Table 1.
Characteristics of patients exposed to prescription opioid analgesics by initial pattern of prescription opioid supply for non-cancer pain and non-palliative care among insured adults in the United States, 2010-2015 (N=4,054,417)
| Initial pattern of prescription opioid supply | |||
|---|---|---|---|
| Overall | Non-daily supply | Daily supply | |
| Patients characteristics | n = 4,054,417 | n=3,943,034 | n=111,383 |
| Observation time in months, mean (SD) | 9.74 (3.66) | 9.74 (3.66) | 9.76 (3.67) |
| Charlson comorbidity index, mean (SD) | 0.21 (0.77) | 0.20 (0.75) | 0.467(1.22) |
| Female, n (%) | 2,221,906 (54.80) | 2,160,536 (54.79) | 61,370 (55.10)a |
| Age in years, mean (SD) | 50.01 (18.26) | 49.67 (18.20) | 62.15 (15.92) |
| Age group in years, n (%) | |||
| 18-24 | 393,954 (9.72) | 392,228 (9.95) | 1,726 (1.55) |
| 25-34 | 573,268 (14.14) | 567,892 (14.40) | 5,376 (4.83) |
| 35-44 | 666,217 (16.43) | 656,876 (16.66) | 9,341 (8.39) |
| 45-54 | 744,309 (18.36) | 726,993 (18.44) | 17,316 (15.55) |
| 55-64 | 664,687 (16.39) | 642,355 (16.29) | 22,332 (20.05) |
| 65+ | 1,011,982 (24.96) | 956,690 (24.26) | 55,292 (49.64) |
| Insurance type, n (%) | |||
| Commercial | 3,078,129 (75.92) | 3,029,814 (76.84) | 48,315 (43.38) |
| Medicare | 976,288 (24.08) | 913,220 (23.16) | 63,068 (56.62) |
| Health plan type | |||
| Exclusive provider organization | 364,973 (9.00) | 359,516 (9.12) | 5,457 (4.90) |
| Health maintenance organization | 757,067 (18.67) | 717,885 (18.21) | 39,182 (35.18) |
| Indemnity | 39,895 (0.98) | 38,088 (0.97) | 1,807 (1.62) |
| Others | 448,367 (11.06) | 424,561 (10.77) | 23,806 (21.37) |
| Point of service | 2,278,627 (56.20) | 2,244,141 (56.91) | 34,486 (30.96) |
| Preferred-provider organization | 165,448 (4.08) | 158,843 (4.03) | 6,645 (5.97) |
| US census region, n (%) | |||
| Midwest | 943,302 (23.27) | 922,117 (23.39) | 21,185 (19.02) |
| Northeast | 461,554 (11.38) | 449,788 (11.41) | 11,766 (10.56) |
| South | 1,722,371 (42.48) | 1,676,020 (42.51) | 46,351 (41.61) |
| West | 927,190 (22.87) | 895,109 (22.70) | 32,081 (28.80) |
| Substance use and misuse, n (%) | |||
| Drug use | 3,143 (0.08) | 2,637 (0.07) | 506 (0.45) |
| OUD | 1,608 (0.04) | 1,306 (0.03) | 302 (0.27) |
| Overdose | 1,799 (0.04) | 1,633 (0.04) | 166 (0.15) |
| Opioid overdose | 317 (0.01) | 270 (0.01) | 47 (0.04) |
| Alcohol use | 14,411 (0.36) | 13,585 (0.34) | 826 (0.74) |
| Tobacco use | 88,338 (2.18) | 84,405 (2.14) | 3,933 (3.53) |
| Cocaine | 750 (0.02) | 699 (0.02) | 51 (0.05) |
| Marijuana | 717 (0.02) | 701 (0.02) | 16 (0.01)b |
| Other substance usec | 1,669 (0.04) | 1,534 (0.04) | 135 (0.12) |
| Pain-related diagnosis, n (%) | |||
| Headaches/migraines | 119,534 (2.95) | 115,654 (2.93) | 3,880 (3.48) |
| Neck pain | 134,293 (3.31) | 128,314 (3.25) | 5,979 (5.37) |
| Back pain | 299,055 (7.38) | 283,046 (7.18) | 16,009 (14.37) |
| Abdominal pain | 220,857 (5.45) | 214,574 (5.44) | 6,283 (5.64) |
| Joint pain/arthritis | 609,390 (15.03) | 583,732 (14.80) | 25,658 (23.04) |
| Fibromyalgia/CFS | 59,497 (1.47) | 55,838 (1.42) | 3,659 (3.29) |
| Chronic pain syndromes | 171,277 (4.22) | 158,164 (4.01) | 13,113 (11.77) |
| Other pains | 131,099 (3.23) | 125,427 (3.18) | 5,672 (5.09) |
| Comorbid conditions, n (%) | |||
| Fractures/strains | 235,215 (5.80) | 227,255 (5.76) | 7,960 (7.15) |
| Surgical diagnosis | 358,187 (8.83) | 348,817 (9.85) | 9,370 (8.41) |
| Mental health disordersd | 253,245 (6.25) | 241,244 (6.12) | 12,001 (10.77) |
| Pregnancy-related claim | 739,434 (18.24) | 713,180 (18.09) | 26,254 (23.57) |
| Use of Psychotropic medications, n (%) | |||
| Benzodiazepines | 290,368 (7.16) | 275,858 (7.00) | 14,510 (13.03) |
| Antidepressant | 536,975 (13.24) | 505,982 (12.83) | 30,993 (27.83) |
| Antipsychotics | 45,521 (1.12) | 41,542 (1.05) | 3,979 (3.57) |
| Gabapentin | 42,908 (1.06) | 37,154 (0.94) | 5,754 (5.17) |
| Characteristics of opioid Rx during index period, mean (SD) | |||
| Number of prescriptions | 1.74 (1.63) | 1.58 (1.18) | 7.13 (4.14) |
| Number of prescription types | 1.17 (0.44) | 1.16 (0.41) | 1.65 (0.84) |
| Number of providers involved | 1.29 (0.65) | 1.26 (0.60) | 2.12 (1.41) |
| Number of pharmacies used | 1.13 (0.42) | 1.12 (0.38) | 1.59 (0.99) |
| Average daily dose, MME | 34.61 (20.42) | 34.47 (18.74) | 39.44 (52.13) |
| Average daily MME, n (%) | |||
| <50 | 3,365,583 (83.01) | 3,275,993 (83.08) | 89,590 (80.43) |
| 50-90 | 633,853 (15.63) | 619,626 (15.71) | 14,227 (12.77) |
| >90 | 54,981 (1.36) | 47,415 (1.29) | 7,566 (6.79) |
| Charlson comorbidity index, n (%) | |||
| 0 | 3,626,558 (89.45) | 3,537,215 (89.71) | 89,343 (80.21) |
| 1+ | 427,859 (10.55) | 405,819 (10.29) | 22,040 (19.79) |
Abbreviations: OUD=Opioid use disorder, SD=standard deviation, CI=confidence interval, MME=morphine milligram equivalents.
a
p-value = 0.03;
b
p-value > 0.05; all other p-values < 0.0001.
c
Includes anxiolytics, stimulants, hallucinogenic drugs, or use of unspecified drugs.
d
Includes adjustment disorders, anxiety disorders, conduct disorders, cognitive disorders, mood disorders, schizophrenia and psychotic disorders, alcohol-related disorders, substance-related disorders, and miscellaneous mental health disorders.