(123) Opioid Prescription Dispensing Patterns Among Patients with Schizophrenia or Bipolar Disorder

Publication Number: 797

Background: Patients with schizophrenia (SZ) or bipolar disorder (BD) who are prescribed opioids may have an increased risk of opioid-related complications, including overdose and misuse.

Objectives: We compared prescription opioid dispensing among patients with SZ or BD vs controls over 5 years (2015–2019), beginning 1 year before publication of the CDC Guideline for Prescribing Opioids for Chronic Pain.

Methods: This retrospective, observational study analyzed claims data from the IBM® MarketScan® Commercial and Multi-State Medicaid Databases. Individuals aged 18–64 years with ≥1 inpatient or ≥2 outpatient claims for SZ or BD diagnoses during the year preceding the analysis years 2015-2019 were included, with age- and sex-matched controls. Baseline characteristics, comorbidities, and medication use were assessed. Opioid dispensing was defined as chronic (≥70 days over a 90-day period or ≥6 prescriptions annually) or nonchronic (≥1 prescription, chronic definition not met during an analysis year).

Results: In 2019, the Commercial and Medicaid databases contained 4773 and 30,179 patients with SZ and 52,780 and 63,455 patients with BD, respectively. Patients with SZ or BD had a higher prevalence of comorbidities, including pain, vs controls in each analysis year. From 2015–2019, among commercially insured patients with SZ, chronic opioid dispensing proportions decreased from 6% (controls: 3%) to 2% (controls: 1%), and, for patients with BD, from 11% (controls: 3%) to 6% (controls: 2%). Chronic opioid dispensing proportions declined in Medicaid-covered patients with SZ from 15% (controls: 15%) to 7% (controls: 6%), and, for patients with BD, from 27% (controls: 12%) to 12% (controls: 5%). Among commercially insured patients with SZ, nonchronic opioid dispensing proportions decreased from 15% (controls: 16%) to 11% (controls: 11%) and, for patients with BD, from 26% (controls: 17%) to 20% (controls: 12%). In Medicaid-covered patients with SZ, nonchronic opioid dispensing proportions declined from 23% (controls: 24%) to 15% (controls: 13%), and, for patients with BD, from 32% (controls: 26%) to 25% (controls: 14%).

Conclusions: From 2015–2019, chronic and nonchronic prescription opioid dispensing decreased in all groups (for patients with SZ or BD and for their respective controls in the Commercial and Medicaid databases). The proportion of individuals dispensed chronic or nonchronic opioids each year was similar between patients with SZ vs controls in both databases, but the proportion was consistently higher for patients with BD vs controls in both the commercially and Medicaid-insured populations.