Nearly one of 10 (7.4 percent) Medicare prescriptions in Colorado is for opioids — prescription drugs such as codeine and oxycodone, new data from 2014 show. That is 1.7 percentage points higher than the national rate.
Rural and frontier counties have the highest Medicare opioid prescribing rates in Colorado.
The opioid prescribing patterns are based on Medicare Part D prescription drug benefit data collected by the Centers for Medicare & Medicaid Services when prescribers submit Medicare claims. The data are available at the state, county and ZIP code levels.
Most Medicare recipients are seniors, although people with a disability or disabilities and those with end stage renal disease, or kidney failure, can also qualify.
Prescription opioids can be safe and effective ways to control pain when used properly. However, misuse of these drugs can lead to dependence or overdoses — sometimes with fatal results.
Colorado recorded 472 opioid overdose deaths in 2015 from both prescription opioids and illegal opioids such as heroin, according to the Colorado Department of Public Health and Environment. The overdose deaths related to opioids made up over half of all drug overdose deaths in Colorado.
The Part D data, despite limitations, are an important source of information for policymakers in Colorado and across the nation working to address the use and abuse of opioids, which has reached what many describe as epidemic levels.
The Centers for Disease Control and Prevention says that improving opioid prescribing is one step toward ensuring that patients have access to adequate, safe pain management and to reduce misuse and abuse of these drugs.
The Part D claims data are from 2014, the most recent year available. Opioid prescription rates are based on data for 61 of the state’s 64 counties. Three counties – Jackson, San Juan and Clear Creek – had small enough figures that their totals are suppressed in 2014.
The opioid prescribing rate for Colorado was 7.5 percent in 2013, 1.7 percentage points above the national rate of 5.8 percent. A year later, in 2014, Colorado’s rate fell slightly to 7.4 percent. The national rate also fell slightly, to 5.7 percent.
A total of 50 Colorado counties in 2014 had rates above the national rate, down from 55 counties in 2013.
County Prescribing Patterns
The range of prescribing rates across reported counties in Colorado is substantial. However, rates should be considered carefully. Percentages can be affected by the size of a county’s Medicare population, the number of prescribers and other factors. For example, a small county could see a large rate change with just a small shift in the number of prescriptions.
Twenty-six of the 61 reporting counties had opioid prescribing rates above the state average rate, with rural and frontier counties disproportionately represented. Only six of those 26 – Arapahoe, Jefferson, Broomfield, El Paso, Larimer and Pueblo — are urban.
Saguache County had the highest opioid prescription rate at 48.4 percent of all Part D claims, while Hinsdale County had the lowest at 1.5 percent. However, these counties had among the smallest numbers of Medicare enrollees, prescribers and overall number of claims.
In particular, Saguache County is one of only two counties in the state with just a single Part D prescriber, and it has the second smallest number of Part D prescriptions overall at 124. So a relatively small number of opioid prescriptions – 60 – results in an opioid prescribing rate way above the rest of the state.
Five counties in the northeastern corner of the state — Yuma, Logan, Sedgwick, Phillips and Kit Carson — all had some of the lowest opioid prescribing rates in Colorado. These rural counties also had relatively few enrollees and prescribers, though their Rx writers were busy. Since there aren’t many of them, they wrote more prescriptions of all types on average than their counterparts elsewhere in Colorado.
It is important to note that smaller counties, usually rural, are more susceptible to shifts in rates with just small changes in the number of prescribers or prescriptions. There are likely several other factors at play across the state as well, such as other types of insurance coverage or varying patient demographics.
Arapahoe County had the highest number of Part D opioid prescriptions in 2014 with 161,000. Jefferson County was second with 147,000 and Denver County was third with 134,000.
Mortality and Prescribing Patterns
Mortality data reflect the increasing toll taken by overdoses for all drugs in Colorado. It’s difficult to say with this data how many deaths are caused by opioid misuse among the Medicare population. That said, eight of the 26 counties with above-average opioid prescribing rates — Arapahoe, Bent, Conejos, Las Animas, Rio Grande, Alamosa, Pueblo and Dolores — also have drug overdose death rates above the state average.
Mortality data include overdose deaths due to the presence of any drug, not just prescription opioids, and the Part D claims are specific to opioids prescribed to Medicare enrollees, not all residents. However, the potential for prescription opioid misuse makes these data important to monitor over time.
The Medicare Part D data provides a good snapshot of the varying rates across the state. Colorado can use these data, with additional sources, to measure the many factors that contribute to overdose deaths, including prescribing rates and misuse of prescription opioids. Finding new resources to better understand the drivers of this epidemic creates opportunities for doing something about it.