OBJECTIVES: In 2015, approximately 33,000 deaths nationally were attributed to opioids. High rates of nonfatal opioid overdose events are reported every year. Studies have shown patients having nonfatal overdose events often continue receiving opioid prescriptions. This study assessed change in prescription opioid use before and after an overdose event among Mississippi Medicaid beneficiaries.

METHODS: A retrospective study was conducted using Mississippi Division of Medicaid claims data. Beneficiaries ages ≥18 years, without cancer and having an opioid-related overdose event from July 1, 2013-December 31, 2016 were included. Opioid prescribing was examined for beneficiaries receiving opioids before and after the overdose event. Regression analyses with generalized estimating equations (GEE) for correlated data were used to assess differences in total days of supply, average and peak morphine equivalent daily dose (MEDD) for the 6-month pre-event and 6-month post-event periods.

RESULTS: A total of 789 beneficiaries had an overdose event, of which 597(76%) received opioid prescriptions before and after the overdose event. Of the 597 beneficiaries, 71% were female, 96% were ages 21-64 years, 69% were Caucasian and 25% African American. Controlling for age, sex and race, regression results showed that for sample means pre- and post-event there was a 17-point decrease (p<0.001) in mean total days of supply, a 13.7-point increase (p<0.001) in the mean MEDD. Peak MEDD decreased 3.8 points but was not significant (p = 0.16).

CONCLUSIONS: Since opioids are commonly used for pain, which in most cases is a chronic condition, it is not surprising that the majority of beneficiaries having an overdose event continue taking opioids after the event. It is encouraging that significant reductions did occur in mean days of supply. However, results indicate the need for continued provider and beneficiary education regarding the need for changes in opioid prescribing in order to avoid risks of overdose events.