27 Nov Association of Disability With Mortality From Opioid Overdose

MedicalResearch.com Interview with:

Dr. Yong-Fang Kuo

Yong-Fang Kuo, PhD
Professor and Director, Office of Biostatistics
Don W. and Frances Powell Professor in Aging Research

Dr. Mukaila Raji

Mukaila Raji, MD, MS, FACP
Professor & Director
Edgar Gnitzinger Distinguished Professorship in Aging

Preventive Medicine and Population Health
UTMB Health

MedicalResearch.com: What is the background for this study?

Response: Medicare beneficiaries who qualified because of disability constitute a growing population of patients hospitalized for opioid/heroin overdose. Although the CDC regularly generates reports of opioid overdose deaths by demographics and states, studies on policy actionable predictors of overdose mortality (e.g., clusters of medical and psychiatric conditions, types of disabling conditions) are lacking in this population. 

MedicalResearch.com: What are the main findings? 

Response: The 1.7 million adult Medicare enrollees who qualified for disability—14.9% of the Medicare population—accounted for 80.6% of all opioid overdose deaths among all Medicare enrollees. Among the 11.1% of the disabled enrollees with three co-occurring conditions of substance abuse, psychiatric diseases and chronic pain syndrome, the opioid overdose death rate was 363.7 per 100,000, which is 23.4 times higher than enrollees without any of the conditions. 

MedicalResearch.com: What should readers take away from your report?

Response:  Patient-informed and evidence-supported co-management strategies by pain, mental health and addiction specialists and targeted interventions (including enhanced access to substance use disorder treatments) have the potential to reduce opioid overdose deaths in this high-risk population while ensuring effective pain management.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response:  Further studies are needed to better understand the range of medical and psychiatric conditions associated with opioid use, misuse, addiction and overdose in this population. Understanding this is key to developing specific and data-driven interventions targeted for each subgroup of high-risk populations. Specifically, it’s now time to conduct randomized clinical trials of non-opioid interventions (e.g. physical therapy, cognitive behavioral therapy and transcutaneous nerve stimulation) and integrative pain management approaches (e.g. therapeutic massage and acupuncture); data from such trials is key to developing clinical practice guidelines aimed at improving function and quality of life for the growing number of Americans living with disability and co-occurring pain and mental health conditions. Information from such clinical trials, especially cost-effectiveness data, will also be critical for convincing the insurance companies and other payers of health care to expand access to and broaden coverage of non-opioid interventions for pain management among their enrollees.

Citation:

Kuo Y, Raji MA, Goodwin JS. Association of Disability With Mortality From Opioid Overdose Among US Medicare Adults. JAMA Netw Open. 2019;2(11):e1915638. doi: https://doi.org/10.1001/jamanetworkopen.2019.15638

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Last Updated on November 27, 2019 by Marie Benz MD FAAD