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Opioid Prescribing Patterns across the United States

June 19, 2018
A McKinsey report reveals how geography, patient assessment, and a lack of standard approaches is affecting the opioid crisis.

The global management consulting firm McKinsey & Company released its latest healthcare systems and services report,1 focused on the US opioid crisis. Researchers uncovered 10 themes affecting prescribers and providers (listed below), but it is important to note that the analysis was based on data found in claims from Medicaid patients, specifically 750 state Medicaid member claims between January 2014 and December 2016. While the data on opioid prescriptions, substance abuse, and/or overdoses from these claims provides an important look at a significant subset of the population, it may not be an accurate representation of the full country’s experience.

The 10 insights include1:

  1. Opioid prescribing is widespread—it does not result primarily from outlier prescribers. Specifically, the researchers found that while the top 1% of prescribers are responsible for only 5% of all opioid prescriptions, the next quarter of prescribers were responsible for 50%.
  2. Prescribing patterns vary significantly by geography, even among patients undergoing similar care.
  3. Within a single region, prescribing patterns often vary significantly, even when providers are treating similar clinical problems or types of patients.
  4. Even within an individual provider’s clinical practice, opioid-prescribing patterns may vary significantly, depending on the type of problem being treated.
  5. Patients with opioid use disorders are heterogeneous but can be grouped into archetypes.
  6. Providers frequently prescribe opioids to patients with known or potential risk factors for abuse. For example, 60% of providers analyzed had prescribed opioids to patients with at least one of these features: a non-opioid substance use disorder (SUD), two or more behavioral health diagnoses other than the SUD, filling opioid prescriptions from more than four providers in the past six months, or using more than four pharmacies to fill opioid prescriptions in the past six months. Researchers questioned why these prescriptions were written—a lack of understanding of the risk factors, or an inability to obtain full patient information?
  7. In one analysis, more than one-third of the patients had a known or potential risk factor for abuse (ie, the risk factors listed in Insight #6).
  8. Patients with concurrent prescriptions for an opioid and a behavioral health condition appear to have a 30% or greater likelihood of developing future opioid dependence. Researchers created a predictive model to identify risk factors for opioid dependence, using: suicide attempt or ideation (81.9%); anxiety disorder (78.3%), bipolar disorder (41.1%), age 35-44 (26%), each additional  prescription for a behavioral health condition (4.6% branded; 2.5% generic); female gender (-50.5), age 0 to 17 (-97.7%), and age 65 or older (-64.9%).
  9. Most opioids are prescribed by providers other than the natural “quarterback” of a patient’s underlying complaint or condition. The researchers noted that “all providers should recognize that they are part of a care team for a patient’s pain management and should make efforts to be aware of what other providers are prescribing to their patients.”
  10.  A small portion of opioid use originates in emergency departments.

As part of the report, the authors posed questions back to the healthcare community and public, including: How can initiatives improve opioid prescribing patterns engage many, if not most, providers?; and What are the most effective ways for provider associations and state and federal health agencies to develop and clarify guidelines and best practices in pain management?

The report concluded that additional research is needed, including the investigation of contributing factors, as well as “non-claims data sources, integration of data sources, and a mix of descriptive, predictive, and prescriptive analytics to improve the design of opioid initiatives.”

What’s your take on this analysis? Email the editor at ppmeditorial@verticalhealth.com.

 

 

 

Last updated on: June 22, 2018
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