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STATISTICAL BRIEF #542:
ANY USE AND "FREQUENT USE" OF OPIOIDS AMONG NON-ELDERLY ADULTS IN 2018-2019, BY
SOCIOECONOMIC CHARACTERISTICS

--------------------------------------------------------------------------------

March 2022 Asako S. Moriya, PhD and Zhengyi Fang, MS

--------------------------------------------------------------------------------


HIGHLIGHTS

 * In 2018-2019, 8.7 percent of non-elderly adults, on average, filled at least
   one outpatient opioid prescription, and 2.3 percent had five or more
   prescription fills during the year.
 * Women were more likely than men to have any opioid use during the year (10.3
   percent vs. 7.0 percent) and to have frequent opioid use (2.7 percent vs. 1.8
   percent).
 * In 2018-2019, the average annual percentages of non-elderly adults who had
   any use and frequent use of prescription opioids during the year were lowest
   for those in excellent health (3.9 percent and 0.4 percent) and highest for
   those in poor health (36.8 percent and 20.1 percent).
 * Non-elderly adults who had family incomes below the federal poverty line
   (13.3 percent), lived in rural areas (12.4 percent), or were covered by
   public insurance due to a disability (30.3 percent) were more likely than
   others to have at least one opioid prescription fill during the year.


INTRODUCTION

Prescription opioids have commonly been used to treat both chronic and acute
pain in the United States despite the fact that they are not recommended as the
first-line treatment for most types of pain due to serious risks of opioid use
disorders (OUDs) and overdose. As OUDs and opioid overdose deaths continue to be
major public health concerns, examining the patterns and trends of the use of
prescribed opioids can contribute to efforts to promote safer and more effective
pain management.

This Statistical Brief presents estimates of fills of prescriptions for opioid
medications that are commonly used to treat pain obtained from the 2018-2019
Medical Expenditure Panel Survey Household Component (MEPS-HC). These estimates
are an update of the 2015-2016 estimates presented in the previous Agency for
Healthcare Research and Quality (AHRQ) Statistical Brief #516. The estimates
only include prescriptions purchased or obtained in an outpatient setting.
Prescription medicines administered in an inpatient setting or in a clinic or
physician's office are not included.

The sample includes all non-elderly adults (ages 18 to 64) in the U.S. civilian
noninstitutionalized population. (Statistical Brief 541 presents estimates of
opioid use for elderly adults ages 65 and older). We examine the average annual
percentages of non-elderly adults in 2018-2019 with any opioid use (one or more
prescription fills during the year) and with frequent opioid use, which we
define as having five or more prescription fills or refills during the year. We
present overall estimates for the full population of non-elderly adults and for
subgroups defined by sex, race/ethnicity, poverty status, insurance coverage,
perceived health status, Census region, and metropolitan statistical area (MSA)
status. All differences mentioned in the text are significant at the .05 level
or better.

Because of methodological and definitional differences, readers should use
caution when comparing Medical Expenditure Panel Survey (MEPS) data with data
from other sources. Details on the MEPS methodology and differences from other
sources are included in the Definitions section of this Statistical Brief.


FINDINGS

Overall and sex (figure 1)

In 2018-2019, an average annual total of 17.3 million non-elderly adults, or 8.7
percent of the 198.4 million non-elderly adults in the U.S. civilian
noninstitutionalized population, filled at least one opioid prescription during
the year, and 4.5 million (2.3 percent) obtained five or more prescription fills
(figure 1). Women were more likely than men to have any opioid use during the
year (10.3 percent vs. 7.0 percent) and to have frequent opioid use (2.7 percent
vs. 1.8 percent).

Race/ethnicity (figure 2)

In 2018-2019, the average annual percentage of those with at least one opioid
prescription fill during the year was higher for non-Hispanic White non-elderly
adults (10.2 percent) than for non-elderly adults in any of the other
race/ethnicity categories (figure 2; the difference between non-Hispanic White
and Black adults was significant at the p < 0.10 level). Non-Hispanic Black
non-elderly adults (9.0 percent) were more likely to fill at least one opioid
prescription than Hispanic adults (5.0 percent) and individuals of other races
(6.3 percent). The average annual percentage of non-elderly adults who had at
least five opioid prescription fills during the year was higher for non-Hispanic
White (2.7 percent) and non-Hispanic Black (2.6 percent) non-elderly adults than
for Hispanic non-elderly adults (1.0 percent).

