(1199) The Prevalence of Long-term Opioid Treatment Among Older Adults with Chronic Non-cancer Pain

Objectives: Nearly one-third or 14.4 million of the 43.6 million Medicare beneficiaries have received a prescription opioid via Medicare Part D. However, pharmaceutical options to treat chronic pain in older adults tend to be only partially effective and can be associated with unexpected adverse outcomes. Previous research in older adults has not investigated Long-Term Opioid Treatment (LTOT) for Chronic Non-Cancer Pain (CNCP) in the context of opioid prescribing patterns, duration of use, and Morphine Milligram Equivalents (MME) thresholds guided by the Centers for Disease Control and Prevention (CDC). Understanding current opioid use patterns and trajectories is the first step to supporting healthcare providers’ and patients’ effective therapeutic decision-making in chronic pain management. The aims of this study are to 1) examine trends in LTOT among Wisconsin Medicare beneficiaries with CNCP from 2016 to 2019, and 2) examine trends in LTOT among different subpopulations based on sociodemographic characteristics, dosing, and drug formulation.

Methods: This study used enrollment and prescription drug claims data from a 100% sample of Wisconsin Medicare beneficiaries enrolled in stand-alone Part D prescription drug plans from 2016 to 2019. The eligible population included beneficiaries aged 65 or older that were continuously enrolled in for Medicare part A, B, and D in each study year. Beneficiaries with less than 90 days from the first day of opioid use and the last day of use during the measurement year and with a history of cancer were excluded from the analysis. Individuals with 2 or fewer prescribed opioids and with 15 or fewer days of prescription opioids supply in total were also excluded during the measurement year. MME per day was defined as strength per opioid unit*the number of quantities dispensed for the prescription/days of supply for the prescription*conversion factor and was calculated for each prescription using conversion factors following the CDC guidance. A beneficiary was identified as a high-dose user if the average daily MME was greater than 90.

Results: The total number of beneficiaries in Medicare Part D in Wisconsin increased by 15.41 percent from 596,517 in 2016 to 688,468 in 2019. The number of high-dose eligible beneficiaries decreased by 17.38% from 64,472 to 53,264 during the same period. The average daily MME per opioid prescription has decreased steadily from 43.96 to 38.78 during the study period. The average daily MME per beneficiary decreased from 27.42 in 2016 to 25.1 in 2019.

Conclusions: After publication of the CDC guidelines for prescribing opioids for chronic pain in 2016, there was a decreasing trends in prescription opioid dispensing in the State of Wisconsin. Future analyses will investigate 1) high dose users (MME per day≥90) among the identified eligible population, 2) stratify the population by opioid formulation (e.g., short-acting opioids only, long-acting opioids only, and combined short and long-acting opioids), 3) annual cost of high dose prescription opioids by payers, and 4) initial diagnosis on LTOT for CNCP.