The article, published in the September edition of the journal Medical Care, found the percentage of Social Security disability insurance (SSDI) recipients younger than 65 receiving any amount of opioid prescriptions rose from 43.9 percent in 2007 to 44.7 percent in 2010, with that figure dipping in 2011 to 43.7 percent.
Study authors Morden et al. reported a steadier rise in what they defined as “chronic use” of opioids (six or more prescriptions filled per year): 21.4 percent in 2007 increased to 23.1 percent in 2011.The authors called the chronic use trend “…worrisome, in light of established and growing evidence that intense opioid use to treat nonmalignant pain may not be effective and may confer important risks.”
The study’s findings are consistent with growing evidence of what some have called an “opioid epidemic” in the U.S. The Centers for Disease Control and Prevention report that 46 people die per day from an overdose of prescription painkillers. Of 22,810 deaths related to pharmaceutical overdose in 2011, 74 percent involved opioid painkillers.
Morden et al. focused on SSDI recipients because growing numbers of Americans are applying for – and receiving – these benefits. The authors report that musculoskeletal conditions, such as back pain, are often treated with opioid pain relievers. In 2011, these conditions were the most common SSDI-qualifying diagnoses, accounting for 33.8 percent of program participants (up from 20 percent in 1996).
The authors write that this shift in the makeup of disabling conditions, combined with increasing national trends in prescription opioid use and overdose deaths, “suggests the potential for substantial opioid use in the SSDI population and raises concern for the overall health and safety of these injured and ill workers.
“Although the best approach to pain management and opioid analgesic prescribing, in particular, are debated,” Modren et al. write, “intense chronic opioid use for non-malignant pain is increasingly recognized as ineffective and potentially hazardous to individuals and to the public.”
In addition to the figures on overall prevalence, the study showed that median daily morphine equivalent doses (MEDs) amongst SSDI recipients per recipient increased overall from 9.8 mg in 2007 to 11 mg in 2010, dropping down slightly in 2011 to 9.9 mg.
Average daily doses remained intense in the growing population of chronic users, with 20 percent of chronic users getting 100 mg of MEDs or more and 10 percent reaching or exceeding 200 mg of MEDs. Studies cited by Morden et al. show that opioid use of this intensity has been associated with risk of overdose death in the general U.S. population.
The study’s authors call for Medicare administrators and clinicians to develop pain management strategies for addressing opioid painkiller use in disabled Medicare recipients, individuals who often already suffer a high burden of illness, injury and low incomes.
When it comes to pain management, prescriber knowledge of DNA sensitivity testing’s role in predicting opioid effectiveness is crucial. An understanding of potential drug-drug interactions is also key, as the study found that about 38 percent of SSDI recipients defined as chronic opioid users also suffered from depression. This raises the possibility of pain medications and anti-depression drugs interacting and decreasing drug effectiveness, causing potentially harmful adverse drug events, or both.
YouScript Personalized Prescribing software can help take some of the uncertainty out of prescribing by identifying drug interactions in a patient’s regimen and suggesting alternatives. YouScript can also identify potential drug-gene and drug-drug-gene interactions when teamed with testing of the body’s highly variable cytochrome P450 pathways. Learn more about how these tools can help here.