Poverty status (figure 3)

Lower-income non-elderly adults were more likely than those with higher incomes
to have any use and frequent use of opioids during the year (figure 3). The
percentage of non-elderly adults with at least one opioid prescription fill was
highest for those with family incomes below the federal poverty line (13.3
percent), and low-income non-elderly adults were more likely to fill at least
one opioid prescription (9.8 percent) than those with middle and high incomes
(8.5 percent and 7.4 percent, respectively). Similarly, the rate of frequent use
was highest among poor non-elderly adults (5.4 percent), and low-income
non-elderly adults were more likely to have frequent opioid use (3.2 percent)
than those with middle (2.1 percent) and high incomes (1.4 percent).

Insurance coverage (figure 4)

This Statistical Brief uses four mutually exclusive categories of insurance: any
private insurance, public coverage due to a disability ("public
disability-related"), public coverage based on other factors ("public other"),
and uninsured. In 2018-2019, non-elderly adults with public disability-related
coverage were substantially more likely to fill at least one opioid prescription
(30.3 percent) and to fill five or more opioid prescriptions (18.8 percent)
compared to those in other insurance categories (figure 4). Among the other
three insurance categories, non-elderly adults with public other coverage had
the highest rates of any use (10.2 percent) and frequent use (2.7 percent) of
opioids, and non-elderly adults with any private insurance were more likely than
the uninsured to have at least one opioid fill (8.0 vs. 3.2 percent) and to have
five or more opioid fills (1.5 vs. 0.6 percent) during the year.

Perceived health status (figure 5)

In 2018-2019, the average annual percentages of non-elderly adults who had any
use and frequent use of prescription opioids during the year were lowest for
those in excellent health (3.9 percent and 0.4 percent), and both measures of
opioid use increased in a stepwise fashion across non-elderly adults who were in
very good (6.4 percent and 1.0 percent), good (10.1 percent and 2.3 percent),
fair (21.5 percent and 8.8 percent), and poor health (36.8 percent and 20.1
percent).

Census region (figure 6)

In 2018-2019, non-elderly adults in the Northeast and West Census regions were
less likely, on average, to fill any opioid prescriptions (6.5 percent and 7.8
percent, respectively) than those in the Midwest and South Census regions (10.6
percent and 9.3 percent, respectively). Similarly, non-elderly adults in the
Northeast and West Census regions were less likely to fill five or more opioid
prescriptions (1.7 percent and 1.6 percent) than those in the Midwest and South
Census regions (2.5 percent and 2.9 percent).

MSA status (figure 7)

Non-elderly adults living in MSAs were less likely than those living in non-MSAs
to fill any outpatient opioid prescriptions (8.2 percent vs. 12.4 percent) and
to obtain five or more opioid prescription fills during the year (2.1 percent
vs. 3.6 percent).


DATA SOURCE

This Statistical Brief uses data from the 2018-2019 MEPS Full Year Consolidated
Data Files (HC-209 and HC-216) and non-public versions of the 2018-2019
Prescribed Medicines Files (HC-207A and HC-213A).


DEFINITIONS

Opioids
In this Statistical Brief, we examine outpatient prescription fills of opioids
that are commonly used to treat pain. These opioids are identified using generic
drug names for narcotic analgesics and narcotic analgesic combinations in the
Multum Lexicon database from Cerner Multum, Inc. We identify slightly more
opioids commonly used for pain than one would find in the MEPS public use files
due to methods used to preserve the confidentiality of sample members. Opioids
that are excluded from our analysis include respiratory agents, antitussives and
drugs commonly used in medication-assisted treatment.

Opioid prescription fills
We examine the average annual percentage of non-elderly adults with any
outpatient opioid prescription fills during the year ("any use") and the
percentage with five or more fills or refills ("frequent use"). Acquisition of
five fills or refills represents the 75th percentile of the distribution of
prescription fills among all adults (elderly and non-elderly) with any fills
during the year.

MEPS estimates of opioid use may differ from estimates based on other data
sources for several reasons. For example, MEPS and the Substance Abuse and
Mental Health Services Administration's National Survey on Drug Use and Health
(NSDUH) have substantial differences in methodologies and objectives. The NSDUH
any-use estimates comprise both prescribed use and misuse. Misuse includes
taking medications for the feeling and in any way a doctor did not prescribe.
NSDUH respondents report use in inpatient settings, as well as outpatient.
Moreover, NSDUH includes targeted questions with show cards for specific drugs,
is self-reported using audio computer-assisted self-interviewing, surveys
persons 12 and older, and questions are asked based on a 12-month recall period.

In contrast, MEPS includes only prescribed drugs purchased in outpatient
settings. Prescription medicines administered in an inpatient setting or in a
clinic or physician's office are not included. MEPS data are household-reported,
and one respondent reports for the entire household. MEPS uses computer-assisted
personal interviewing, and questions are asked using a recall period of 3-6
months. Finally, this Statistical Brief examines opioid use among adults ages 18
to 64.

