Title: Digging into the opioid crisis: using administrative data to gain new insights into the opioid epidemic

Opioid use has been declared public health emergency, with legally prescribed drugs contributing to substantial morbidity and mortality from addiction and overdoses. We use administrative data from claims to study the past 10 years of the prescription opioid epidemic.

We find opioid use remains common, with only modest reductions in prevalence of use from the peak of the epidemic in 2010-2011. Chronic users of opioids consume the majority of all opioids and often take very high doses (more than 100 mg morphine equivalents per day), placing them at high risk for adverse outcomes. To understand the risk of of non-users becoming chronic users, we follow people who were opioid naïve filling their first opioid prescription in the Emergency Department (ED) and in other care settings. Prescriptions written in the ED are more likely to follow best practices for dose and duration of use, and are associated with a lower risk of chronic opioid use than prescriptions written in other settings.

Finally, we explore an apparent anomaly in the data—a sudden, steep decrease in average opioid doses that was caused by the removal of propoxyphene from the market. Despite decades of concern about its safety, propoxyphene was one of the most popular prescription drugs until it was pulled in late 2010. We describe treatment courses for people using propoxyphene at the time it was discontinued in 2010, finding large reductions in their opioid use as they were switched to alternative opioids at lower, safer doses.