OBJECTIVES : To examine the costs and resource utilization associated with high risk prescription opioid use.

METHODS : Retrospective cohort study of IQVIA health plan claims for 191,405 non-elderly adults with at least 1 opioid prescription and continuous enrollment in 2012-2013. We used the Johns Hopkins Adjusted Clinical Group (ACG) Risk Adjustment System to create covariates, calculate costs and identify hospital and Emergency Department admissions. We used generalized linear models with propensity score weighting and covariates to quantify total, medical and pharmacy costs as well as any hospitalization and any emergency department visit associated with: (1) users of ≥100 morphine milligram equivalents per day for ≥90 consecutive days (chronic users); (2) ≥30 days of concomitant opioid and benzodiazepine use (concomitant users); and (3) individuals diagnosed with an opioid use disorder. We also examined how the associations varied based on the length of time individuals were characterized as a high-risk user.

RESULTS : Of individuals with one or more opioid prescription, 1.45% were chronic users, 4.81% were concomitant users and 0.94% were users with a diagnosed opioid use disorder. After adjustment and weighting, chronic users had higher prospective total (40%), medical (3%) and pharmacy (172%) costs. The corresponding increased costs were 13% (total costs), 7% (medical costs) and 41% (pharmacy costs) for concomitant users, and 28% (total costs), 21% (medical costs) and 63% (pharmacy cost) for users with a diagnosed opioid use disorder. All estimates were statistically significant (p<0.01), and both total and pharmacy costs increased with the length of time individuals were characterized as a high-risk user. Of the three risk groups, only concomitant users were associated with a higher odds of hospitalization or emergency department use.

CONCLUSIONS : Individuals with high-risk prescription opioid use have significantly higher health care costs and utilization than their counterparts, especially those with chronic high dose opioid use.