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Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History

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Abstract

Opioid overprescribing is a major driver of the current opioid overdose epidemic. However, annual opioid prescribing in the USA dropped from 782 to 640 morphine milligram equivalents per capita between 2010 and 2015, while opioid overdose deaths increased by 63%. To better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, we analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records. We found that of the 1893 opioid-related overdoses, 573 (30.2%) decedents had not filled an opioid analgesic prescription within the 6 years prior to death. Decedents without an opioid prescription were more likely to be black (33.3% vs 20.2%, p < .001), Hispanic (16.3% vs 8.8%, p < .001), and Chicago residents (46.8% vs 25.6%, p < .001) than decedents with at least one filled opioid prescription. Decedents who did not fill an opioid prescription were less likely to die of an overdose involving prescribed opioids (7.3% vs 19.5%, p < .001) and more likely to fatally overdose on heroin (63% vs 50.4%, p < .001) or fentanyl/fentanyl analogues (50.3% vs 41.8%, p = .001). Between 2012 and the time of death, decedents without an opioid prescription had fewer emergency department admissions (2.5 ± 4.2 vs 10.6 ± 15.8, p < .001), were less likely to receive an opioid use disorder diagnosis (41.3% vs 47.5%, p = .052), and were less likely to be prescribed buprenorphine for opioid use disorder treatment (3.3% vs 8.6%, p < .001). Public health interventions have often focused on opioid prescribing and the use of CSMPs as the core preventive measures to address the opioid crisis. We identified a subset of individuals in Illinois who may not be impacted by such interventions. Additional research is needed to understand what strategies may be successful among high-risk populations that have limited opioid analgesic prescription history and low health care utilization.

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Notes

  1. We are using the terminology CSMP to more accurately describe these databases, which house information about receipt of controlled substance prescriptions (as opposed to all prescriptions) that are obtained in retail pharmacies.

  2. AL, AR, AZ, CA, CO, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NV, NY, OH, OK, OR, PA, TN, TX, UT, VA, WI.

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Acknowledgments

The authors were funded by the University of Chicago Institute of Politics (ABA), NIDA UG3DA044829 (MTP), and AHRQ R00HS022433 (MTP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Ali B. Abbasi

  2. Illinois Department of Public Health, Chicago, IL, USA

    Ali B. Abbasi, Jennifer E. Layden & Mai T. Pho

  3. Center for Multi-System Solutions to the Opioid Epidemic, American Institutes for Research, Chicago, IL, USA

    Elizabeth Salisbury-Afshar

  4. Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL, USA

    Dejan Jovanov

  5. Prescription Monitoring Program, Illinois Department of Human Services, Chicago, IL, USA

    Craig Berberet

  6. Cook County Chief Medical Examiner, Chicago, IL, USA

    Ponni Arunkumar

  7. Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago, IL, USA

    Steven E. Aks

  8. Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA

    Mai T. Pho

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  1. Ali B. Abbasi
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Correspondence to Ali B. Abbasi.

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Abbasi, A.B., Salisbury-Afshar, E., Jovanov, D. et al. Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History. J Urban Health 96, 38–48 (2019). https://doi.org/10.1007/s11524-018-00329-x

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