A Nation in Pain: U.S. Opioid Trends
Exactly how are patients in the U.S. using narcotic pain medications known as opioids? Can we identify potential ways to improve the safe prescribing of these medications?
To gain a deeper understanding of these concerns, Express Scripts conducted an in-depth examination of more than 36 million de-identified pharmacy claims from 6.8 million insured Americans of all ages who filled at least one prescription for an opioid to treat short-term or longer-term pain from 2009 through 2013. Prevalence, utilization and costs were evaluated during the five-year study period, including assessments of trends according to age, gender and geography. The research also looked at users prescribed opioids in combination with other medications. The analysis looked at both short-term use and longer-term use of opiate pain medicines; however, the majority of this report focuses on longer-term opioid use given the clinical complexities, and the risks of drug dependence and addiction commonly associated with longer-term opioid treatment.
For the purposes of this research, short-term users were defined as patients who were prescribed an opiate pain medication for a total supply of 30 days or less within a one-year period. Longer -term users were defined as those prescribed an opiate pain medication for more than a 30-day supply in a one-year period.
The analysis assessed the amount of medication used by patients by examining three metrics: number of prescriptions filled, days’ supply (the number of days of medication per prescription), and the morphine equivalent dose (MED).
Fewer Patients, Increasing Number of Prescriptions: The number of Americans filling prescriptions for opioids declined 9.2% between 2009 and 2013, but both the number of prescriptions filled and the number of days of medication per prescription rose approximately 8.4%.
Short-Term Use of Prescription Opiates Declined: The number of longer-term opioid users remained fairly constant over the five years studied; the number of short-term users declined 11.1% between 2009 and 2013.
Patients Likely to Use Prescription Opiates Long-Term: Nearly one half of patients who took opiate painkillers for more than 30 days in the first year of use continued to use them for three years or longer. Almost 50% of those patients were taking only short-acting opioids, putting them at higher risk of addiction.
Younger Adults Use More Opioid Medications: The elderly have the highest prevalence of opioid use, but younger adults (age 20-44) filled more opioid prescriptions and had the greatest increase in the number of days of medication prescribed, per prescription, of any age group over the five year period.
Opioid Use More Prevalent Among Women: 30% more women than men took prescription opiates in 2013; however, men are more likely to fill more prescriptions and take higher doses of these medications.
Pain Prescriptions Most Prevalent in Southeastern Small Cities: The greatest concentration of opioid use is found in small cities in the Southeastern region of the U.S., with the vast majority of these cities located in four states: Kentucky, Alabama, Georgia and Arkansas.
Most Long-Term Opioid Users Take Dangerous Drug Combinations: Nearly 60% of patients using opioids were taking a combination of drugs that are dangerous and potentially fatal; among these mixtures, almost one in three patients were prescribed anti-anxiety drugs known as benzodiazepines along with an opioid – the most common cause of overdose deaths involving multiple drugs.