Opioid Dependence Claims Up 3200% Among Private Insurers, Report Finds

The report by FAIR Health notes that today's opioid epidemic, unlike past crises, is affecting more white suburban dwellers, who are more likely to have private insurance.

The opioid crisis is swamping private insurers, who have seen claims for abuse and dependence skyrocket among enrollees who are mostly white young adults. Women have now overtaken men in misusing the drug, according to a new report.

Data from FAIR Health, culled from more than 20 billion private insurance claims going back to 2002, show that claims for opioid dependence rose 3203% from 2007 to 2014, with claims for opioid abuse rising 317% in that same period. While it is known that the current opioid and heroin epidemic is hitting much harder among suburban whites than prior spikes in abuse, the report spells out the role that private insurance plays in this crisis.

Among the findings:

· Claims for opioid or heroin dependence are concentrated among young adults. Those age 19-35 accounted for 69% of claims for opioid dependence, a severe condition associated with increased drug tolerance and withdrawal for those who try to stop using opioids.

· Opioid abuse, a less severe condition associated with continued use despite adverse consequences, was slightly higher among men from 2007 through 2012. Since then, abuse by women has eclipsed that of men.

· Women are more likely to have an overdose, in part because they weigh less, but opioid-related deaths are more common among men.

· New users of heroin confirm that opioid abuse is the pathway to the street drug. Among this group, 75% said they started using heroin after taking prescription medication.

· Claims involving a pregnant woman’s drug dependence rose 511% from 2007-2014, although this could involve both opioids and other drugs.

The report discusses the shocking finding from CDC, first reported in March, that 2014 was a record year for opioid deaths—more than 28,000. In fact, 2014 saw the highest number of drug deaths ever in the United States, with virtually all the increase due to opioid and heroin. CDC has issued new prescribing guidelines for physicians to halt the epidemic, and CMS has dropped questions about pain from its patient satisfaction measures, due to the perception that complaints could cut reimbursements to hospitals.

However, the flood of prescription pain medication into American medicine cabinets from 1999 onward has taken its toll. CDC reported that in 2012, doctors wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.

CDC has found that heroin use is especially clustered around those 18 to 25 years old. While risky behavior has always been more common among teenagers and young adults, the trend toward prescribing more drugs to this population may affect heroin use rates, the report found.

“The present crisis is disproportionately affecting white, middle-class people in non-urban settings, including those with private insurance,” the report states, later adding, “Indeed, while heroin use has increased across most demographic groups, it has grown particularly sharply among the privately insured, a group that historically had relatively low rates of heroin use.”