Comparison of Opioid Prescriptions for Medicaid Patients in Florida

Nearly two decades after the initial surge of opioid overdose fatalities in the United States, data from the Centers for Disease Control and Prevention reveals that over 75% of drug overdose deaths in 2021 were linked to opioid usage. Ophelia delved into the variations in U.S. prescription opioid dispensing rates across states in 2021 using data from the Centers for Medicare and Medicaid Services, which encompasses information about Medicaid, a public health insurance program catering to low-income households and individuals with specific disabilities, jointly administered by states and the federal government.

According to the National Institute on Drug Abuse, fatalities resulting from opioid overdoses associated with pain management prescriptions surged by over five times from 1999 to 2017, peaking at 17,000. Although there has been a decrease in fatalities since then, the COVID-19 pandemic saw a marginal rise. Over the past decade, policies aimed at regulating legal opioid distribution and advocating for alternative nonopioid pain therapies have been acknowledged for mitigating the number of prescriptions and overdose deaths. Despite most states implementing laws governing opioid prescriptions and facilitating access to naloxone—an opioid overdose-reversing medication like Narcan—fatalities involving prescription opioids in 2021 totaled 16,700.

Opioids are classified as Schedule II controlled substances by the Drug Enforcement Administration due to their high potential for abuse and the likelihood of severe psychological or physical dependence. However, the data presented here does not distinguish between prescribing purposes. Opioids prescribed for addiction treatment, such as buprenorphine and methadone, actually contribute to reducing opioid overdose incidence and associated fatalities. Additionally, a 2023 study published in JAMA Network Open discovered that the COVID-era expansion in methadone accessibility for opioid use disorder treatment did not correlate with an upsurge in opioid overdose deaths.

The proliferation of oxycodone and hydrocodone in the 1990s marked the onset of widespread opioid misuse, leading to a surge in prescription opioid overdose deaths. By 2016, opioid-related fatalities had reached alarming levels, prompting the declaration of a health crisis and subsequently, a public health emergency by the U.S. government. Subsequently, 27 states enacted laws regulating the duration or dosage of initial opioid-based pain treatment medications, resulting in a 2.23% decline in opioid prescriptions by 2021. However, the infiltration of fentanyl into the illicit drug market has impeded efforts to combat opioid-related overdose fatalities. Described by the CDC as “50 times stronger than heroin and 100 times stronger than morphine,” the synthetic opioid poses significant challenges in tackling the crisis.

In Florida, 2.5% of Medicaid claims were for opioids in 2021, totaling approximately 680,000 claims. This marks a decrease of -3.2 percentage points since 2013, when there were 1,477,965 total opioid claims. For a comprehensive analysis of the states with the highest rates of Medicaid opioid prescriptions in 2021, refer to the national overview.

States with the highest opioid prescribing rates include Montana and Virginia, with Iowa following closely. Rural counties, in particular, bear the brunt of opioid use disorder, according to the Department of Agriculture.

Conversely, New York, Pennsylvania, and West Virginia exhibit the lowest number of Medicaid opioid prescriptions. West Virginia, previously plagued by the highest overdose death rate in the nation and elevated opioid prescription rates, attributed this trend to the prevalence of labor-intensive industries such as mining, timbering, and manufacturing. Employees in these sectors are susceptible to injuries, predominantly treated with opioid pain relievers by physicians. The decline in opioid prescriptions in West Virginia is attributed to a statewide program aimed at curbing opioid-based medication use following a “statistically significant increase in drug overdose deaths” reported by the CDC in 2015, as per the DEA report.

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