The Evidence Base

Informing Policy in Health, Economics & Well-Being
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USC Dornsife Center for economic and social research

Hooked in Hospitals: Many Medicare Patients Received First Painkillers There

More seniors are abusing prescription painkillers than ever before, and for many their addiction appears to start under the care of a doctor. This is according to two studies co-written by Schaeffer Center researchers.

The studies, jointly written with researchers at Harvard Medical School and the University of Minnesota, looked at several hundred thousand Medicare beneficiaries over 2010-11.

In one study, a survey of more than 600,000 hospitalized Medicare beneficiaries not currently taking such drugs showed nearly 15 percent were prescribed opioids following their discharge. Ominously, 90 days after leaving the hospital a large proportion of these patients – more than 2 in 5 – still were using these painkillers, such as buprenorphine, fentanyl, hydrocodone, methadone, morphine and oxycodone.

Perhaps more concerning are the findings from a second study that show Medicare patients often obtain opioids through multiple providers, a fact associated with higher rates of drug-related hospitalizations.

“Opioid use and abuse has reached epidemic proportions in the United States – even among the elderly,” Goldman said in an interview with USC News. “If we are going to do something to combat this alarming trend, we first need to understand the clinical context in which patients are gaining access to painkillers.”

These conclusions are of great concern considering deaths in the United States attributable to prescription opioids more than tripled from 1999 to 2014.

Long-term (ab)use common

About 3 in every 20 Medicare beneficiaries that were hospitalized – 14.9 percent – received an opioids prescription within 7 days of leaving the hospital, according to the JAMA Internal Medicine study.

And of those who received such a prescription, the study showed 42.5 percent still taking opioids three months after their discharges.

New opioid use was more common among residents of rural areas, and those receiving low-income subsidies or dually eligible for Medicare and Medicaid.

Prescription rates across hospitals ranged between 10 and 20 percent of the patients under study receiving opioids. Interestingly, institutions more likely to prescribe opioids were rated higher by patients for pain management. However, Goldman said further inquiry on hospital practices is needed.

Many pills, many providers

In the other study published in The BMJ in 2014, of 1.2 million Medicare patients who filled an opioid prescription in 2010, researchers found that more than 2 in 5 acquired their painkillers from more than one provider. In fact, almost 12 percent had used four or more providers.

And of those beneficiaries with four or more providers, more than three-quarters (77.2 percent) reported using separate sources to obtain concurrent prescriptions.

The health care industry and policymakers are paying greater attention to the frequency with which patients obtain painkillers from numerous sources (such as physicians, dentists or, less often, physician assistants). At best, the researchers said, it might indicate fragmented patient care. At worst, it might reflect patients’ illegally obtaining more drugs through “doctor shopping” for multiple prescribers.

Patients with multiple sources of opioids were at greater risk of being hospitalized due to those drugs, the paper also found. For those with four or more providers, the annual rate of opioids-related admission was 4.83 percent – almost triple the rate (1.63 percent) for people with only one provider.

Other drugs worsen the problem

And the deleterious effects go beyond opioids, the paper discovered. Beneficiaries receiving painkillers from multiple providers also were more likely to be prescribed other drugs with high rates of adverse effects and misuse.

Understanding the context of opioid providing, provider patterns, and patient behavior is the first step to developing policies that will adequately halt this pressing public health issue.

The studies’ lead author was Anupam Jena of Harvard Medical School, while Pinar Karaca-Mandic of the University of Minnesota was a co-author. Lesley Weaver, also of the University of Minnesota, contributed to the paper published in BMJ.

The studies were supported by grants from the National Institutes of Health, National Institute on Aging and the University of Minnesota Academic Health Center.

By: Mike Branom