OBJECTIVES: Both new and long-term prescription opioid use have been decreasing in the US. This study aimed to provide updates on utilization and trends in new opioid prescriptions and long-term prescription opioid use among older adults enrolled in Medicare.

METHODS: This retrospective cohort study utilized 5% national Medicare claims data from 2012-2020. Medicare beneficiaries older than 65 who were enrolled in Medicare Parts A, B, and D for at least ten months in a year were included. Beneficiaries enrolled in Medicare Advantage plans were excluded from the study. Annual utilization and trends in new and long-term prescription opioid use episodes were measured over the study period.

RESULTS: Administrative claims of nearly 2.75 million older adult Medicare beneficiaries were analyzed. A majority of them were female (~56%) and White (~81%) with a mean age of about 75 years in each year. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then steadily decreased to 5.37% in 2020. The proportion of individuals with long-term opioid use among those with a new opioid prescription decreased steadily from 12.40% in 2013 to 8.86% in 2019 and increased to 10.68% in 2020. Among new long-term opioid users, the proportion of beneficiaries with cancer during the study years fluctuated between 13.30%-15.60%, and the proportion with chronic non-cancer pain fluctuated between 28.99%-33.67%. Across all years, Southern states accounted for a large proportion of long-term opioid users increasing from 41.61% in 2013 to 55.73% in 2020.

CONCLUSIONS: Updated evidence supported that both new opioid use and long-term opioid use decreased among older adults in the last decade; however, regional variation in long-term opioid use exists, indicating differences in the approaches to manage chronic pain across geographic locations.