Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

Sullivan, Mark D.; Edlund, Mark J.; Fan, Ming-Yu; DeVries, Andrea; Brennan Braden, Jennifer; Martin, Bradley C.

doi:10.1016/j.pain.2008.04.027

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Volume 138, Issue 2 , Pages 440-449, 31 August 2008

Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

Mark D. Sullivan
- Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195-6560, USA
- Corresponding author. Tel.: +1 206 685 3184; fax: +1 206 221 5414.
Mark J. Edlund
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Ming-Yu Fan
- Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195-6560, USA
Andrea DeVries
- HealthCore, 800 Delaware Avenue, Fifth Floor, Wilmington, DE, USA
Jennifer Brennan Braden
- Department of Psychiatry and Behavioral Sciences, Division of Consultation-Liaison Psychiatry, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195-6560, USA
Bradley C. Martin
- College of Pharmacy, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Received 5 December 2007; received in revised form 14 March 2008; accepted 28 April 2008. published online 11 June 2008.

Abstract

Opioids are widely prescribed for non-cancer pain conditions (NCPC), but there have been no large observational studies in actual clinical practice assessing patterns of opioid use over extended periods of time. The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured population (HealthCore plan data) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000–2005). We track enrollees with the four most common NCPC conditions: arthritis/joint pain, back pain, neck pain, headaches, as well as HIV/AIDS. Rates of NCPC diagnosis and opioid use increased linearly during this period in both groups, with the Medicaid group starting at higher rates and the HealthCore group increasing more rapidly. The proportion of enrollees receiving NCPC diagnoses increased (HealthCore 33%, Medicaid 9%), as did the proportion of enrollees with NCPC diagnoses who received opioids (HealthCore 58%, Medicaid 29%). Cumulative yearly opioid dose (in mg. morphine equivalents) received by NCPC patients treated with opioids increased (HealthCore 38%, Medicaid 37%) due to increases in number of days supplied rather than dose per day supplied. Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.

Keywords: Narcotics, Opiates, Administrative claims data, Opioid potency, Chronic pain, Back pain, Neck pain, Joint pain, Arthritis, Migraines, Headaches, HIV