Non-elderly adults
This category consists of individuals ages 18 to 64. The age variable used to
identify non-elderly adults is based on the sample person's age as of the end of
the year. If data were not collected during a round because the sample person
was out of scope (e.g., deceased or institutionalized), then age at the time of
the previous round was used.

Race/ethnicity
Classification by race/ethnicity was based on information reported for each
family member. First, respondents were asked if the person's main national
origin or ancestry was Puerto Rican; Cuban; Mexican, Mexican-American, or
Chicano; other Latin American; or other Spanish. All persons whose main national
origin or ancestry was reported in one of these Hispanic groups, regardless of
racial background, were classified as Hispanic. All other persons were
classified according to their reported race. For this analysis, the following
classification by race and ethnicity was used: Hispanic, non-Hispanic Black,
non-Hispanic White, and non-Hispanic other. The other category includes American
Indian, Alaska Native, Asian or Pacific Islander, other race, and multiple
races.

Poverty status
Each sample person was classified according to the total annual income of his or
her family. Possible sources of income included annual earnings from wages,
salaries, bonuses, tips, and commissions; business and farm gains and losses;
unemployment and workers' compensation; interest and dividends; alimony, child
support, and other private cash transfers; private pensions, individual
retirement account withdrawals, Social Security, and U.S. Department of Veterans
Affairs payments; Supplemental Security Income (SSI) and cash welfare payments
from public assistance and Temporary Assistance for Needy Families; gains or
losses from estates, trusts, partnerships, S corporations, rent, and royalties;
and a small amount of "other" income. Poverty status is the ratio of family
income to the corresponding federal poverty thresholds, which control for family
size and age of the head of family. Categories are defined as follows:
 * Poor: Household income below the federal poverty line.
 * Low income: Household income greater than or equal to the poverty line and
   less than 200 percent of the poverty line.
 * Middle income: 200 percent to less than 400 percent of the poverty line.
 * High income: Greater than or equal to 400 percent of the poverty line.

Insurance coverage

 * Any private: Individuals classified as having any private health insurance
   coverage had private insurance that provided coverage for hospital and
   physician care (including Medigap coverage and TRICARE) at some point during
   the year.
 * Public disability-related: Individuals are considered to have public
   disability-related health insurance coverage if they were not covered by
   private insurance or TRICARE (Armed Forces-related coverage) and they were
   covered by Medicare at some point during the year, or they received SSI and
   were covered by Medicaid or other public hospital and physician coverage at
   some point during the year. Most, but not all, individuals with Medicare
   coverage were dually eligible for Medicaid or other public coverage.
 * Public other: Individuals are considered to have public other health
   insurance coverage if they were not covered by private insurance, TRICARE, or
   Medicare; did not receive SSI; and were covered by Medicaid, or other public
   hospital and physician coverage, at some point during the year.
 * Uninsured: Individuals who did not have health insurance coverage for the
   entire calendar year were classified as uninsured. The uninsured were defined
   as people not covered by Medicaid, Medicare, TRICARE, other public
   hospital/physician programs, private hospital/physician insurance (including
   Medigap coverage), or insurance purchased through health insurance
   Marketplaces. People covered only by non-comprehensive state-specific
   programs (e.g., Maryland Kidney Disease Program) or private single service
   plans such as coverage for dental or vision care only, or coverage for
   accidents or specific diseases, were considered uninsured.

Perceived health status
The MEPS respondent was asked to rate the health of each person in the family at
the time of the interview according to the following categories: excellent, very
good, good, fair, and poor. For persons with missing health status in a round,
the response for health status at the previous round was used, if available. A
small percentage of persons (less than 1 percent) had a missing response for
perceived health status.

Census region
The Census region variable is based on the location of the household at the end
of the year. If missing, the most recent location available is used.
 * Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island,
   Connecticut, New York, New Jersey, and Pennsylvania
 * Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa,
   Missouri, North Dakota, South Dakota, Nebraska, and Kansas
 * South: Delaware, Maryland, District of Columbia, Virginia, West Virginia,
   North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee,
   Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas
 * West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada,
   Washington, Oregon, California, Alaska, and Hawaii

Metropolitan statistical area
The MSA variable is based on the location of the household at the end of the
year and reflects the most recent delineations of MSAs established by Office of
Management and Budget. An MSA contains a core urban area of 50,000 or more
population. All counties that are not part of an MSA are considered rural.


ABOUT MEPS

The Medical Expenditure Panel Survey Household Component (MEPS-HC) collects
nationally representative data on healthcare use, expenditures, sources of
payment, and insurance coverage for the U.S. civilian noninstitutionalized
population. The MEPS-HC is cosponsored by the Agency for Healthcare Research and
Quality (AHRQ) and the National Center for Health Statistics (NCHS). More
information about the MEPS-HC can be found on the MEPS website at
https://www.meps.ahrq.gov/.


