Study examines varying rates of opioid prescriptions to Medicare beneficiaries

A study published by JAMA Internal Medicine has found that the use of new opioid prescriptions after hospitalization is common among Medicare beneficiaries, while the rate of patients using a prescription opioid 90 days after hospitalization varies by location.

The problem of opioid prescriptions has become a major issue in the U.S., with some states even banning the prescription of the drug for long-term care. THe study investigated the rate of frequency of opioid prescribing at hospital discharge among Medicare beneficiaries without an opioid prescription claim 60 days prior to hospitalization. It also documented hospital variation in prescribing.

When physicians prescribe opioids at the time of discharge, according to the study, there is always the risk that the “opioid-naïve” patient will develop a long-term addiction. With limited evidence on prescribing opioids at hospital discharge to opioid-naïve patients, this study’s main outcome was whether a beneficiary filled a prescription for an opioid within 7 days of hospital discharge. This study also aimed to provide information on three secondary outcomes including:

• To assess longer-term use by following patients with a 90-day follow-up and identify those patients that filled an opioid after 90 days of discharge.
• To analyze dosing differences across hospitals by comparing those proportion of discharges in which new opioid use within seven days of hospital discharge was 20 morphine equivalents per day or higher.
• To analyze how duration of opioid prescribing varied across hospitals by studying the proportion of discharges that were prescribed opioids for a week after hospital discharge but exceeded their seven-day supply. 

“Using data on prescription drug claims of a national random sample of Medicare beneficiaries who were hospitalized in 2011 and did not have a prescription claim for an opioid in the 60 days prior to hospitalization, we estimated the frequency with which individuals filled a prescription for an opioid within 1 week of hospital discharge, described variation across hospitals in rates of post discharge prescription opioid use, and analyzed patient and hospital factors associated with post discharge opioid use,” wrote Anupam B. Jena, MD, and colleagues.

In the sample of 623,957 hospitalizations with no opioid claim in the 60 days prior to hospital admission, 92,882 (14.9 percent) were classified as a new opioid claim within 7 days of discharge, 77,092 of these 92,882 hospitalizations included a 90-day follow-up, and 32,731 (42.5 percent) were associated with an opioid claim after 90 days’ post discharge.

Broken down into categories, the results included:

• Beneficiaries 65 years or older accounted for the largest group of new opioid uses after hospital discharge.
• 8.2 percent of discharges with new opioid use were beneficiaries younger than 45.
• 57.9 percent of beneficiaries with new opioid use were female.
• 41.7 percent of discharges with new opioid use involved beneficiaries who were dually eligible for Medicare and Medicaid.

The most common reasons for the prescription of opioids to new opioid users post discharge included hypertension (82.7 percent), hyperlipidemia (65 percent), anemia (55.7 percent), rheumatoid arthritis (49.4 percent), ischemic heart disease (49.3 percent), diabetes (40.2 percent), depression (31.5 percent), and congestive heart failure (30.4 percent).