Patterns of Opioid Prescribing in Minnesota: 2012 and 2015
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ISSUE BRIEF | APRIL, 2018 Patterns of Opioid Prescribing in Minnesota: 2012 and 2015 Introduction Key Findings: Opioids are a class of drugs that include prescription • Overall rates of opioid prescribing declined in opioid medications for pain relief —such as oxycodone Minnesota from 2012 to 2015, but the morphine (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, milligram equivalents (MME) per prescription and fentanyl—as well as illicitly produced drugs like heroin increased. and fentanyl-related substances (also called fentanyl analogs).1 While prescription opioids play a role in the • Medicare and Medicaid, where eligibility is determined management of some types of severe acute, cancer-related by age, disability status, and/or income, covered and end-of-life pain, increased opioid use since 1990, approximately one-third of Minnesotans with general including for chronic pain unrelated to cancer, has resulted health coverage and accounted for two-thirds of opioid in sharply rising opioid addiction and overdoses, as well as prescriptions filled in 2015. increased healthcare utilization and costs. Recent Centers • Nearly one in three Minnesotans with an opioid for Disease Control and Prevention (CDC) guidelines point prescription in 2015 had multiple prescribers. out the limitations of the evidence base in support of opioid therapy for pain, recommend non-opioid therapy • In both 2012 and 2015, 6 in 10 opioid prescriptions for chronic pain, and emphasize the risks associated with were filled within 15 days of the patient’s last medical opioid therapy.2 In Minnesota, opioids—both prescription visit; however, 1 in 10 opioid prescriptions were filled and illicit—were responsible for 336 overdose deaths without a medical visit in the past 90 days, suggesting in 2015, more than a six-fold increase since 2000.3 In closer patient-prescriber communication or opioid 2016, opioid use accounted for 395 overdose deaths in oversight may be needed in some cases. Minnesota—a one-year increase of nearly 18 percent.4 Forty-nine percent of the opioid overdose deaths in • Prescription opioid use varied across counties. In some Minnesota in 2016 were from prescription opioids.5 In counties, prescription opioid use in 2015 was over 3 addition to overdose deaths, opioids play a causal role in times the statewide average of 523 MME per resident. other deaths, including automobile accidents. As Minnesota, like other states, struggles with the economic, community and individual impacts of the opioid to reduce unnecessary use and overuse of prescription epidemic, this issue brief looks to bring new empirical opioids. They may also help identify additional analytic evidence specific to Minnesota to discussions about the questions and contribute to assessments of the impact shape of the problem, contributing factors, and options of policy changes currently debated by the Minnesota for addressing them. This issue brief focuses on opioid Legislature. prescription patterns among Minnesotans with private or public insurance coverage in 2012 and 2015. We explore The research in this issue brief relies on the Minnesota opioid prescription trends by payer, patients’ diagnoses All Payer Claims Database (MN APCD), a comprehensive preceding a prescription opioid fill, number of prescribers, state repository of health care transactions for Minnesota and patients’ geographic location. The results may offer patients.6 The MN APCD is derived from health care insights to policy makers and payers about opportunities claims records submitted by private insurers, Medicare, PATTERNS OF OPIOID PRESCRIBING IN MINNESOTA: 2012 AND 2015 1 HEALTH ECONOMICS PROGRAM Measures used in this issue brief: Opioid prescription rate - The number of opioid and Medicaid and other state public programs such as and Medicaid and other state public programs such as prescriptions per 100 covered persons in the MN APCD. MinnesotaCare (here, collectively called Medicaid).7 Measures used in this issue brief: MinnesotaCare (here, collectively called Medicaid).7 A lower opioid prescription rate indicates a reduced These unique data cover interactions with the health These unique data cover interactions with the health care Opioidlikelihood prescription that covered rate- MinnesotansThe number offill opioid an opioid care system for nearly 90 percent of insured system for nearly 90 percent of insured Minnesotans, prescriptionsprescription. per 100 covered persons in the MN APCD. A Minnesotans, Schedule II opioid prescription rate - The number of thereby permitting analyses that are generalizable to most lower opioid prescription rate indicates a reduced likelihood thereby permitting analyses that are generalizable to