Opioid Analgesic and Benzodiazepine Prescribing Among Medicaid-Enrollees with Opioid Use Disorders

The Influence of Provider Communities

Published in: Journal of Addictive Diseases, 2016

Posted on RAND.org on August 23, 2016

by Bradley D. Stein, Joshua Mendelsohn, Adam J Gordon, Andrew W. Dick, Rachel M. Burns, Mark J. Sorbero, Regina A. Shih, Rosalie Liccardo Pacula

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Research Questions

  1. How frequently are people with opioid use disorders (OUDs) prescribed opioid analgesics or benzodiazepines?
  2. What factors influence the prescribing practices and medication choices among physicians who share and refer patients (a "provider community") with OUDs?

Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.

Key Findings

  • In the year following an OUD diagnosis, a substantial number of Medicaid-enrollees filled a prescription for an opioid analgesic (45%) or a benzodiazepine (37%), and one in five filled prescriptions for both.
  • Patients who filled prescriptions for these drugs were more likely to be female, older, diagnosed with a pain syndrome, or living in a county with higher rates of poverty.
  • Prescribing rates for these drugs varied widely across provider communities.
  • In provider communities with the highest rates of use of either one or both of these drugs, patients were between 2.5 and 5 times as likely to be prescribed these medications as they were in communities with the lowest rates of use.

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