What are opioids?
Opioids are medications used to treat moderate to severe pain that may not respond well to other pain medications (1). They reduce the sending of pain messages to the brain and reduce feelings of pain. They include codeine, fentanyl, hydrocodone, methadone, morphine and oxycodone. Hydrocodone medications are the most commonly prescribed for conditions such as dental and injury-related pain (2). Morphine is used before and after surgery for severe pain.
Opioid addiction
People who take opioids for a long period of time begin to depend on larger doses to achieve the same effect in reducing pain. If they stop taking them, withdrawal symptoms such as diarrhea, nausea, vomiting, muscle pain, anxiety, and irritability can occur. For some, this dependence turns into compulsive use, and ultimately addiction (1). The physician who prescribes opioids to his patients plays an important role by managing their dosages.
Data on Opioid-Related Deaths in New York State
A study found that opioid-related death rates per 100,000 among all New York state residents enrolled in Medicaid increased from 3.48 to 8.31 from 2003 through 2012, compared to 1.18 to 2.82 for non-Medicaid enrollees over the same time period (3). Males with Medicaid and those aged 45-64 had the highest death rates. The state of New York passed legislation in June 2014 to address the growing opioid epidemic including new programs and insurance reforms. In addition, the New York State Department of Health, Office of Quality and Patient Safety released a set of data on opioid-related deaths in the state drawn from death certificate data and hospital discharge data (4).
The dataset is comprised of facility visits filtered by ICD-9 and ICD-10 codes that pertain to opioid-related diagnoses. The codes include a range of poisonings by opiates, opium, heroin, methadone, and other narcotics. The visits include inpatient discharges and outpatient visits. The dataset was derived from the Statewide Planning and Research Cooperative System (SPARCS), New York State’s reporting system which collects data on hospital discharges, ambulatory surgery discharges, and emergency department visits in the state.
Results
Below are several findings from the dataset:
Overall Opioid-Related Facility Visits in New York
From 2010 through 2015, Medicaid patients appear to have more facility visits than patients with other types of insurance. Overall facility visits include emergency room, inpatient, ambulatory surgery, and outpatient.
Emergency Room Visits in New York with Opioid Code
From 2014 to 2015, there was a steep jump in the number of emergency room visits with an opioid code by Medicaid patients. From 2010 through 2015, Medicaid patients had the highest rate of increase in emergency room visits with an opioid code.
Inpatient Discharges in New York with Opioid Code
From 2010 through 2015, Medicaid patients had the highest number of inpatient discharges with an opioid code, regardless of whether or not the patient was admitted through the emergency room.
Discussion
In the dataset, Medicaid patients comprised the majority of the ER and inpatient utilization in New York pertaining to opioid codes. Studies show that Medicaid patients have complex issues, such as mental illness, homelessness, high medical comorbidity, untreated substance abuse and pain diagnoses (5). It is possible that they are abusing opioids to deal with such problems, resulting in poisoning and the need for immediate medical attention. Outpatient utilization pertaining to opioid codes was low across all payers, which means that the ER and the hospital are usually the first line of contact for abusers of opioids, especially for those with Medicaid. Studies show that the opioid epidemic hits the Medicaid population hard. Medicaid beneficiaries are prescribed painkillers at twice the rate of non-Medicaid patients and are three-to-six times the risk of prescription painkillers overdose (3,6).
Conclusion
New York emergency rooms and hospitals must be ready to handle the increasing number of Medicaid patients who overdose on opioids. The complex issues of Medicaid patients and their lack of access to primary care are possibly leading them to rely on opioids as a way to deal with pain. Unfortunately, this reliance on opioids can lead to addiction, overdose, and ultimately death.
Sources
1. Web MD. Opioid (Narcotic) Pain Medications. http://www.webmd.com/pain-management/guide/narcotic-pain-medications?page=1#1. Accessed June 8, 2016.
2. National Institute on Drug Abuse. Prescription Drug Abuse. https://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-opioids. Accessed June 8, 2016.
3. Sharp M, Melnik T. Poisoning Deaths Involving Opioid Analgesics – New York State, 2003-2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a2.htm#tab. Morbidity and Mortality Weekly Report. Published April 17, 2015. Accessed June 8, 2016.
4. New York State Department of Health, Office of Quality and Patient Safety. SPARCS: Opioid-Related Facility Visits in New York State: Beginning 2010 data dictionary. Accessed June 8, 2016.
5. Revisiting Emergency Department Use in Medicaid. Medicaid and CHIP Payment and Access Commission Web site. https://www.macpac.gov/wp-content/uploads/2015/01/MACFacts-EDuse_2014-07.pdf. Accessed June 8, 2016.
6. Coolen P, Lima A, Savel J, et al. Overdose Deaths Involving Prescription Opioids Among Medicaid Enrollees— Washington, 2004-2007. Morbidity and Mortality Weekly Report. 2009; 58: 1171-1175.
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