prescriptions per 100 covered persons in the MN APCD population groups and areas of the state. Nevertheless, that covered Minnesotans fill an opioid prescription. most population groups and areas of the state. for opioids classified by the U.S. Drug Enforcement opioid prescription rates in this issue brief somewhat Nevertheless, opioid prescription rates in this issue brief ScheduleAdministration II opioid as prescription having elevated rate -potential The number for of underestimate the complete statewide burden because somewhat underestimate the complete statewide prescriptionsproducing severe per 100 psychological covered persons or physical in the dependence,MN APCD the MN APCD does not include claims from plans that do burden because the MN APCD does not include claims forcompared opioids classified with other by opioids.the U.S. Drug Enforcement not cover general medical care (such as accident-only or from plans that do not cover general medical care (such AdministrationAverage morphine as having milligram elevated equivalents potential (MME) for producing per dental plans) or from Workers’ Compensation, Veterans as accident-only or dental plans) or from Workers’ severeprescription psychological - MME or is physical a standard dependence, measure of compared opioid Affairs, Indian Health Service, or Tricare; nor does it include Compensation, Veterans Affairs, Indian Health Service, or withpotency other opioids.relative to morphine. An increase in average services provided to uninsured persons. The MN APCD Tricare; nor does it include services provided to MME per prescription indicates an increase in opioid does include pharmacy claims for prescriptions written Averagepotency morphine per day, milligramthe number equivalents of days prescribed, (MME) per or uninsured persons. The MN APCD does include pharmacy by dentists. Further, the analyses in this issue brief were prescriptionboth. claims for prescriptions written - MME is a standard measure of opioid limited to patient populations for whom current CDC and Average MME per covered person - Average opioid by dentists. Further, the analyses in this issue brief were potency relative to morphine. An increase in average MME proposed Minnesota guidelines are intended to apply; potency per covered person in the MN APCD. An limited to patient populations for whom current CDC and per prescription indicates an increase in opioid potency per thus, opioid prescribing for cancer patients or those in increase in average MME per covered person indicates proposed Minnesota guidelines are intended to apply; day, the number of days prescribed, or both. hospice care settings was excluded. an increase in the potency of opioid fills per covered thus, opioid prescribing for cancer patients or those in Averageperson, MME an increase per covered in potency person per - Average prescription, opioid or both. hospiceThis issue care brief settings includes was prescriptions excluded. for all Schedule II-V potencyRate of per high-dose covered opioidperson prescriptions in the MN APCD. - The An number increase of in Thisopioids, issue which brief areincludes identified prescriptions by matching for all theSchedule National II-V averageopioid MME prescriptions per covered of at person least 90 indicates MME per an day,increase per in opioids, which are identified by matching the National Drug Code (NDC) associated with the prescription to the thecovered potency person of opioid in the fills MN per APCD. covered High-dose person, opioidan increase Drug Code (NDC) associated with the8,9 prescription to the CDC’s list of Schedule II-V opioids. Clinically, Schedule in potencyprescriptions per prescription, have been associated or both. with a greater CDC’sII opioids list haveof Schedule a greater II-V potential opioids.8 for,9 Clinically,producing Schedule severe chance of opioid overdose and death. IIpsychological opioids have or a physicalgreater potentialdependence, for producing compared severe with RateAverage of high-dose MME per opioid covered prescriptions resident - -Average The number opioid psychologicalother opioids. or Examples physical of dependence, Schedule II opioidscompared include with of potencyopioid prescriptions prescribed per of personat least in90 the MME MN per APCD, day, otherhydrocodone, opioids. hydromorphone,Examples of Schedule oxycodone, II opioids and include fentanyl. perattributed covered person to the person’sin the MN county APCD. of High-dose residence. opioid hydrocodone, hydromorphone, oxycodone, and fentanyl. prescriptions have been associated with a greater chance of opioid overdose and death. Results Average MME per covered resident - Average opioid Overall ratesrates ofof opioidopioid prescribing prescribing declined declined from from 2012 2012 to potency prescribed per person in the MN APCD, attributed