Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017

January 8, 2020

Questions for Lead Author Anna Rui, Health Statistician, of “Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017.”

Q: Why did you decide to look at opioid prescribing at emergency department discharges?

AR: There is a large body of research reporting increases in opioid prescription rates from 1999 to 2010 but less is known about how rates have changed from 2010 on, particularly in the emergency department setting, where many patients present with pain symptoms and are likely to receive opioids for treatment. In response to the opioid epidemic, hundreds of local, state, and federal programs were implemented in recent years with the goal of changing prescribing practices. A goal of this report was to evaluate recent trends in opioid prescribing, in order to monitor the effects of public health policy.


Q: How did the data vary by patient/hospital characteristics and in the type of opioids prescribed at discharge?

AR: Variation in the rate of change was found for age, patient residence, and primary expected source of payment. The rate of decrease in the percentage of visits with an opioid prescribed at discharge by younger patients aged 18-44 from both the beginning of the study period (2006-2007) and from the inflection point (2010-2011) to the end of the study period (2016-2017) was the highest across all age groups. Similarly, the percentage of visits by patients living in medium or small metropolitan counties decreased by the highest percentage across the study period among all urban and rural categories. Both Medicaid and self-pay/no charge/charity experienced the highest rate of decrease from 2010-2011 through 2016-2017 whereas the percentage of visits by patients with Medicare that included an opioid prescribed at discharge remained stable across the study period.

In terms of hospital characteristics, among the four regions, the largest decrease in opioids prescribed at discharge from 2006-2007 to 2016-2017 was observed in the Northeast region. Generally, a higher percentage of visits at proprietary (or for-profit) hospital EDs, compared with nonprofit and government hospital EDs, included an opioid prescribed at discharge. Despite the high percentage, the rate of decrease among visits made to proprietary hospital EDs from 2006-2007 through 2016-2017 was modest.

In terms of the type of opioids prescribed, the percentage of opioid mentions with acetaminophen-hydrocodone (e.g., Vicodin) prescribed remained stable through 2012-2013 and decreased starting from 2014-2015. Corresponding to this decrease, the percentage of opioid mentions with tramadol and acetaminophen-codeine, which are known as having a lesser risk of dependence, increased starting in 2014-2015 and continued through 2016-2017.


Q: Was there a specific finding in the data that surprised you?

AR: One finding that surprised me was the magnitude of decrease in the percentage of opioids prescribed from 2010-2011 through 2016-2017 for most of the pain-related diagnoses. For example, the percentage of visits for extremity and back pain decreased by 68.8% and 49.1%, respectively, between 2010-2011 and 2016-2017.


Q: How did you obtain this data for this report?

AR: Restricted data (available from the Research Data Center) collected from the National Hospital Ambulatory Medical Care Survey were used for this report. Masked public use data are available for download from the Ambulatory Health Care Data website (https://www.cdc.gov/nchs/ahcd/datasets_documentation_related.htm)


Q: What is the take home message for this report?

AR: I think the take home message of the report is recent trends show a decrease in the percentage of visits with opioids prescribed at discharge from 2010-2011 through 2016-2017, and this trend was observed for most of the patient and hospital characteristics examined, as well as for most of the pain-related diagnoses prompting the ED visit.


QuickStats: Percentage of Adults Aged 18 Years or Older Who Took Medication To Help Fall or Stay Asleep Four or More Times in the Past Week, by Sex and Age Group

December 13, 2019

During 2017–2018, 8.2% of adults aged 18 years or older took medication to help fall or stay asleep four or more times in the past week (6.6% for men and 9.7% for women).

Among men, the percentage who took medication for sleep four or more times in the past week increased with age from 3.8% among those aged 18–44 years to 10.7% among those aged 65 years or older.

Among women, the percentage increased from 5.8% for those aged 18–44 years to 12.7% among those aged 45–64 years and 13.2% among those aged 65 years older.

Across all age groups, the percentage was higher among women than men.

Source: National Center for Health Statistics, National Health Interview Survey, 2017 and 2018. https://www.cdc.gov/nchs/nhis.htm.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6849a5.htm


QuickStats: Percentage of Adults Aged 18 Years or Older Who Did Not Take Their Medication as Prescribed or Asked for Lower-Cost Medication to Save Money Among Those Prescribed Medication in the Past 12 Months by Number of Chronic Conditions

November 1, 2019

In 2018, among adults aged 18 years or older who were prescribed medication in the past 12 months, the percentage who did not take their medication as prescribed to save money increased with the number of reported chronic conditions, from 6.2% with no chronic conditions to 9.1% with 1–2 chronic conditions and 14.0% with more than 3 chronic conditions.

The percentage who asked their doctor for a lower-cost medication also increased with the number of reported chronic conditions from 15.1% among those with no chronic conditions to 18.4% among those with 1–2 chronic conditions and 27.4% among those with more than 3 chronic conditions.

Source: National Health Interview Survey, 2018 data. https://www.cdc.gov/nchs/nhis.htm.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6843a6.htm


Strategies Used by Adults With Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017–2018

August 21, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of ”Strategies Used by Adults with Diagnosed Diabetes to Reduce Their Prescription Drug Costs, 2017-2018.”

Q: What do you think is the most significant finding in your report?

RC: Among adults with diagnosed diabetes, more than 13 percent did not take their medication as prescribed to save money and almost 1 in 4 asked their doctor for a lower cost medication.


