Prescription Opioid Use in Older Adults: Trends and Changes in New and Long-Term Use in the United States, 2013-2020.

BACKGROUND

There is limited knowledge regarding prescription opioid use following the release of the 2016 CDC guidelines, which recommended prioritizing non-opioid therapies for chronic pain, prescribing the lowest effective opioid dose for the shortest duration, and closely monitoring to minimize risks. This study evaluated trends in new and long-term prescription opioid use among older Medicare beneficiaries from January 2013 to September 2020.

METHODS

This cohort study utilized 5% national Medicare claims data from 2012 to 2020, including older Medicare beneficiaries (≥ 65 years) with Parts A, B, and D, but not Part C enrollment for at least 10 months in a year. Annual utilization of individual demographic and clinical characteristics, average morphine milligram equivalent (MME) of new prescriptions, percentage of high-dose new prescriptions (MME ≥ 50) users, percentage of short-acting formulation users, and the average days of supply of new prescriptions were reported. Trends in new and long-term prescription opioid use were measured and changes over time were assessed using joinpoint regression. Sensitivity analyses were performed to determine whether subgroups defined by race, region, and clinical characteristics followed the national trend over the study years or deviated from it.

RESULTS

The study included approximately 2.75 million Medicare beneficiaries annually, mostly women (56%) and white (81%), with a mean age of 75 years. The percentage of beneficiaries with at least one new prescription opioid use increased from 6.6% in 2013 to 10.1% in 2016 (annual percentage change (APC) = 14.2; 95% confidence interval (CI): 2.2-50.0) and significantly decreased afterward to 5.4% in 2020 (APC = -15.3; 95% CI: -32.2 to -9.1). The percentage of individuals with long-term opioid use among new prescription opioid users decreased steadily from 12.4% in 2013 to 8.6% in 2017 (APC = -11.6; 95% CI: -24.2 to -5.7). It increased afterward to 10.7% in 2020, although non-significant (APC = 7.4; 95% CI: -2.8 to 24.2). Sensitivity analyses demonstrate that subgroups defined by race, region, and clinical characteristics generally followed the national trend in new long-term opioid therapy episodes over the study years, with minimal difference in inflection points. The mean (SD) MME per new prescription declined from 31.5 (27.44) in 2013 to 26.82 (17.48) in 2020, and the percentage of high-dose prescription users fell from 15.3% in 2013 to 7.6% in 2020. Short-acting formulation users rose from 97.41% in 2013 to 99.41% in 2020, while the average (SD) days of supply per new prescription decreased from 21.91 (23.49) to 12.40 (15.27).

CONCLUSIONS

A comprehensive assessment of trends in prescription opioid use before and after the release of the 2016 CDC guidelines suggested an overall decline in new and long-term prescription opioid use among older adults, as well as average dose and percentage of high-dose prescription opioid users.