Opioid Dependence Leads to ‘Tsunami’ of Medical Services

Researchers find seven million dependency diagnoses in 2014

Fair Health, a nonprofit corporation focused on health-care cost transparency and insurance information, has found that medical services for people with opioid dependence diagnoses skyrocketed more than 3,000% between 2007 and 2014, according to an article posted on the Kaiser Health News (KHN) website.

The study considered a large cohort of people who had either job-based insurance or bought coverage on their own. Its findings illustrate that the opioid problem is “in the general mainstream,” Robin Gelburd, president of Fair Health, told KHN. “Is the health system preparing for this tsunami of services?” she asked.

The researchers used claims data from insurers representing 150 million patients, looking for diagnosis codes related to opioid dependency and abuse, to the adverse effects of heroin use, and to problems caused by the misuse or abuse of other types of opiates. While heroin is a street drug, other opiates are often prescription medications.

They found that much of the rise in opioid dependence occurred since 2011, a period marked by increased attention to the problem and a growing number of advocates calling on doctors to reduce the number of opioid prescriptions.

Opioid dependence is defined by symptoms such as increased tolerance, withdrawal, or unsuccessful attempts to quit. Younger patients (19 to 35 years of age) were most likely to be diagnosed as opioid dependent compared with other age groups. These younger patients were also more likely than older ones to overdose on heroin. The reverse was true, however, for overdoses related to other types of opioids. People in their mid-40s to mid-50s were more likely to experience those overdoses.

The primary diagnosis of opioid dependency leads to a number of medical services, including office visits, laboratory tests, and other related treatments. The Fair Health report found that the number of such services provided to patients with a dependency diagnosis increased from approximately 217,000 in 2007 to about seven million in 2014.

Other findings from the report include:

  • Across all age groups, men were more likely than women to be diagnosed with dependency. That gap narrowed among patients in their 40s and 50s, with women representing 45% of those diagnosed.
  • Women were more likely than men to experience an overdose.
  • The ratio of opioid dependence to other substance-abuse problems varied by state. Rhode Island had the highest ratio, and Maine and Montana had the lowest.

Most states have begun prescription monitoring programs aimed at identifying and tracking people who are “doctor shopping” to obtain multiple prescriptions for narcotics. Pharmacists or physicians can check those databases to see if a particular patient already has a prescription for narcotics before dispensing another. In 2001, only 16 states had laws allowing such programs. By 2012, 41 states were operating one, according to a report by the Pew Charitable Trusts.

Sources: Kaiser Health News; August 1, 2016; and Fair Health; July 2016.