The Burden of Undiagnosed Opioid Abuse Among Commercially Insured Individuals

Kirson, Noam Y.; Shei, Amie; Rice, J. Bradford; Enloe, Caroline J.; Bodnar, Katharine; Birnbaum, Howard G.; Holly, Pamela; Ben‐Joseph, Rami

doi:10.1111/pme.12768

Cited by 29 publications

(28 citation statements)

References 12 publications

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“…Because OUD diagnosis occurs oftentimes delayed, the reported opioid dose trajectories should not be interpreted as causal risk factors for the development of OUD or overdose but rather understood as a historical snapshot of prescription opioid use that is available to clinicians when diagnosing OUD or overdose. Also, there is a limitation to the use of ICD codes for identifying OUD, as some clinicians may under- or overreport misuse/abuse in patients with opioid treatment [3]. To our knowledge, there are no studies to validate the ICD code–based algorithm for OUD.…”

Section: Discussionmentioning

confidence: 99%

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Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

et al. 2019

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BackgroundWith governments’ increasing efforts to curb opioid prescription use and limit dose below the Centers for Disease Control and Prevention (CDC)-recommended threshold of 90 morphine milligram equivalents per day, little is known about prescription opioid patterns preceding opioid use disorder (OUD) or overdose. This study aimed to determine prescribed opioid fills and dose trajectories in the year before an incident OUD or overdose diagnosis using a 2005–2016 commercial healthcare database.Methods and findingsThis cross-sectional study identified individuals aged 18 to 64 years with incident OUD or overdose in the United States. We measured the prevalence of opioid prescription fills and trajectories of opioid morphine equivalent dose (MED) prescribed during the 12-month period before the diagnosis. Of 227,038 adults with incident OUD or overdose, 33.1% were aged 18 to 30 years, 52.9% were males, and 85.0% were metropolitan residents. Half (50.5%) of the patients had a diagnosis of chronic pain, 32.7% had depression, and 20.3% had anxiety. Overall, 79,747 (35.1%) patients filled no opioid prescription in the 12 months before OUD or overdose diagnosis, with the proportion significantly increasing between 2006 and 2016 (adjusted prevalence ratio, 1.86; 95% CI 1.79–1.93; P < 0.001). Patients without (versus with) prescribed opioids tended to be younger males and metropolitan and Northeast US residents. Of 145,609 patients who filled opioid prescriptions, 5 distinct prescribed daily dose trajectories preceding diagnosis emerged: consistent low dose (<3 mg MED, 34.6%), consistent moderate dose (20 mg MED, 27.3%), consistent high dose (150 mg MED, 15.0%), escalating dose (from <3 to 20 mg MED, 13.7%), and de-escalating dose (from 20 to <3mg MED, 9.4%). Overall, over two-thirds of patients with OUD or overdose with prescription opioids were prescribed a mean daily dose below 90 mg MED before diagnosis. Major limitations include the limited generalizability of the study findings and lack of information on out-of-pocket drug spending, race/ethnicity, and socioeconomic status of participants, which prevents analyses addressing these characteristics.ConclusionsIn this study, we found that absence of opioid prescription fills in the year before incident OUD or overdose diagnosis was prevalent, and the majority of the patients received prescription opioid doses below the risk threshold of 90 mg MED. An increasing proportion of high-risk patients could be missed by current programs solely based on opioid prescribing and dispensing information in this new era of limited access to prescription opioids.

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Section: Discussionmentioning

confidence: 99%

“…An estimate of 2 million individuals in the US have OUD, with the majority being adults aged 18 to 64 years [2]. The prevalence of diagnosed OUD in adult populations has increased between 2006 and 2011 (from 0.07% to 0.19%) [3] and continued to rise each year thereafter [4].…”

Section: Introductionmentioning

confidence: 99%

Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

et al. 2019

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“…These studies, however, typically focus on those with ICD-9 codes for OUD in claims data, implying that they have been recognized as having the disorder. Unfortunately, surveys indicate that the ratio of undiagnosed to diagnosed OUD is as high as 5 to 1 and the costs of undiagnosed individuals who are commercially insured are nearly as high as health care costs of those who have been diagnosed (Kirson et al, 2015). Evidence points to similarly high excess health care costs among those with AUD and low rates of treatment even among those with generous private insurance coverage (Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Behavioral Health Statistics and Quality, 2016).…”

Section: Discussionmentioning

confidence: 99%

Effects of Global Payment and Accountable Care on Medication Treatment for Alcohol and Opioid Use Disorders

Donohue

Barry

Stuart

et al. 2018

Journal of Addiction Medicine

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“…SUDs contribute significantly to the burden of diseases in the United States 3 and are major risk factors for disease conditions globally 4 . The high prevalence of diagnosed and undiagnosed opioid use disorders (OUDs) has been associated with increasing healthcare costs 5 while current trends portend growing toll of alcohol‐attributable adverse health outcomes 6 . Although progress has been made in reducing its prevalence, smoking is still popular 7 .…”

Section: Introductionmentioning

confidence: 99%

Innovations in pre‐doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder

Odusola

Smith

Bisaga

et al. 2020

Journal of Dental Education

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Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence‐based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first‐year dental students (DDS1) attended a 90‐minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi‐squared test for bivariate comparison. We then applied a Bonferroni correction to the P‐values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.

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The Burden of Undiagnosed Opioid Abuse Among Commercially Insured Individuals

Abstract: Per-patient healthcare costs of undiagnosed abusers among the commercially insured are estimated to be lower than those of diagnosed abusers. However, the higher prevalence of undiagnosed opioid abuse implies that undiagnosed abuse represents a substantial burden to commercial payers.

Cited by 29 publications

References 12 publications

Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

Effects of Global Payment and Accountable Care on Medication Treatment for Alcohol and Opioid Use Disorders

Innovations in pre‐doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder

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