An increase in chronic users may be the reason behind increased opioid consumption among disabled Medicare beneficiaries. A study of disabled beneficiaries under age 65 published in Medical Care showed that the percentage of beneficiaries with any opioid use decreased slightly from 43.9 percent in 2007 to 43.7 in 2011. However, the percentage of chronic users rose from 21.4 percent to 23.1 percent. Although they recognize that some chronic use can be beneficial, the authors suggest that Medicare administrators and clinicians find ways to monitor pain management to avoid unnecessary use.
The authors were interested in opioid use among disabled workers who received social security disability benefits due to musculoskeletal conditions, which are commonly treated with opioids. They examined opioid prescription fill patterns among a pool of disabled Medicare beneficiaries under age 65, as SSDI beneficiaries make up most of that group, from 2007 through 2011. Individuals were present an average of 3.3 of the 58 years studied.
Overall use peaked in 2010, but declined slightly in 2011. However, chronic use increased. In the authors’ words, the chronic use was “intense,” with 20 percent receiving 100 milligrams of morphine equivalents per day and 10 percent receiving 200 milligrams or more. Although musculoskeletal conditions are more prevalent in the disabled Medicare population (65 percent compared to 50 percent in the general U.S. adult population) and even more extreme among chronic users (94 percent), this did not appear to account for chronic use. The presence of regional differences in prescription fills regardless of the strictness of state drug laws was troubling to the authors, because it suggested inconsistent approaches. For example, “oxycodone was prominent on the eastern seaboard, whereas Texas prescribers all but eschewed these products,” despite similar regulations among states.
The authors encourage the possible use of quality measures for chronic opioid management, as well as measures to limit the number of prescribers per user, monitoring, and consultations with pain specialists. They recognize that such programs will require expenditures. However, they believe “inaction will also come at a substantial cost.”