Risk of Continued Opioid Use (COU)

The percentage of persons 18 years of age 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 persons with at least 15 days of prescription opioids in a 30-day period. 
  2. The percentage of persons with at least 31 days of prescription opioids in a 62-day period. 

Why It Matters

Since 2006, the average days supply for opioid prescriptions has risen 33% (from 13.3 days to 17.7 days in 2015)1. Literature suggests that an association exists between the duration of initial opioid therapy and continued use2. Continued opioid use for noncancer pain is associated with increased risk of opioid use disorder (OUD), opioid-related overdose, hospitalization and opioid overdose-related mortality3. The sharpest increases in the probability of continuing opioid use at 1 and 3 years post-initial-prescription were observed after the 5th and 31st days on therapy4. To address the association between prescribing practices and risk of continued opioid use and its associated negative outcomes, NCQA identified a measure concept that assesses members with a new episode of opioid use who are dispensed opioids for a period of time that puts them at an increased risk of continued use. 

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

* Adapted with financial support from the Centers for Medicare & Medicaid Services (CMS) and with permission from the measure developer, Minnesota Department of Human Services. 

Historical Results – National Averages

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References

  1. Guy, G.P. Jr., K. Zhang, M.K. Bohm, et al. 2017. “Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015.” MMWR Morb Mortal Wkly Rep 66:697–704.
  2. Shah A., C.J. Hayes, and B.C. Martin. 2017. “Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use—United States, 2006–2015.” MMWR 66(10): 265–9.
  3. Brat G.A., D. Agniel, A. Beam, B. Yorkgitis, M. Bicket, M. Homer, K.P. Fox, D.B. Knecht, C.N. McMahill-Walraven, N. Palmer and I. Kohane. “Postsurgical Prescriptions for Opioid Naïve Patients and Association with Overdose and Misuse: Retrospective Cohort Study.” BMJ 360: j5790
  4. Carey, C.M., A.B. Jena, and M.L. Barnett. 2018. “Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012.” Annals of Internal Medicine. 168(12):837-845.

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