Project Summary: Impact of a High Dose Opioid Policy on Prescription Opioid Use, Misuse, and Overdose Outcomes

Category: Public Health

Scholarship Recipient: Yes

Background: In 2009, drug overdose deaths surpassed deaths due to motor vehicle accidents in the US. This epidemic is primarily driven by misuse and abuse of prescription drugs, mostly obtained through the health care system (20%) or from friends or relatives (71%). Opioid analgesics, or pain killers, have dominated these trends. From 1997 to 2007 the volume of opioid analgesics dispensed through pharmacies has increased more than six-fold and roughly paralleled the number of people dying from opioid overdose. Medicaid recipients are more likely to have substance abuse disorders and are disproportionately represented in the overdose deaths.

Objective: An opioid dose limit policy was implemented in the Oregon Medicaid program. The aim of this study was to determine the extent to which this policy affected overall utilization, opioid misuse, and potentially opioid-related overdose.

Methodology: The prior authorization policy limiting high dose opioids policy was implemented in the Oregon fee-for-service Medicaid program. Colorado Medicaid, which did not have any dose limit policies at that time, was used as a control population. Patients were included if they were enrolled in their respective state Medicaid fee-for-service program, had at least one opioid prescription filled, and were not dually eligible for Medicare.

Data Analyzed: Colorado and Oregon Medicaid claims January 2011 to December 2013

Results: The prior authorization policy was associated with significant declines in high dose opioid use. Researchers observed increases in lower dose opioid usage in the Oregon Medicaid population compared to the Colorado control group. Researchers at Oregon State University believe careful implementation of a prior authorization policy is a valid approach to reduce high dose opioid use and may have positive effects on other measures of misuse and utilization. Colorado and other states may also benefit from implementing similar policies for high dose opioid use.