GEOGRAPHIC VARIATION OF HIGH-RISK OPIOID USE AND RISK OF OVERDOSE AMONG DISABLED MEDICARE BENEFICIARIES IN THE US FROM 2011 TO 2015
Author(s)
Lo-Ciganic W1, Gellad WF2, Zhou L3, Donohue JM4, Roubal A5, Hines L6, Lindermann J7, Malone DC3, Bhattacharjee S3, Lee JK3, Kwoh CK3
1The University of Arizona, Tucson, AZ, USA, 2Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA, 3University of Arizona, Tucson, AZ, USA, 4University of Pittsburgh, Pittsburgh, PA, USA, 5Robert Wood Johnson Foundation, Princeton, NJ, USA, 6Pharmacy Quality Alliance, Springfield, VA, USA, 7ESRI Inc., Broomfield, CO, USA
OBJECTIVES: The Pharmacy Quality Alliance (PQA) has developed quality measures of high-risk opioid prescribing/use that address 1) high-dose use, 2) receipt of opioid prescriptions from multiple providers, and 3) concurrent benzodiazepine use. We examined the patterns of high-risk opioid use across regions and the association with subsequent overdose risk in Medicare from 2011 through 2015. METHODS: Among 249,594 non-cancer, disabled Medicare beneficiaries who had > RESULTS: Adjusted annual rates of high-dose use (~9%), having multiple providers(~5%), and concurrent benzodiazepine use (~34%) remained stable over five years. In 2015, the ratio of 75th-to-25th percentile rates of high-risk measures across HRRs were 1.80 for high-dose use, 1.87 for having multiple providers, and 1.33 for concurrent benzodiazepine use. The top 3 HRRs with the highest rate of: high-dose use were Sarasota, FL(17.2%), Sun City, AZ(17.2%) and Clearwater, FL(16.9%); multiple providers were Slidell, LA(14.0%), Muskegon, MI(12.5%), and Bryan, TX(12.0%); and concurrent benzodiazepine use were Dearborn, MI(58.0%), Miami, FL(55.4%), and Spartanburg, SC(55.1%). These measures were associated with subsequent overdose risk for high-dose (hazard ratio [HR]=2.19, 95%CI=1.86-2.57); multiple providers (HR=1.58, 95%CI=1.30-1.92); and concurrent benzodiazepine use (HR=1.82, 95%CI=1.58-2.10). CONCLUSIONS: High-risk opioid use measures were associated with overdose risk among disabled Medicare beneficiaries. Areas and individuals with prevalent high-risk opioid use may benefit from targeted interventions (e.g.,lock-in programs) to prevent overdose.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
MH3
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior
Disease
Mental Health