Gender differences in opioid prescriptions among americans with Medicaid, 2010

Background: The purpose of this study was to examine gender differences in opioid use among Medicaid recipients, a group at high risk of opioid overdose. Methods: Using claims in the 2010 MarketScan® Multi-State Medicaid databases, we identified 359,368 enrollees with at least one opioid prescription among continuously enrolled, Medicaid recipients aged 18-64 years in 12 states. Indicators included number of prescriptions, overlapping prescriptions, and high daily doses of opioids (≥100 morphine milligram equivalents per day). Results: Medicaid recipients in the sample received over 2,000,000 opioid prescriptions in 2010. The mean number of opioid prescriptions was higher for males (7.1) than females (6.0). A significantly higher percentage of women, however, received potentially risky prescription combinations (opioid and benzodiazepine; 30.6%; opioid and muscle relaxant; 33.7%; opioid, benzodiazepine and muscle relaxant 15.7%) than men (28.2%; 32.5%; 12.7% respectively). A significantly higher percentage of women had a single incident during the year of receiving a high daily dose of an opioid (10%) than men (7.3%), but men were more likely to have two or more incidents (10%) compared to women (7.4%). Conclusions: Despite the fact that men are more likely to use opioids nonmedically and to die from drug overdoses involving opioids, some measures of potential risk were higher in women than men, thus identifying gender-specific foci for intervention. The use of integrated claims data, similar to our analyses, might reduce overdose, by detecting prescribing and use behaviors that contribute to risk and thus leading to improved quality of care.