Opioid Dependence Claims Soar Among Privately Insured

Between 2007 and 2014, private health insurance claims for opioid dependence rose an astounding 3203%, and claims for opioid misuse jumped 317%, according to data from the nonprofit FAIR Health reported in the American Journal of Managed Care.

The group’s white paper, The Opioid Crisis among the Privately Insured: The Opioid Abuse Epidemic as Documented in Private Claims Data, draws on more than 20 billion privately billed health care claims.   

“The United States is currently experiencing an epidemic of abuse of opioids, including prescription opioid pain relievers and heroin,” the report states. “Unlike earlier opioid abuse epidemics, the present crisis is disproportionately affecting white, middle-class people in nonurban settings, including those with private health insurance.”

According to the report, in 2014 women had more opioid abuse claims than men, a reversal from earlier years. Opioid abuse is considered less severe than opioid dependence, the latter of which is linked with increased tolerance and withdrawal for people who try to stop using the drug. Men are more likely to be diagnosed with opioid dependence, but the gender gap narrows particularly between ages 46 and 55. Opioid overdose, meanwhile, is more prevalent among women, according to FAIR Health data, although prescription opioid overdose deaths affect more men.

Grouped by age, the most claims for opioid-related diagnoses were for young adults. Between 2007 and 2014, enrollees age 19 to 35 had 69% of opioid dependence claims and 50% of opioid abuse claims, FAIR Health reported. This age demographic was behind 78% of claims for heroin overdoses between 2009 and 2014.

FAIR Health also reported that three-quarters of new heroin users said they started using the street drug after abusing prescription opioid medication. The greatest increase among various types of opioid overdoses involved heroin overdoses, which grew by 510% between 2009 and 2014.

Finally, claims for drug dependence were also up among pregnant women. Between 2007 and 2014, claims with a pregnancy drug dependence diagnosis increased by 511%. —Jolynn Tumolo