Medicare disability recipients account for most Medicare opioid overdose deaths

  • JAMA Netw Open

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Adults aged

Why this matters

  • Among Medicare participants with a disability, having 3 co-occurring conditions of substance abuse, mental illness, and chronic pain syndrome was associated with a 23.4-fold increase in risk of opioid-related overdose death.

Study design

  • Cohort study of 1,766,790 Medicare enrollees (age, 21-64 years) who qualified for disability.
  • The opioid overdose rate was assessed.
  • Funding: The National Institute on Drug Abuse, NIH.

Key results

  • Medicare enrollees who qualified for disability represented:
    • 14.9% (95% CI, 14.9%-15.0%) of all Medicare patients; and
    • 80.8% (95% CI, 78.9%-82.7%) of opioid overdose deaths.
  • Conditions associated with opioid overdose death were (P<.001 from: style="list-style-type:circle;">
  • substance abuse:
    • opioid use disorder (aOR, 3.23),
    • drug use disorder (aOR, 1.86), 
    • tobacco use disorder (aOR, 1.77).
  • psychiatric diseases:
    • anxiety (aOR, 1.65),
    • bipolar disorder (aOR, 1.51), 
    • depression (aOR, 1.29).
  • chronic pain (aOR, 1.86),
  • chronic kidney disease (aOR, 1.59),
  • pressure and chronic ulcers (aOR, 1.48),
  • hepatitis (aOR, 1.68).
  • The rate of opioid overdose death was 363.7/100,000 among adults with disability who had substance use, psychiatric disease, and pain.

Limitations

  • Findings may not be generalizable.

Coauthored with Chitra Ravi, MPharm