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Top 10% of privately insured patients account for most opioid use

Eric C. Sun

In a cohort of privately insured U.S. adults, the top 10% of opioid users accounted for 76% of the prescription opioid use, according to a brief research report published in the Annals of Internal Medicine.

In the report, researchers Eric C. Sun, MD, PhD, assistant professor of anesthesiology, perioperative and pain medicine at Stanford University Medical Center, and Anupam B. Jena, MD, PhD, Ruth L. Newhouse associate professor of health care policy at Harvard Medical School, wrote that the CDC recently issued recommendations for opioid prescribing for chronic pain.

“In light of this and other public health efforts, an integral piece of epidemiological information about opioid misuse remains unknown: the distribution of use across the population,” they wrote. “Concentration of opioid use among a few patients would argue for focused efforts aimed at reducing use among these persons. Conversely, even distribution would argue for broader, population-wide policies.”

The researchers sought to determine the extent to which population-level opioid use among privately insured adults without cancer in the U.S. was focused among a few opioid users from 2001 to 2013. Using pharmacy claim data from MarketScan, the researchers isolated prescriptions for opioids commonly administered orally, such as hydromorphone, hydrocodone, morphine, oxymorphone and oxycodone. They then calculated the total oral morphine equivalents (MEQs) for each of the 19,530,587 patients in their sample and the share of this total used by patients in each percentile group on an annual basis. Mean follow-up was 4 years.

In 2013, the top 5% of opioid users accounted for 59% of all MEQs and the top 10% accounted for 76%; however, in 2001, the top 5% accounted for 55% of all MEQs and the top 10% accounted for 69% in 2001, suggesting that opioid use became concentrated among fewer users over the study period (P < .001 for both).

When generalizing to the entire U.S. population of prescription opioid users, which is approximately 100 million, the researchers observed that the top 10% account for most U.S. opioid use.

In addition, the top 10% of opioid users were older and more likely to be male compared with other users, and 0.4% of all patients were prescribed an average daily dose of more than 90 MEQ, the limit recommended by the CDC.

“Further research efforts aimed at characterizing this population, analyzing the incidence of opioid-related adverse events, and identifying approaches to reduce opioid use could be most effective in reducing total population-level use, especially because adverse events are most common at the highest MEQs,” Sun and Jena wrote. “In addition, understanding the distribution of use in other populations not studied here (for example, Medicare recipients) and of opioid prescribing across physicians is important.” – by Savannah Demko

Disclosures: Sun reports he has received grants from NIH and personal fees from Egalet, Inc. Jena reports he has received grants from NIH, and personal fees from Pfizer, Hill Rom Services Inc., Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals and Precision Health Economics.