Sources of prescription opioids among diagnosed opioid abusers

Abstract

Objective:

Diversion and abuse of prescription opioids are important public health concerns in the US. This study examined possible sources of prescription opioids among patients diagnosed with opioid abuse.

Methods:

Commercially insured patients aged 12–64 diagnosed with opioid abuse/dependence (‘abuse’) were identified in OptumHealth Reporting and Insights medical and pharmacy claims data, 2006–2012, and required to have continuous eligibility over an 18 month study period surrounding the first abuse diagnosis. We examined whether abusers had access to prescription opioids through their own prescriptions and/or to diverted prescription opioids through family members’ prescriptions obtained prior to the abuser’s first abuse diagnosis. For comparison, we examined access to prescription opioids of a reference population of non-abusers. Sensitivity analyses focused on patients initially diagnosed with opioid dependence and, separately, abusers not previously treated with buprenorphine.

Results:

Of the 9291 abusers meeting the selection criteria, 79.9% had an opioid prescription prior to their first abuse diagnosis; 20.1% of abusers did not have an opioid prescription prior to their first abuse diagnosis, of whom approximately half (50.8%) had a family member who had an opioid prescription prior to the abuser’s first abuse diagnosis (compared to 42.2% of non-abusers). Similar results were found among patients initially diagnosed with opioid dependence and among abusers not previously treated with buprenorphine.

Limitations:

The study relied on the accuracy of claims data to identify abusers, but opioid abuse is often undiagnosed. In addition, only prescription claims that were reimbursed by a health plan were included in the analysis.

Conclusions:

While most abusers had access to prescription opioids through their own prescriptions, many abusers without their own opioid prescriptions had access to prescription opioids through family members and may have obtained prescription opioids that way. Given the study design and data source, this is likely a conservative estimate of prescription opioid diversion.

Keywords: :

• Abuse
• Diversion
• Opioid analgesics

Transparency

Declaration of funding

This study was funded by Purdue Pharma LP.

Declaration of financial/other relationships

A.S., J.B.R., N.Y.K., K.B. and H.G.B. have disclosed that they are employees of Analysis Group Inc., a company that received funding from Purdue Pharma LP to conduct this study. P.H. and R.B.-J. have disclosed that they are employees of Purdue Pharma LP.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work. Peer reviewer 1 has disclosed that she/he has been a consultant to Inspirion, Mallinckrodt, Baxter, Purdue Pharma LLP, Grunenthal GmhB, Iroko, and Johnson and Johnson. Peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to acknowledge the assistance of Caroline J. Enloe in the preparation and submission of the manuscript. Ms. Enloe is an employee of Analysis Group Inc.

Notes

*For abusers, we examined what share had access to a prescription opioid (either through prescriptions obtained by themselves or their family members) prior to their index date, which was defined as the date of their first abuse diagnosis. Because non-abusers did not have an abuse diagnosis, by definition, their index date was defined as the date of a random medical claim for any service.