Medicaid Patients Hit Hard by Opioid Epidemic

Opioid use among Medicaid-insured women 13% higher than the general population.

The opioid epidemic has resulted in drug overdoses becoming the number 1 cause of accidental deaths in the United States, with more than 150,000 individuals dying because of overdoses from pain drugs in 2016, according to a report from Express Scripts. While there have been thousands of overdose deaths, many more individuals are misusing, abusing, or receiving treatment.

The opioid epidemic has plagued Americans at all income levels, but it has particularly affected patients insured through Medicaid. Express Scripts reports that these individuals are 10 times more likely to develop substance misuse disorder compared with the general population.

In the new study, the pharmacy benefit manager (PBM) examined annual opioid use among 3.1 million patients insured through Medicaid in 2015. The investigators looked at age, gender, and opioid usage across patients in 14 different states.

Notably, the study revealed that nearly one-quarter of Medicaid patients filled a prescription for opioids, with one-third taking the drugs for more than 30 days.

The rate of opioid use was high among youth was also high, with 4.3% of Medicaid-insured patients younger than 19 were treated with narcotics, according to the study. However, 31.1% of patients aged 45 to 64 filled an opioid prescription, making them the population with the highest use of the drugs.

Overall, the authors discovered that opioids accounted for 6% of prescriptions in Medicaid and 4.1% of costs. Not only would reducing opioid use reduce the number of patients developing substance use disorders, it would also reduce drug spending.

Opioid use was found to be 68% higher among women compared with men, which is 13% higher compared with privately insured individuals. Women were also more likely to fill prescriptions compared with men, according to the report.

A solution to successfully combat the opioid epidemic is identifying patterns of patients and prescribers, since patients are likely to seek opioid prescriptions from multiple prescribers. The investigators found that more than 25% of Medicaid members received the same drug from multiple prescribers.

The study also showed that the average Medicaid patient received prescriptions from 1.8 prescribers, with almost 8.9% using at least 4 prescribers. These patients used an average of 1.4 pharmacies to fill their medications, with 3.4% using more than 3 pharmacies, according to the report.

The report also found that the top 5 most prescribed drugs among Medicaid members were: hydrocodone-acetaminophen, oxycodone-acetaminophen, tramadol HCL, oxycodone, and suboxone.

The investigators found that many Medicaid patients were taking dangerous combinations of drugs, such as opioids and antidepressants, anticonvulsants, or skeletal muscle relaxants. These combinations can increase the risk of adverse reactions.

Specifically, 34% of Medicaid patients were prescribed an opioid and a benzodiazepine and/or muscle relaxant. The FDA previously warned against the concomitant use of opioids and benzodiazepines, as the combination can be lethal.

Another approach is to utilize alternative formulations of opioids that cannot be abused. Some of these products include an opioid antagonist to prevent the euphoria associated with the drugs.

However, abuse-deterrent opioids are typically branded and are costly compared with generic drugs. The high costs result in Medicaid promoting the use of long-acting opioids as a first line treatment for narcotic pain management, which accounted for 90.6% of pain medication claims in the study, according to Express Scripts.

The prescribing habits of healthcare professionals may also be targeted to combat the opioid epidemic. The study found that most prescribers of opioids were practiced family medicine, internal medicine, emergency medicine, OB/GYN and orthopedic surgery.

Both federal and state governments have taken steps towards reducing opioid prescriptions. State governments have begun implementing electronic prescribing, enacting first-fill restrictions, imposing quality and morphine-equivalent dose limits, and increasing access to naloxone, according to the press release.

Due to the high volume of patients in various stages of misuse, abuse, and treatment, providing care requires a holistic approach that includes collaboration between PBMs, prescribers, pharmacies, employers, and opioid users, Express Scripts concluded.