The Opioid Epidemic in America: An Update

In this report, the Blue Cross Blue Shield Association (BCBSA), in collaboration with Blue Health Intelligence (BHI), examines opioid prescription rates, opioid use patterns and opioid use disorder among commercially insured Blue Cross and Blue Shield (BCBS) members (excluding members diagnosed with cancer or who were undergoing palliative or hospice care).

In 2017, BCBSA released a report illustrating the impact of opioid use and opioid use disorder on the health of Americans. This analysis examines progress towards preventing inappropriate prescription opioid use.1,2

While progress has been made, there were 241,900 BCBS members diagnosed with opioid use disorder in 2017. Identifying evidence-based treatment for these members is a priority.

The opioid epidemic remains a critical health crisis in America. This report provides updated data-driven insights on the opioid epidemic.

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Key Findings

01

Nationally, the total number of opioid medications filled by commercially insured BCBS members has declined by 29% since 2013, with significant variation among states. Thirty-four states had higher reductions, with Massachusetts leading at 51%.

Key Findings

02

In 2017, 67% of BCBS members filled their first opioid prescription within the CDC-recommended guidelines for both dose and duration. Some states did significantly better than the average, led by Rhode Island at 80%, Mississippi at 74% and Vermont and Massachusetts at 73%.3

Key Findings

03

When examining total opioid prescriptions for BCBS members in 2017, not just the first prescription, 45% of members filled prescriptions within the CDC-recommended dose and duration guidelines, up from 39% in 2013.

Key Findings

04

In 2016, opioid use disorder claims stabilized, with 6.2 in 1,000 BCBS members diagnosed. The rate dipped slightly to 5.9 in 1,000 members in 2017.

ENDNOTES

  1. This report builds upon and provides updated results on a previously published BCBS Health of America report from 2017 entitled, “America’s opioid epidemic and its effect on the nation’s commercially-insured population.” It is based on the prescription and medical claims of over 41 million commercially insured BCBS members. In this report, “opioids” include prescription opioid medications. Members diagnosed with cancer who were undergoing palliative or hospice care were excluded from this analysis.
  2. The Centers for Disease Control and Prevention (CDC) reports that, on average, 115 Americans die each day from an opioid-related overdose. Further, the CDC cites that of those 115 deaths, about 46 people die per day from overdoses linked to prescription opioid medications. For more information, see: https://www.cdc.gov/drugoverdose/epidemic/index.html, https://www.cdc.gov/drugoverdose/data/overdose.html and https://wonder.cdc.gov/
  3. First prescriptions were determined by identifying members with an opioid prescription in 2017 and then looking back two years to verify that no opioid prescription was previously filled by that member. The CDC recommends prescribing first opioid medications for seven days or less and under 50 morphine milligram equivalents, or MME, per dose. For more information, see: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm and https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf

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