REFERENCES

For a detailed description of the MEPS-HC survey design, sample design, and
methods used to minimize sources of nonsampling error, see the following
publications:

Centers for Disease Control and Prevention (CDC). CDC Guideline for Prescribing
Opioids for Chronic Pain. U.S. Department of Health and Human Services, CDC.
https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household
Component. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. July 1997.
Agency for Health Care Policy and Research (AHCPR), Rockville, MD.
https://www.meps.ahrq.gov/data_files/publications/mr1/mr1.pdf

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household
Component. MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. July 1997.
AHCPR, Rockville, MD.
https://www.meps.ahrq.gov/data_files/publications/mr2/mr2.pdf

Mattson, C. L., Tanz, L. J., Quinn, K., Kariisa, M., Patel, P., and Davis, N. L.
(2021). Trends and geographic patterns in drug and synthetic opioid overdose
deaths - United States, 2013-2019. Morbidity and Mortality Weekly Report (MMWR),
70(6), 202-207. https://doi.org/10.15585/mmwr.mm7006a4


SUGGESTED CITATION

Moriya, A. S., and Fang, Z. Any Use and "Frequent Use" of Opioids among
Non-Elderly Adults in 2018-2019, by Socioeconomic Characteristics. Statistical
Brief #542. March 2022. Agency for Healthcare Research and Quality, Rockville,
MD. https://meps.ahrq.gov/data_files/publications/st542/stat542.shtml

* * *
AHRQ welcomes questions and comments from readers of this publication who are
interested in obtaining more information about access, cost, use, financing, and
quality of healthcare in the United States. We also invite you to tell us how
you are using this Statistical Brief and other MEPS data and tools and to share
suggestions on how MEPS products might be enhanced to further meet your needs.
Please email us at MEPSProjectDirector@ahrq.hhs.gov or send a letter to the
address below:

Joel W. Cohen, PhD, Director
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality
5600 Fishers Lane, Mailstop 07W41A
Rockville, MD 20857




FIGURE 1. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, OVERALL AND BY SEX

Sex Percentages of non-elderly adults with any fills Percentages of non-elderly
adults with five or more fills2 Overall 8.7% 2.3% Male 7.0% 1.8% Female 10.3%
2.7%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.



FIGURE 2. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY RACE/ETHNICITY

Race/ethnicity Percentages of non-elderly adults with any fills Percentages of
non-elderly adults with five or more fills2 Non-Hispanic White 10.2% 2.7%
Non-Hispanic Black 9.0% 2.6% Hispanic 5.0% 1.0% Non-Hispanic other 6.3% 1.9%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.



FIGURE 3. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY POVERTY STATUS

Household poverty status Percentages of non-elderly adults with any fills
Percentages of non-elderly adults with five or more fills2 Poor 13.3% 5.4% Low
income 9.8% 3.2% Middle income 8.5% 2.1% High income 7.4% 1.4%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.



FIGURE 4. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY INSURANCE COVERAGE

Insurance coverage Percentages of non-elderly adults with any fills Percentages
of non-elderly adults with five or more fills2 Any private 8.0% 1.5% Public:
disability-related 30.3% 18.8% Public: other 10.2% 2.7% Uninsured 3.2% 0.6%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.


FIGURE 5. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY PERCEIVED HEALTH STATUS

Perceived health status Percentages of non-elderly adults with any fills
Percentages of non-elderly adults with five or more fills2 Excellent 3.9% 0.4%
Very good 6.4% 1.0% Good 10.1% 2.3% Fair 21.5% 8.8% Poor 36.8% 20.1%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.


FIGURE 6. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY CENSUS REGION

Census region Percentages of non-elderly adults with any fills Percentages of
non-elderly adults with five or more fills2 Northeast 6.5% 1.7% Midwest 10.6%
2.5% South 9.3% 2.9% West 7.8% 1.6%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.


FIGURE 7. AVERAGE ANNUAL PERCENTAGES OF NON-ELDERLY ADULTS WHO FILLED OUTPATIENT
OPIOID1 PRESCRIPTIONS IN 2018-2019, BY METROPOLITAN STATISTICAL AREA (MSA)
STATUS

MSA status Percentages of non-elderly adults with any fills Percentages of
non-elderly adults with five or more fills2 MSA 8.2% 2.1% Non-MSA 12.4% 3.6%

Source: Agency for Healthcare Research and Quality, Center for Financing, Access
and Cost Trends, Household Component of the Medical Expenditure Panel Survey,
2018-2019.
1 Comprising all opioids commonly used to treat pain.
2 Acquisition of five fills or refills represents the 75th percentile of the
distribution of prescription fills among all adults (elderly and non-elderly)
with any fills during the year.


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