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Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds

By Kaiser Health News  
   August 01, 2016

The primary diagnosis of opioid dependency kicks off a number of medical services, including office visits, lab tests and other related treatments. The number of such services rendered to patients with a dependency diagnosis went from about 217,000 in 2007 to about 7 million in 2014.

This article first appeared August 1, 2016 on the Kaiser Health News website.

By Julie Appleby

In one of the first looks at privately insured patients with opioid problems, researchers paint a grim picture: Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.

The study considers a huge cohort of people who have either job-based insurance or buy coverage on their own. Its findings illustrate that the opioid problem is "in the general mainstream," said Robin Gelburd, president of Fair Health, a nonprofit databank corporation focused on health care cost transparency and insurance information. "Is the health system preparing for this tsunami of services?" she said.

The researchers used de-identified claims data from insurers representing 150 million patients, looking for diagnosis codes related to opioid dependency and abuse, adverse effects of heroin use, and problems caused by the misuse or abuse of other types of opiates. While heroin is a street drug, other opiates are often prescription medications.

They found that much of the increase in opioid dependence occurred since 2011, a period marked by increased attention to the problem and a growing drumbeat by advocates calling on doctors to reduce the number of opioid prescriptions.

Younger patients — 19 to 35 — were most likely to be diagnosed as opioid dependent compared to other age groups. Dependence is defined by symptoms such as increased tolerance, withdrawal or unsuccessful attempts to quit.

Those younger patients were also more likely than older ones to overdose on heroin. The reverse was true, however, for overdoses related to other types of opioids. People in their mid-40s to mid-50s were more likely to suffer this consequence.

The primary diagnosis of opioid dependency kicks off a number of medical services, including office visits, lab tests and other related treatments. The report found that the number of such services rendered to patients with a dependency diagnosis went from about 217,000 in 2007 to about 7 million in 2014.

The scope of the increase found by Fair Health stunned even those already familiar with the problem.

"A 3,000 percent increase is enormous," said Andrew Kolodny, senior scientist at the Heller School for Social Policy and Management at Brandeis University. He did not work on the study.

Such a sharp rise over a short period of time is a classic definition of an epidemic, he said, and one that points out that much more effort is needed to prevent future cases and treat people who already have addiction problems.

Still, experts caution that research based solely on claims data, while common, is a good way to track the use of health services, but may not paint a complete picture. The accuracy of claims codes — which are used for billing — may be poor, for example. In this case, increased attention to the opioid problem may have also resulted in an increased use of the code. Some research studies also pair claims data with medical record information — the doctors' notes — to provide additional information. This study did not.

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Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


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