Toolkits Use Prescription Drug Claims Data to Combat Opioid Misuse

The Department of Health and Human Services Office of the Inspector General (HHS OIG) has developed two toolkits to identify certain patients at risk of opioid misuse or overdose using prescription drug claims data.

The toolkits provide highly technical information to assist the public and private sectors – including Medicare Part D plan sponsors, private health plans, and State Medicaid Fraud Control Units – with analyzing their own prescription drug claims data to help combat the opioid crisis.

OIG has done extensive research on opioid use in Medicare Part D. Most recently, the agency analyzed opioid levels in Medicare Part D in a data brief, which showed that almost 49,000 Part D beneficiaries were at serious risk of misuse or overdose.

Some of these beneficiaries received extreme amounts of opioids – each had an average daily MED that exceeded 240 mg for the entire year, more than two-and-a-half times the dose that the CDC recommends avoiding.

Others seem to be “doctor shopping,” meaning they’re receiving high amounts of opioids from multiple prescribers and multiple pharmacies. The analysis identified at-risk beneficiaries by calculating their opioid levels using Part D prescription drug data.

“The opioid crisis remains a public health emergency. As one of the lead Federal agencies fighting health care fraud, OIG is committed to supporting our public and private partners in their efforts to curb the opioid epidemic,” said HHS.

“These toolkits and the accompanying code can be used to analyze claims data for prescription drugs and identify patients who may be misusing or abusing prescription opioids and may be in need of additional case management or other follow-up. These toolkits and accompanying code can also be used to answer research questions about opioid utilization.”

The first toolkit, released in 2018, includes SAS programming code, as well as steps to calculate patients’ average daily morphine equivalent dose (MED). A patient’s MED converts various prescription opioids and strengths into one standard value. This toolkit also includes a detailed description of the analysis and programming code that can be applied to the user’s own data.

The resulting data can be used to identify certain patients who are at risk of opioid misuse or overdose. Users can also modify the code to meet their needs, like identifying patients at varying levels of risk.

The second toolkit was released in May 2020, and includes R and SQL programming code. The SAS code, R code, and SQL code provide the same data.

This effort is especially important given the COVID-19 pandemic, OIG noted. NIH recently issued a warning that individuals with opioid use disorder could be especially hard hit by COVID-19, as respiratory disease is known to increase mortality among people taking opioids.

“Chronic respiratory disease increases risk for fatal overdose in those who use opioids therapeutically. In addition, slowed breathing due to opioids causes hypoxemia, which can lead to cardiac, pulmonary, and brain complications and, if severe, can result in overdoses and death,” Dr. Nora D. Volkow, director of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, said in a study published in Annals of Internal Medicine.

“At least 2 million persons in the United States have opioid use disorder, and more than 10 million misuse opioids; these individuals may be at increased risk for the most adverse consequences of COVID-19.”

With these toolkits, OIG will continue to combat the opioid crisis and mitigate opioid misuse among Medicare Part D beneficiaries.

“OIG has made fighting the opioid epidemic a top priority, forming a multidisciplinary team dedicated to protecting beneficiaries from prescription drug abuse and misuse. As a part of its efforts, OIG has conducted extensive data analysis, which is the basis of this toolkit,” the agency stated.