Peeling Back the Curtain on Regional Variation in the Opioid Crisis Interview with:

Robin Gelburd, JD President FAIR Health

Robin Gelburd

Robin Gelburd, JD
FAIR Health What is the background for this study?

Response: The opioid crisis is affecting the entire nation, but not in the same way in every location. Although a number of studies have been conducted on geographic variations in the opioid epidemic, there remains a need for more information on the regional level. To help meet that need, FAIR Health consulted its database of more than 23 billion privately billed healthcare claims, the largest such repository in the country. Focusing on the most recent complete ten-year period (2007-2016), FAIR Health examined claims data from rural and urban settings, the country’s five most populous cities (Chicago, Houston, Los Angeles, New York and Philadelphia) and the states where those cities are located.

When the term “opioid-related diagnoses” is used in this study, it refers to opioid abuse, opioid dependence, heroin overdose and opioid overdose (i.e., overdose of opioids excluding heroin). What are the main findings?

Response: In the period 2007-2016:

Claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people.

Compared to the other four most populous cities, Philadelphia had the greatest number of claim lines with opioid-related diagnoses as a percentage of the number of claim lines for all medical care in its state.

Of six regions in California, the greatest increase in claim lines with opioid-related diagnoses from 2007 to 2016 was in southern California (including Los Angeles), where the increase was 31,897 percent—more than five times as great as the next largest increase.

In New York State, New York City constituted 43 percent of the population but only 13 percent of the distribution of claim lines with opioid-related diagnoses.

In Texas, San Antonio and its immediate surrounding areas constituted 5 percent of the population, but 66 percent of the distribution of claim lines with opioid-related diagnoses.

In both Illinois and Pennsylvania, claim lines with an opioid dependence diagnosis occurred more frequently in males than females in all age groups—but the gap narrowed over the age of 50 years, with males at 55 percent and females at 45 percent.

In 2016: The top five procedures associated with opioid-related diagnoses, and the top five expenditures, differed in each of the five states profiled in this study:

  • In the distribution of top five procedure codes, only one code was shared by all five states under study—G0479, “drug test(s), any number of drug classes, not optical.”
  • In California, the most common procedure codes were for outpatient services and drug tests.
  • In Illinois, naltrexone (J2315) represented 22 percent of the distribution and 71 percent of the expenditures.
  • In New York, methadone administration (H0020) was the number one procedure in the distribution and the third most costly procedure.
  • Pennsylvania and Texas had only laboratory tests in their distribution of top procedure codes, including tests that indicated a high level of urinalyses. What should clinicians and patients take away from your report?

Response: The characteristics and extent of the opioid crisis vary greatly according to region. The variation in top procedure codes by distribution and expenditure suggests that states differ in how they approach treatment of opioid-related diagnoses, with each state a laboratory for its particular strategy. What recommendations do you have for future research as a result of this study?

Response: More research is needed into statewide, regional and local variations in the opioid crisis, and in the treatment approaches that are most effective. Since the states appear to be pursuing different treatment approaches, longitudinal studies of the effectiveness of those approaches are warranted. Is there anything else you would like to add?

Response:  All healthcare stakeholders, including payors, providers, government officials and policy makers, have an interest in addressing the opioid crisis. FAIR Health continues to be ready to use its vast data repository to aid in that effort.


Peeling Back the Curtain on Regional Variation in the Opioid Crisis: Spotlight on Five Key Urban Centers and Their Respective States, A FAIR Health White Paper, FAIR Health, June 2017

Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health oversees the nation’s largest collection of healthcare claims data, which includes a repository of over 23 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses data and data products to businesses, hospitals and healthcare systems, government agencies and researchers. The company also uses its database to power a free, award-winning website that enables consumers to estimate and plan for their healthcare expenditures, as well as learn more about healthcare reimbursement. A recipient of a 2016 Dig|Benefits Technology Innovator Award, bestowed by Employee Benefit News, Robin has been invited to speak to organizations across the country on topics of critical importance to employers, employees, healthcare professionals and institutions, health plans, third-party administrators, consultants, researchers and other healthcare stakeholders. She also has published numerous articles on topics such as data analytics and quality, healthcare cost transparency, consumer engagement and protection, among many others. Prior to being recruited as president of FAIR Health, Robin served for eight years as general counsel of a medical research foundation comprising approximately 30 premier academic medical centers, hospitals and research institutions in New York. Before becoming general counsel, Robin was a health law partner at a New York City law firm representing a broad array of healthcare-based clients. Earlier, Robin worked as a litigation and corporate associate at the international law firm Morrison & Foerster. She began her legal career as a federal appellate law clerk to the Honorable Francis D. Murnaghan, Jr. from the Court of Appeals, 4th Circuit. Thank you for your contribution to the community.


A Window into California’s Response to the Opioid Crisis

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.




Last Updated on June 19, 2017 by Marie Benz MD FAAD