Q: Do you have other data that would put these diabetes findings in context with other diseases?

RC: We have not looked at strategies adults use to reduce their prescription for other diseases. However, two previously published reports examined strategies used by adults aged 18-64 (https://www.cdc.gov/nchs/products/databriefs/db333.htm) and by adults aged 65 and over (https://www.cdc.gov/nchs/products/databriefs/db335.htm) to reduce their prescription drug costs in 2016-2017.


Q: Do you have any data on this topic for earlier years?

RC: We do not have reports addressing strategies used by adults with diagnosed diabetes for earlier years. However, two previous reports examined strategies used by adults to reduce their prescription drug costs in 2011 and 2013.


Q: Which age group or demographic group seems to be having the biggest problem with the cost of diabetes medication or with taking their medication?

RC: Among U.S. adults with diagnosed diabetes who were prescribed medication in the past 12 months, the percentages of adults who did not take their medication as prescribed to reduce their prescription drug costs were highest among women and adults under age 65.  Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.


Q: Any other significant points you’d like to make about your report?

RC: Among adults aged 18-64, those who were uninsured (35.7%) were more than twice as likely than those with either private (14.0%) or Medicaid (17.8%) coverage to not take their medication as prescribed to save money.


Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016

May 31, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”

Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?

AR:

Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.

In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both.  However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered.  I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported.  This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.


Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?

AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge.  Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men.  Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.


Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?

AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.


Q: Was there a specific finding in your report that surprised you?

AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses.  For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge.  Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge.  For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.


Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?

AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.


Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

May 22, 2019

Questions for Robin Cohen, Ph.D. and Lead Author of “Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017

Q: Why did you decide to do a report on strategies used to reduce prescription drug costs in the United States?

RC: Although most adults aged 65 and over have prescription drug coverage through either Medicare Part D or some other source such as private health insurance Medicaid, or VA coverage, previous data indicate that some older adults may still use strategies to reduce prescription drug costs including not taking medication as prescribed or asking their doctor for a lower cost medication.


Q: Do you have data that directly corresponds with this report that goes back further than 2016-2017?

RC: We previously examined this topic using the 2013 National Health Interview Survey. However, this previous report was not solely focused on adults aged 65 and over.


Q: How did the data vary by age, sex and insurance coverage?

RC: In 2016–2017, among U.S. adults aged 65 and over who were prescribed medication in the past 12 months, the percentage who did not take their medication as prescribed or asked their doctor for a lower-cost medication to reduce their prescription drug costs varied by sex, age, insurance status, and poverty status. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.


Q: Was there a specific finding in your report that you did not expect?

RC: No, the findings in this report were similar to those previously published with earlier data. However in this report we were able to expand on previous research by focus on adults aged 65 and over and examine differences by sex, age group, health insurance status, and poverty status.


Q: What is the take home message for this report?

RC: Among adults aged 65 and over who were prescribed medication in the past 12 months, 4.8% did not take their medication as prescribed to reduce their prescription drug costs, and 17.7% asked their doctor for a lower-cost medication. Among adults aged 65 and over, women, those aged 65–74, those with Medicare only, and those who were near poor were the most likely to not take their medication as prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who were not poor were the least likely to ask their doctor for a lower-cost medication.

 


Prescription Drug Use in the United States, 2015–2016

May 8, 2019

Questions for Lead Author Crescent Martin, Health Statistician, of “Prescription Drug Use in the United States, 2015–2016.”

Q: Why did you decide to do a report on prescription drug use in the United States?

CM: We wanted to update a previous report that found an increase in prescription drug use from 1999–2000 through 2007–2008, using the latest available data from 2015–2016.


Q: Do you have data for the years between 2007-2008 and 2015-2016 on prescription drug use?

CM: Yes, the trends analysis (shown in Figure 4) includes an estimate for each two-year survey cycle from 2007–2008 through 2015–2016 (i.e. 5 time points over the decade.)


Q: How did the data vary by age, sex and race?

CM: The percentage of the population that used prescription drugs increased with age among every group we looked at: overall, among both males and females, and among each race and Hispanic origin group.

By sex, prescription drug use was higher among females than males, though this overall difference was primarily driven by the difference observed among adults aged 20–59. Among children age 11 and younger, a higher percentage of boys than girls used prescription drugs.

Prescription drug use was highest among Non-Hispanic white persons, followed by non-Hispanic black persons, and was lowest among non-Hispanic Asian and Hispanic persons. This pattern also varied by age, and among adults aged 60 and over no differences were observed between race and Hispanic origin groups.


Q: Was there a specific finding in your report that surprised you?

CM: I was interested to see the different types of prescription drugs that were most commonly used within each age group. The most commonly used types of prescription drugs were bronchodilators (such as asthma rescue inhalers) for children aged 11 and under, central nervous system stimulants for adolescents aged 12-19, antidepressants for adults aged 20-59, and cholesterol-lowering drugs for adults aged 60 and over.

The top drug type for each age group was actually the same drug type that was most commonly used in 2007–2008, from the earlier report.


Q: What is the take home message for this report?

CM: Overall, almost half of the U.S. population took one or more prescription drugs in the past 30 days during 2015–2016.

When we look at trends over time and take into account how the age distribution of the US population has gotten older over this decade, we see a decline in the use of prescription drugs from 2007–2008 through 2015–2016.