Substance abuse disorder is now the fifth most impactful condition affecting commercially insured Americans.
This is according to a new Blue Cross Blue Shield study analyzing the patterns of opioid use and abuse in the United States. The study looked at medical claims from BCBS members diagnosed with opioid use disorder (OUD) from 2010 to 2016. In 2016, nearly 1% of all BCBS members were diagnosed with OUD. Overall, 21% of BCBS members filled at least one opioid script in 2015.
A key finding in the report was that patients who fill high-dosage opioid prescriptions are much more likely to abuse the drug than patients who fill low-dosage scripts. The study analyzed 6.3 million unique patients in 2015 to find out opioid prescription lengths and strengths. The majority of prescriptions, 54%, were for a short duration (less than 90 days) and low dosage (less than 100 MEDD); followed by long duration and low dosage, 39%; then by long duration and high dosage, 6%; and finally, by short duration and high dosage, 1%. Patients receiving high-dose, long duration prescriptions are more than 40 times as likely to develop OUD than patients on low-dose, short duration prescriptions.
Among those on high-dose prescriptions, 45 to 90 day prescriptions led to the highest OUD rates (216.6 per 1000), even more than prescriptions lasting over one year (143.8 per 1000).
The study also found that for patients over 45, women had higher rates of OUD than men, but for patients under 45 males had higher rates. According to the study, this is consistent with the fact that older women generally have longer prescription durations. Overall, women filled more opioid prescriptions than men across all age groups.
A higher rate of medication-assisted treatments (MATs) does not correlate to higher OUD rates. Between 2010 and 2016, there was a 65% increase in MATs (reflecting the use of buprenorphine), which according to the study does not account for the 493% increase in OUD diagnoses. For example, the New England region has the highest MAT rates in the country, but the lowest OUD diagnosis rates.
Among the possible MATs, buprenorphine was by far the most popular. Methadone rates declined steadily between 2010 and 2016, and were overtaken by clonidine and naltrexone in 2016.