Use of Opioids From Multiple Providers (UOP)

The percentage of persons 18 years and older, receiving prescription opioids for ≥15 days during the measurement period, who received opioids from multiple providers. Three rates are reported: 

  1. Multiple Prescribers. The percentage of persons receiving prescriptions for opioids from ≥4 different prescribers during the measurement period.  
  2. Multiple Pharmacies. The percentage of persons receiving prescriptions for opioids from ≥4 different pharmacies during the measurement period. 
  3. Multiple Prescribers and Multiple Pharmacies. The percentage of persons receiving prescriptions for opioids from ≥4 different prescribers and ≥4 different pharmacies during the measurement period (i.e., the percentage of persons who are numerator compliant for both the Multiple Prescribers and Multiple Pharmacies rates). 

Why It Matters

The morbidity and mortality associated with opioid use has reached epidemic proportions, and is recognized by the Centers for Disease Control and Prevention, the Surgeon General and the White House as a significant public health problem in the U.S. Prescription opioid pain relievers cause nearly three out of four prescription drug overdoses1. The age-adjusted prescription opioid mortality rate nearly quadrupled from 1999–2011, from 1.4 per 100,000 to 5.4 per 100,000. In 2021, there were 16,706 fatal overdoses involving prescription opioids2. 

One area of risk related to opioid use is the receipt of opioids prescriptions from multiple prescribers and pharmacies. Limiting the number of opioid providers for a single patient is supported by the CDC Guideline for Prescribing Opioids for Chronic Pain3. 

Evidence suggests that people who use multiple prescribers or multiple pharmacies are at higher risk of opioid overdose, and patients who use four or more prescribers or pharmacies have a higher likelihood of opioid-related overdose death compared with patients who receive opioids from one prescriber or one physician4 5 6. Medicare enrollees who received opioids from four prescribers had an adjusted absolute risk (aAR) of 6.4 per 1,000 beneficiary-years for opioid overdose in the following year7. Out of several risk factors assessed, the risk associated with receipt of opioids from multiple pharmacies was one of the highest observed, with use of five pharmacies associated with an aAR of 12.87 for opioid overdose in the subsequent year among Medicare enrollees7. 

A lower rate indicates a better performance for this measure. 

* Adapted with financial support from CMS and with permission from the measure developer, Pharmacy Quality Alliance (PQA). 

Historical Results – National Averages

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References

  1. Centers for Disease Control and Prevention (CDC). 2011. “Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008.” MMWR 60: 1–6.
  2. CDC. 2014. “Drug-Poisoning Deaths Involving Opioid Analgesics: United States, 1999–2011” NCHS Data Brief 166. http://www.cdc.gov/nchs/data/databriefs/db166.pdf
  3. CDC. 2016. “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016.” https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm. Accessed October 28, 2020
  4. Gwira Baumblatt, J.A., C. Wiedeman, J.R. Dunn, W. Schaffner, L.J. Paulozzi, T.F. Jones. 2014. “High-Risk Use By Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths.” JAMA Intern Med 174(5):796–801. PMID: 24589873.
  5. Katz, N., L. Panas, M. Kim, A.D. Audet, A. Bilansky, J. Eadie, P. Kreiner, F.C. Paillard, C. Thomas, and G. Carrow. 2010. “Usefulness of Prescription Monitoring Programs for Surveillance—Analysis of Schedule II Opioid Prescription Data in Massachusetts, 1996–2006.”
  6. 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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