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Concerns About Opioid Use in Medicare Part D in the Appalachian Region

See also: 2019 Appalachian Region Opioid Takedown


Overdose deaths are at epidemic levels and the opioid crisis is now considered a public health emergency. In 2016, there were more than 42,000 opioid-related overdose deaths in the United States-115 deaths per day. Nearly 7,000 of these deaths occurred in five States in the Appalachian region-Alabama, Kentucky, Ohio, Tennessee, and West Virginia. All five of these States had high opioid prescribing rates and four reported opioid-related overdose death rates that far exceeded that of the Nation. Identifying beneficiaries who are at risk of overdose or abuse is key to addressing this crisis. This data brief provides data on opioid use in Medicare Part D in these five States in 2017, including the number of beneficiaries who were at serious risk of opioid misuse or overdose.


We based this data brief on an analysis of Part D prescription drug event records for opioids received in 2017. We determined beneficiaries' morphine equivalent dose (MED), which is a measure that converts all of the various opioids and strengths into one standard value.


Thirty-six percent of Part D beneficiaries in five States in the Appalachian region received a prescription opioid in 2017; these States are Alabama, Kentucky, Ohio, Tennessee, and West Virginia. Almost 49,000 beneficiaries in these States received high amounts of opioids, far exceeding levels CDC says to avoid. Nearly 6,000 beneficiaries in these States are at serious risk of opioid misuse or overdose.


The use of opioids described in this study may indicate that opioids in the Appalachian region are being prescribed for medically unnecessary purposes and then diverted for resale or recreational use. It may also indicate that the beneficiary is receiving poorly coordinated care or that the beneficiary's care may need to be reassessed. In addition, it raises questions as to whether prescribers are checking State prescription drug monitoring databases or whether these databases have current information. The severity of the crisis makes it imperative that the Department of Health and Human Services, including the Centers for Medicare & Medicaid Services and OIG, continue to work with its partners to address this epidemic. OIG is committed to fighting the opioid crisis and protecting beneficiaries from prescription drug abuse and misuse. We are working with our law enforcement partners to bring resources and expertise to these five States through the Appalachian Regional Prescription Opioid Strike Force. Further, OIG supports States' efforts to implement and enforce strong prescription drug monitoring programs that require prescribers and pharmacies to check the State database before prescribing and dispensing opioids. By working together and expanding our efforts, we can help curb the opioid crisis in the Appalachian region and in the Nation.