title: Prescription opioid use among disabled Medicare beneficiaries: intensity, trends, and regional variation.
abstract: BACKGROUND
  Prescription opioid use and overdose deaths are increasing in the United States. Among disabled Medicare beneficiaries under the age of 65, the rise in musculoskeletal conditions as qualifying diagnoses suggests that opioid analgesic use may be common and increasing, raising safety concerns.
  
  
  METHODS
  From a 40% random-sample Medicare denominator, we identified fee-for-service beneficiaries under the age of 65 and created annual enrollment cohorts from 2007 to 2011 (6.4 million person-years). We obtained adjusted, annual opioid use measures: any use, chronic use (≥ 6 prescriptions), intensity of use [daily morphine equivalent dose (MED)], and opioid prescribers per user. Geographic variation was studied across Hospital Referral Regions.
  
  
  RESULTS
  Most measures peaked in 2010. The adjusted proportion with any opioid use was 43.9% in 2007, 44.7% in 2010, and 43.7% in 2011. The proportion with chronic use rose from 21.4% in 2007 to 23.1% in 2011. Among chronic users: mean MED peaked at 81.3 mg in 2010, declining to 77.4 mg in 2011; in 2011, 19.8% received ≥ 100 mg MED; 10.4% received ≥ 200 mg. In 2011, Hospital Referral Region-level measures varied broadly (5th-95th percentile): any use: 33.0%-58.6%, chronic use: 13.9%-36.6%; among chronic users, mean MED: 45 mg-125 mg; mean annual opioid prescribers: 2.4-3.7.
  
  
  CONCLUSIONS
  Among these beneficiaries, opioid use was common. Although intensity stabilized, the population using opioids chronically grew. Variation shows a lack of a standardized approach and reveals regions with mean MED at levels associated with overdose risk. Future work should assess outcomes, chronic use predictors, and policies balancing pain control and safety.
authors.affiliation: *Department of Community and Family Medicine, The Dartmouth Institute for Health Policy & Clinical Practice †National Bureau of Economic Research, Cambridge Massachusetts, Lebanon, NH.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Munson
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Colla
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Skinner
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhou
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002908:Chronic Disease; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000188:drug therapy*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid