The opioid crisis has been declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States--115 deaths per day. Identifying patients who are at risk of overdose or abuse is key to addressing this national crisis. Medicaid beneficiaries may be especially vulnerable to opioid misuse because they are more likely than nonbeneficiaries to have chronic conditions and comorbidities that require pain relief, especially those who qualify because of a disability. In 2016, Medicaid covered nearly 4 in 10 nonelderly adults with opioid addiction. Opioids include narcotics intended to manage pain from surgery, injury, or illness. They can create a euphoric effect, which makes beneficiaries vulnerable to opioid abuse and misuse (i.e., taking opioids in a way other than prescribed). Although opioids can be appropriate under certain circumstances, the Office of Inspector General (OIG) and others are concerned about fraud, abuse, and misuse of opioids obtained through Medicaid and the Children's Health Insurance Program (CHIP), including drug diversion--the redirection of prescription drugs for an illegal purpose, such as recreational use or resale. In addition to the risk of abuse and misuse, opioids carry a number of health risks. Side effects from using opioids may include respiratory depression, confusion, tolerance to lower doses, and physical dependence. Prescription opioid abuse can also lead to the use of illegal drugs such as heroin. For these reasons, it is essential that Medicaid and CHIP beneficiaries receive only medically necessary opioids in the appropriate amounts. Prescribers play a crucial role in ensuring that beneficiaries receive appropriate amounts of opioids. To help inform prescribers, the Centers for Disease Control and Prevention (CDC) published a guideline on prescribing opioids to patients with chronic pain. The guideline recommends that prescribers use caution when ordering opioids at any dosage and avoid increasing to dosages that are equivalent to 90 mg or more of morphine a day for chronic pain. In addition, because long-term opioid use often begins with the treatment of acute pain, the guideline recommends that prescribers order opioids for the lowest effective dose and duration. The Centers for Medicare & Medicaid Services (CMS) has also initiated projects to address opioid misuse and inappropriate prescribing, including providing educational materials for States and prescribers. States also play an important role in ensuring that beneficiaries receive appropriate amounts of opioids. Ohio has a number of collaborative efforts underway to help address its opioid crisis that involve local and State partners, including law enforcement personnel, public health officials, addiction and treatment specialists, health care providers, educators, and parents. Key initiatives include (1) educational initiatives designed to prevent drug use; (2) opioid prescribing guidelines and laws developed to address proper pain management practices; (3) prescription monitoring requirements via the State's prescription drug monitoring program (PDMP); (4) a lock-in program that limits where certain beneficiaries can fill their prescriptions; (5) data analytics designed to identify fraudulent prescribers for administrative or legal actions; and (6) Ohio's "Pill Mill" law, which helps to close illegal pain clinics. For more information about Ohio's opioid initiatives, see Appendix A. This data brief is part of a larger OIG effort to fight the opioid crisis. OIG's previous work highlighted beneficiaries who were at serious risk of opioid misuse or overdose and opioid prescribers who stood out when compared to their peers in Medicare Part D. Additionally, OIG is currently assessing multiple prevention and treatment efforts underway at State and national levels. OIG also released a toolkit that provides detailed steps for using prescription drug data to analyze patients' opioid levels and identify patients who are at risk of opioid misuse or overdose. This data brief extends previous Medicare Part D work to Medicaid claims in Ohio to identify beneficiaries at serious risk of opioid misuse or overdose and prescribers who ordered opioids for these beneficiaries at higher rates than their peers. We selected Ohio to examine as the first State in a series of State Medicaid studies focusing on opioid use in the Medicaid program. Ohio is among the States most severely impacted by the opioid crisis, with nearly 3,500 overdose deaths in 2016.
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