How prescription opioids are collected for Medicaid patients

Almost 20 years after the first wave of opioid overdose deaths in the US, more than 75% of drug overdose deaths were related to opioid use in 2021, according to the latest data from the Centers for Disease Control and Prevention of Diseases.

Ophelia explored how prescription opioid dispensing rates in the US in 2021 varied by state using data from the Centers for Medicare and Medicaid Services, which includes information about Medicaid, a public health insurance coverage for low-income families. and people with certain disabilities that is provided jointly by the states and the federal government.

According to the National Institute on Drug Abuse, overdose deaths involving opioids prescribed for pain management increased more than fivefold from 1999 to 2017, when they peaked at 17,000. Since then, the number of deaths has declined, although there was a slight increase during the COVID-19 pandemic.

Within the past decade, policies aimed at controlling the distribution of legal opioids and promoting alternative non-opioid pain treatments have been credited with slowing the number of prescriptions and overdose deaths.

In 2021, even though most states had implemented laws regulating prescription opioids and freed up access to naloxoneopioid overdose reversal medications like Narcan, the number of deaths involving prescription opioids reached 16,700.

Opioids are Schedule II controlled substances, meaning that the Drug Enforcement Administration views them as narcotics with “a high potential for abuse that can lead to severe psychological or physical dependence.” Although the data included here do not differentiate between reasons for prescribing, opioids prescribed for addiction treatment, such as buprenorphine and methadone, actually work to decrease the incidence of opioid overdose and decrease related deaths. Additionally, a 2023 study in JAMA Network Open found that the COVID-era increase in access to methadone for the treatment of opioid use disorder was not associated with an increase in opioid overdose deaths.

Prescription opioid overdose deaths began to rise in the 1990s when the growing circulation of oxycodone and hydrocodone led to the first wave of widespread opioid drug abuse. By 2016, opioid-related overdose deaths had reached such alarming levels that the health crisis was considered an epidemic. A year later, the US government declared it a public health emergency.

Since then, 27 states passed laws regulating the duration or dosage of opioid-based medications for pain treatments for the first time, statutes that resulted in a 2.23% decrease in opioid prescriptions by 2021. However, the introduction of fentanyl into The illegal drug market has delayed the fight against opioid-related overdose deaths. The CDC describes the synthetic opioid as “50 times stronger than heroin and 100 times stronger than morphine.”

In Massachusetts, 2.2% of Medicaid claims were for opioids in 2021, or about 355,000 claims. This is a change of -3.8 percentage points since 2013, when there were 761,512 total opioid claims. Read the national analysis to see which states had the highest rates of Medicaid opioid prescriptions in 2021.

States with the highest opioid prescribing rates

Montana and Virginia had the highest number of Medicaid opioid prescriptions in 2021, followed by Iowa. In particular, rural counties are most affected by opioid use disorder, according to the Department of Agriculture.

On the other end of the spectrum, New York, Pennsylvania and West Virginia have the lowest number of Medicaid opioid prescriptions. In 2015, West Virginia had the highest rate of overdose deaths in the nation and one of the highest rates of opioid prescriptions. According to a report by the DEA, this can be attributed to the preponderance of jobs in heavy manual labor, including mining, lumber and manufacturing. Workers in these industries are prone to injuries, which doctors mostly treat with opioid pain relievers.

The drop in opioid prescriptions in West Virginia results from a statewide program designed to reduce the use of opioid-based drugs after the CDC reported a “statistically significant increase in drug overdose deaths” in 2015, according to the DEA report.

This story features data reporting by Elena Cox, written by Martha Sandoval, and is part of a series using data automation in the 50 states and Washington, D.C.

This story originally appeared in Ophelia and was produced and
distributed in partnership with Stacker Studio.

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