Abstract
BackgroundIn 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes.MethodsUsing Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon’s high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level.ResultsThere was an immediate reduction in high dose opioid prescriptions after the program was implemented (− 1.55 prescription per 1000 enrollee; 95% CI − 2.26 to − 0.84; p < 0.01). Program implementation was also associated with an immediate drop (− 1.29 percentage points; 95% CI − 1.94 to − 0.64 percentage points; p < 0.01) and trend reduction (− 0.23 percentage point per month; 95% CI − 0.33 to − 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program.ConclusionsAlthough Oregon’s high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.
Highlights
In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs)
Patient demographics across CCOs were similar in enrollee age and sex, but differed by rural/urban designation, prescription opioid use, high-dose prescription opioid use, and opioid overdose rates
Efforts to confront the opioid epidemic have often focused on reducing risks associated with prescription opioids, such as high-dose prescribing
Summary
In 2015, Oregon’s Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). Despite declines in opioid prescribing, opioid use remains several fold higher today relative to the early 1990s and prescription opioids are still involved in more than one-third of opioid-related deaths in the US [1, 2] To confront this public health crisis, federal and state authorities have mounted diverse initiatives such as developing clinical practice guidelines that advocate. Like the rest of the country, Oregon’s opioid-related overdose rate in 2017 was more than twice the rate observed in 2001 [8] Efforts to address this public health crisis in Oregon have been diverse and included prior authorization for opioid prescriptions exceeding 120 morphine milligram equivalents (MME) that was limited to the fee-for-service program (~ 10% of Oregon Medicaid population), introduction of Oregon’s Prescription Drug Monitoring Program (PDMP) in 2011, and developing evidence-based reviews to support Medicaid coverage standards [9, 10]. Naloxone access initiatives did not yet have wide reach
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