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Opioids in Ohio Medicaid: Review of Extreme Use and Prescribing

WHY WE DID THIS STUDY

The opioid crisis has been declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States-115 deaths per day. Medicaid beneficiaries may be especially vulnerable to opioid misuse because they are more likely to have chronic conditions and comorbidities that require pain relief, especially those who qualify because of a disability. Although opioids can be appropriate under certain circumstances, the Office of Inspector General (OIG) and others are concerned about fraud, abuse, and misuse of opioids obtained through Medicaid and the Children's Health Insurance Program (CHIP), including drug diversion-the redirection of prescription drugs for an illegal purpose, such as recreational use or resale.

HOW WE DID THIS STUDY

We based this data brief on an analysis of Ohio's Transformed Medicaid Statistical Information System (T-MSIS) prescription drug records of opioids received from June 2016 to May 2017. We determined beneficiaries' morphine equivalent dose (MED), which is a measure that equates all of the various opioids and strengths into one standard value. We also identified prescribers whose opioid prescribing stood out compared to others prescribing to high risk beneficiaries.

WHAT WE FOUND

Nearly 5,000 beneficiaries received high amounts of opioids and did not have cancer or hospice care treatment. Among those receiving high amounts, more than 700 beneficiaries are at serious risk of prescription opioid misuse or overdose; some received extreme amounts of opioids, while others appeared to be doctor shopping. Nearly 50 prescribers stood out by prescribing opioids to more beneficiaries at serious risk than others who prescribed opioids to such beneficiaries.

WHAT WE CONCLUDE

Our results underscore the tenacity of the opioid crisis and the importance of Ohio's ongoing commitment to addressing it. Ohio has taken a number of steps to address the opioid crisis and has reduced opioid use among its residents. However, despite Ohio's efforts, we found that some Medicaid beneficiaries and prescribers have opioid use or prescribing patterns that may put beneficiaries at risk and warrant further scrutiny. OIG supports Ohio's continued efforts to explore new strategies to address this challenging problem.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201