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Opioid Prescribing in the 2016 Medicare Fee-for-Service Population.

Publication ,  Journal Article
Maciejewski, ML; Zepel, L; Hale, SL; Wang, V; Diamantidis, CJ; Blaz, JW; Olin, S; Wilson-Frederick, SM; James, CV; Smith, VA
Published in: J Am Geriatr Soc
February 2021

BACKGROUND AND OBJECTIVES: Opioid use and misuse are prevalent and remain a national crisis. This study identified beneficiary characteristics associated with filling opioid prescriptions, variation in opioid dosing, and opioid use with average daily doses (ADDs) equal to 120 morphine milligram equivalents (MMEs) or more in the 100% Medicare fee-for-service (FFS) population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: In a cohort of FFS beneficiaries with 12 months of Medicare Part D coverage in 2016, we examined patient factors associated with filling an opioid prescription (n = 20,880,490) and variation in ADDs (n = 7,325,031) in a two-part model. Among those filling opioids, we also examined the probability of ADD equal to 120 MMEs or more via logistic regression. RESULTS: About 35% of FFS beneficiaries had one or more opioid prescription fills in 2016 and 1.5% had ADDs equal to 120 MMEs or more. Disability-eligible beneficiaries and beneficiaries with multiple chronic conditions were more likely to fill opioids, to have higher ADDs or were more likely to have ADD equal to 120 MMEs or more. Beneficiaries with chronic obstructive pulmonary disease (COPD) were more likely to fill opioids (odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.46-1.47), have higher ADDs (rate ratio = 1.06, 95% CI = 1.06-1.06) when filled and were more likely to have ADD equal to 120 MMEs or more (OR = 1.23, 95% CI = 1.21-1.24). Finally, black and Hispanic beneficiaries were less likely to fill opioids, had lower overall doses and were less likely to have ADDs equal to 120 MMEs or more compared to white beneficiaries. CONCLUSION: Several beneficiary subgroups have underappreciated risk of adverse events associated with ADD equal to 120 MMEs or more that may benefit from opioid optimization interventions that balance pain management and adverse event risk, especially beneficiaries with COPD who are at risk for respiratory depression.

Duke Scholars

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

February 2021

Volume

69

Issue

2

Start / End Page

485 / 493

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Prescription Drugs
  • Practice Patterns, Physicians'
  • Pain Management
  • Opioid-Related Disorders
  • Needs Assessment
  • Medicare
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Maciejewski, M. L., Zepel, L., Hale, S. L., Wang, V., Diamantidis, C. J., Blaz, J. W., … Smith, V. A. (2021). Opioid Prescribing in the 2016 Medicare Fee-for-Service Population. J Am Geriatr Soc, 69(2), 485–493. https://doi.org/10.1111/jgs.16911
Maciejewski, Matthew L., Lindsay Zepel, Sarah L. Hale, Virginia Wang, Clarissa J. Diamantidis, Jacquelyn W. Blaz, Serene Olin, Shondelle M. Wilson-Frederick, Cara V. James, and Valerie A. Smith. “Opioid Prescribing in the 2016 Medicare Fee-for-Service Population.J Am Geriatr Soc 69, no. 2 (February 2021): 485–93. https://doi.org/10.1111/jgs.16911.
Maciejewski ML, Zepel L, Hale SL, Wang V, Diamantidis CJ, Blaz JW, et al. Opioid Prescribing in the 2016 Medicare Fee-for-Service Population. J Am Geriatr Soc. 2021 Feb;69(2):485–93.
Maciejewski, Matthew L., et al. “Opioid Prescribing in the 2016 Medicare Fee-for-Service Population.J Am Geriatr Soc, vol. 69, no. 2, Feb. 2021, pp. 485–93. Pubmed, doi:10.1111/jgs.16911.
Maciejewski ML, Zepel L, Hale SL, Wang V, Diamantidis CJ, Blaz JW, Olin S, Wilson-Frederick SM, James CV, Smith VA. Opioid Prescribing in the 2016 Medicare Fee-for-Service Population. J Am Geriatr Soc. 2021 Feb;69(2):485–493.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

February 2021

Volume

69

Issue

2

Start / End Page

485 / 493

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Prescription Drugs
  • Practice Patterns, Physicians'
  • Pain Management
  • Opioid-Related Disorders
  • Needs Assessment
  • Medicare
  • Male
  • Humans