 had 1.07 times the odds of cessation (95% CI: 1.05-1.09) compared to those in period 1. Additionally, the increase in opioid cessation over time was larger in states with Medicaid expansion compared to those without.

Conclusion

The increase in opioid cessation after 2016 suggests the potential effects of the CDC guidelines on opioid prescribing and underscores the need for further research on the relationship between opioid cessation and subsequent change in pain control, quality of life, and opioid toxicity.

SUBMITTER: Westra J

PROVIDER: S-EPMC9410627 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013-2018.

Westra Jordan J Raji Mukaila M Kuo Yong-Fang YF

Medicine 20220801 34

<h4>Objective</h4>To understand the changes in opioid cessation surrounding the release of CDC guidelines and changes in state Medicaid coverage at the individual patient level.<h4>Methods</h4>This study used a 20% national sample of Medicare beneficiaries between 2013 and 2018 with at least 90 days of consecutive opioid use in the first year of either of 2 study periods (2013-2015 or 2016-2018). Cessation of opioid use was assessed in year 3 of each period by generalized linear mixed models.<h4 ...[more]

PMID: 36042655

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Project description:ImportanceUse of opioids during and shortly after an acute hospitalization is warranted in some clinical settings. However, given the potential of opioids for short-term adverse events and long-term physiologic tolerance, it is important to understand the frequency of opioid prescribing at hospital discharge, hospital variation, and patient and hospital factors associated with opioid prescribing, which is currently unknown in the United States.ObjectiveTo estimate the frequency of opioid prescribing at hospital discharge among Medicare beneficiaries without an opioid prescription claim 60 days prior to hospitalization; to document hospital variation in prescribing; and to analyze patient and hospital factors associated with prescribing, including hospital average performance on pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures.Design, setting, and participantsAnalysis of pharmacy claims of a 20% random sample of Medicare beneficiaries hospitalized in 2011 without an opioid prescription claim in the 60 days before hospitalization.Main outcomes and measuresOur main outcome was a new opioid claim within 7 days of hospital discharge. We estimated a multivariable linear probability model of patient factors associated with new opioid use and described hospital variation in adjusted rates of new opioid use. In multivariable linear regression analysis, we also analyzed hospital factors associated with average adjusted new opioid use at the hospital level, including the percentage of each hospital's patients who reported that their pain during hospitalization was always well controlled in the 2011 HCAHPS surveys.ResultsAmong 623 957 hospitalizations, 92 882 (14.9%) were associated with a new opioid claim. Among those hospitalizations with an associated opioid claim within 7 days of hospital discharge, 32 731 (42.5%) of 77 092 were associated with an opioid claim after 90 days postdischarge. Across 2512 hospitals, the average adjusted rate of new opioid use within 7 days of hospitalization was 15.1% (interquartile range, 12.3%-17.4%; interdecile range, 10.5%-20.0%). A hospital's adjusted rate of new opioid use was modestly positively associated with the percentage of its inpatients reporting that their pain was always well managed (increase from 25th to the 75th percentile in the HCAHPS measure was associated with an absolute increase in new opioid use of 0.89 percentage points or a relative increase of 6.0%; P < .001).Conclusions and relevanceNew opioid use after hospitalization is common among Medicare beneficiaries, with substantial variation across hospitals and a large proportion of patients using a prescription opioid 90 days after hospitalization. The degree to which observed hospital variation in short- and longer-term opioid use reflects variation in inappropriate prescribing at hospital discharge is unknown.

Project description:ImportanceIn response to the opioid epidemic, policies aiming to reduce opioid prescribing, misuse, and abuse may have the unintended consequence of restricting access to necessary opioid therapy for cancer-related pain. It is unknown how opioid prescribing patterns have changed among generalists and oncologists during this era.ObjectiveTo examine trends in opioid prescription rates for Medicare Part D beneficiaries from 2013 to 2017 among oncologists and generalists.Design, setting, and participantsThis repeated cross-sectional study of generalist physicians (internal medicine, family medicine, geriatric medicine, general practice) and oncology specialists (medical oncology, hematology-oncology, and radiation oncology) analyzed the Medicare Provider Utilization and Payment Data: Part D prescriber files from 2013 to 2017.ExposuresGeneralist vs oncology specialty.Main outcomes and measuresOutcomes included physician-level rates of both opioid and long-acting opioid prescriptions per 100 Medicare Part D beneficiaries. Poisson regression was used to estimate annual predicted outcome rates and incidence rate ratios, adjusting for prescriber characteristics and state fixed effects.ResultsWe analyzed the prescribing patterns of 251 820 generalists and 14 210 oncologists. From 2013 to 2017, the annual adjusted predicted mean rate of opioid prescriptions per 100 Medicare beneficiaries decreased from 68.2 to 49.7 among generalists (adjusted incidence rate ratio [aIRR] = 0.73; 95% CI, 0.73-0.73) and from 77.8 to 58.8 among oncologists (aIRR = 0.76; 95% CI, 0.74-0.77). The rate of long-acting opioid prescriptions per 100 Medicare beneficiaries also decreased from 8.0 to 5.4 for generalists (aIRR = 0.67; 95% CI, 0.66-0.68) and from 18.6 to 13.3 for oncologists (aIRR = 0.72; 95% CI, 0.69-0.74).Conclusions and relevanceWe found large declines in opioid prescription rates for Medicare beneficiaries by generalists and oncologists from 2013 to 2017. Opioid policy and advocacy appear to have been effective in reducing the extent of opioid prescribing in the Medicare population. Similar declines between generalists and oncologists raise concern that access to cancer pain management may have been inadvertently restricted. How much of the decrease in prescribing by oncologists is appropriate vs inappropriate deserves further investigation.

Dataset Information

National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013-2018.

Objective

Methods

Results

Conclusion

Publications

National patterns of cessation of prescription opioids among Medicare beneficiaries, 2013-2018.

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