Last month, AHA News Now highlighted addiction research from the Johns Hopkins Bloomberg School of Public Health.1 The study’s authors found that 43 percent of patients receiving buprenorphine for opioid addiction filled prescriptions for other opioids during their treatment. Another 67 percent filled a prescription for an opioid in the 12 months following treatment. The research relied on pharmacy claims from 2006-2013. Given the surprising findings, the VHHA Analytics Team plumbed the Virginia All Payer Claims Database (APCD)2 to see if a similar trend is observable among Virginians. APCD data from 2011-2015 was mined for this analysis. Our findings indicate that Virginians taking buprenorphine for opioid addiction have similar prescription habits as those being treated for opioid addiction elsewhere. Forty-five percent (45) of Virginians receiving buprenorphine filled a prescription for another opioid during their treatment. Following treatment, many patients still used prescription opioids. Fifty-one (51) percent of the patients filled prescriptions for opioids in the 12 months following treatment. The most common drug prescribed was hydrocodone/acetaminophen. The top three drugs prescribed were the same during and post-treatment: hydrocodone/acetaminophen, oxycodone/acetaminophen, and tramadol. In the past 15 years, buprenorphine has gained favor over methadone as the treatment for opioid addiction because it does not require a specialized clinic. Buprenorphine can be prescribed in a physician’s office making treatment more accessible. It is a common misconception that people treated for opioid addiction are cured. Individuals with substance use disorders have a lifelong vulnerability even when they are not actively using drugs or alcohol. The pattern of opioid use during and after treatment suggests that many patients do not have well-coordinated treatment for opioid use and chronic pain. This could be driving the pattern in the Virginia data as well as the national data. Having more accessible treatment does not obviate the need for coordinating care among providers.
1 Daubresse, M., Saloner, B. Pollack, H. A., and Alexander, G. C. (2017) Non-buprenorphine opioid utilization among patients using buprenorphine. Addition, doi:10.1111/add.13762 (http://dxdoi.org/10.1111/add.13762).
2 The Virginia All Payer Claims Database is derived from insurance claims and includes pharmacy claims. It currently has 65 percent of the commercially-insured population and 99 percent Medicaid claims. It does not include data on uninsured patients or traditional fee for service Medicare.