Opioid use common among disabled workers enrolled in Medicare

Almost half of disabled workers enrolled in Medicare’s prescription drug program fill a prescription for opioids each year, and more than 1 in 5 were chronic users, filling 6 or more opioid prescriptions each year, according to a study in the September issue of Medical Care.

Researchers at the Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, N.H., studied more than 6 million disabled workers enrolled in Medicare’s prescription drug program between 2006 and 2011, excluding those with cancer diagnoses.

The researchers estimated the prevalence of filling 1 or more opioid prescriptions and the prevalence of chronic opioid use, filling 6 or more prescriptions, in each year, adjusting for patient characteristics such as age, race, sex, and comorbid illness. They also computed hospital region prevalence of filling opioid prescriptions and chronic opioid use adjusted for these same characteristics.

In some cases, regular users filled prescriptions suggesting very high doses (20% of chronic users filled prescriptions totaling >100 mg morphine equivalents per day, and 10% filled prescriptions totaling >200 mg per day).

“The prevalence of chronic opioid use, and the dose among chronic users varied widely across regions,” said one of the study authors Ellen Meara, associate professor, the Dartmouth Institute for Health Policy and Clinical Practice.  

In a broad national population, use of opioids for management of non-cancer pain is common, widely variable, and sometimes involves opioid doses that have been associated with overdose in prior population studies, despite uncertain evidence regarding benefits of chronic opioid use for non-cancer pain.

“The use of opioids for chronic pain has uncertain benefits and clear risks of addiction and overdose,” Meara said. “Quality improvement efforts should work to make alternative approaches to chronic non-cancer pain management more readily available, and decision-makers should work with state legislative and enforcement efforts to minimize harmful use of opioids.”

Much of the evidence on opioid use focuses on limited populations from a specific state or region, according to Meara.

“We wanted to understand patterns of prescribing in a national population frequently treated for chronic pain,” she said. “Given the high and rising prevalence of musculoskeletal conditions among the 9 million disabled workers in the United States receiving Medicare due to disability, we wanted to know how opioids were used in this population.”