The research examined that increased attention to opioid abuse, prescriptions have remained relatively unchanged for many U.S. patients. They show that opioid prescription rates have remained flat for commercially insured patients over the past decade. Rates for some Medicare patients are leveling but remain above where they were 10 years ago. The study was published in The BMJ.

Our data suggest not much has changed in prescription opioid use since about five years ago. Million U.S. patients who had insurance coverage between 2007 and 2016. Using deidentified insurance claims from the OptumLabs Data Warehouse, the team compared opioid prescriptions among commercially insured patients; Medicare Advantage recipients 65 and older; and Medicare Advantage beneficiaries younger than 65, who generally qualify because of long-term disability. 

Opioid Prescription

They found that over the course of one year, 14% of commercially insured patients, 26% of Medicare Advantage patients 65 and older, and 52% of disabled Medicare Advantage patients received an opioid prescription.

For that group, quarterly opioid use was lowest in 2007 at 26 percent, peaked in 2013 at 41%, and was 39% in 2016. The average daily dose increased from the equivalent of seven pills of 5-milligram oxycodone to a high of about nine pills in 2012. In 2016, it went back to roughly eight pills.

Among Medicare Advantage recipients 65 and older, quarterly opioid use was lowest at the start of the study period in 2007, increased to 15% in 2010, and decreased to 14% by the end of the 10-year period. 

For commercial patients, quarterly opioid use remained relatively flat at 6-7% for the study period, and the average daily dose, which is the equivalent of about two pills of 5-milligram oxycodone, remained the same for that group, as well. 

Opioid Overdoses

Adding to the urgency of addressing this issue is the steadily increasing number of deaths in the U.S. attributed to opioid overdoses. From 1999 to 2014, overdose deaths increased by 200 percent, and by 28% from 2015 to 2016 alone.

The new Mayo research also shows:

1. Over the 10-year period, disabled Medicare Advantage recipients had an average daily opioid dose equaling about nine pills of 5-milligram oxycodone, compared to about three pills for Medicare Advantage recipients 65 and older, and about two pills for commercially insured patients.

2. Long-term opioid use made up 3% of commercial patients, 7 percent of Medicare Advantage recipients 65 and older, and 14% of the disabled Medicare Advantage recipients. However, this small group of patients made up the majority of total opioid pills dispensed: 62% for commercial; 70% for Medicare Advantage 65 and older; and 89% for disabled Medicare Advantage.

Commercially insured patients made up about 89 percent of those studied, while about 10% were Medicare Advantage recipients 65 and older, and less than 2% were disabled Medicare Advantage recipients. The study did not include people with Medicaid insurance, those covered by the Veterans Affairs or Tricare (military insurance), or the uninsured.

Changing Prescriptions

This research has been translated into opioid prescribing guidelines and tools for medical practices at Mayo and beyond, identifying patients who may not need opioids and, in some cases, cutting prescriptions in half.