Risk of Continued Opioid Use (COU)

Assesses potentially high-risk opioid analgesic prescribing practices. The percentage of members 18 years and older who have a new episode of opioid use that puts them at risk for continued opioid use. Two rates are reported:

  1. The percentage of members with at least 15 days of prescription opioids in a 30-day period.
  2. The percentage of members with at least 31 days of prescription opioids in a 62-day period.

Why It Matters

In 2016, opioid-related overdoses accounted for more than 42,000 deaths in the United States.1 Of those, 40% involved prescription opioids.1 Literature suggests that long-term opioid use often begins with the treatment of acute pain, and a relationship exists between early prescribing patterns and long-term use of opioids.2 Continued opioid use for noncancer pain is associated with increased risk of opioid use disorder, opioid-related overdose, hospitalization and opioid overdose-related mortality.3,4,5,6

Studies find a consistent link between increasing days’ supply of the first prescription with probability of continued opioid use, and the rate of opioid use at 1 year post-initial prescription increases substantially for patients with 31 or more days of opioid therapy.2,7

This measure is intended to identify a population that is at risk for opioid overuse and misuse who may benefit from additional monitoring, services or support.

Results – National Averages

Risk of Continued Opioid Use - >=31 Days (Total)

Measure YearCommercial HMOCommercial PPOMedicaid HMOMedicare HMOMedicare PPO

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.


  1. S. Department of Health and Human Services (HHS). 2019. “What is the U.S. Opioid Epidemic?” Updated September 4, 2019. Retrieved from: https://www.hhs.gov/opioids/about-the-epidemic/index.html
  2. Shah A, Hayes CJ, and Martin BC. Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies. The Journal of Pain. 2017; 18(11): 1374–383. doi:10.1016/j.jpain.2017.06.010.
  3. Edlund M.J., Martin C., Russo J.E., DeVries A., Braden J.B., and Sullivan M.D. (2014). The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain. 30:557–64.
  4. Dunn K.M., Saunders K.W., Rutter C.M., Banta-Green C.J., Merrill J.O., Sullivan M.D., Von Korff M. (2010). Overdose and prescribed opioids: associations among chronic non-cancer pain patients. Annals of Internal Medicine. 152(2): 85–92.
  5. DeyoA., Hallvik S.E., Hildebran C., Marino M., Dexter E., Irvine J.M., O’Kane N., Van Otterloo J., Wright D.A., Leichtling G., and Millet L.M. (2016). Association between initial opioid prescribing patterns and subsequent long-term use among opioid-naïve patients: a statewide retrospective cohort study. Journal of General Internal Medicine. 32(1): 21-27.
  6. Paulozzi L.J., Kilbourne E.M., Shah N.G., Nolte K.B., Desai H.A., Landen M.G., Harvey W., and Loring L.D. (2012). A history of being prescribed controlled substances and risk of drug overdose death. Pain Medicine. 13(1): 87–95.
  7. Shah A., Hayes C.J., and Martin B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR. Morbidity and Mortality Weekly Report. 66(10): 265-269.

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