Awareness of prescribing behavior across the Commonwealth is a key first step in understanding opioid availability. Due to the availability of prescription claims data1 in the Virginia All-Payer Claims Database, we can answer questions about prescription volume, refills, and which clinical specialty areas are responsible for dispensing the greatest volume of opioids. And with the addition of 2016 data, the database has enough information to identify prescription volume trends. For this analysis, the VHHA Analytics Team reviewed claims for individuals covered by Medicaid and commercial insurance for 2015 and 2016. A summary of findings is provided in Figure 1 (see below). It shows the types of opioids prescribed, the frequency of prescriptions, and prescribing trends. APCD prescription claims data show that during 2015 and 2016, approximately 2.5 million prescriptions were written for 677,000 patients, averaging out to roughly 3.7 prescriptions per patient. Records show significantly fewer refills occurred after an initial refill, and the available data reveals that family practice physicians and non-physician practitioners write the largest percentages of opioid prescriptions. Beginning in January 2015, the monthly volume of opioid prescriptions written was 111,739. By December 2016, the monthly volume declined to 95,011. It is important to note that seven of 106 substances were excluded from the analysis, thereby reducing the total prescription volume from 5.5 million to 2.5 million.2 These seven substances were excluded due to their common use in treating opioid addiction.3 It is also noteworthy that a large number of prescriptions (326,641) were not identified as having a refill (value shows as “null”). About twice that many prescriptions were refilled at least once. Data show significantly fewer refills occur after the first refill, which could be where the changes noted in trending occur. Additional research is needed to test that hypothesis. Family practice physicians account for the largest percentage of physicians writing opioid prescriptions, though non-physician practitioners (including those in specialty practices) write nearly as many prescriptions. While there is a natural tendency to assume that most prescriptions are given to emergency room patients, the data shows such assumptions are inaccurate. What’s most encouraging in the data analyzed is the trend line showing that prescription volumes fell between 2015 and 2016. Looking ahead, projections based on the positive changes from 2015 to 2016 lead us to surmise that 2017 data will show the volume of prescriptions continued to decline last year. We will revisit this subject later this year when 2017 prescription claims data becomes available. (1/26)
1 VHI estimates that approximately 50 percent of commercially insured and 100 percent of Medicaid residents of Virginia are represented in the Virginia APCD.
2 Excluded from APCD Analgesic/Opioid drug classifications: Buprenorphine HCL, Buprenorphine HCL/Nalaxon, Dolphine, Methadone HCL, Methadone HCL Intensol, Methadose, Suboxone.
3 National Institute on Drug Abuse, January 2018, https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview