The number of Americans receiving Social Security Disability Insurance (SSDI) has risen sharply in recent years, and over 40 percent of them are taking opioid pain medication, according to a large new study reported in Medical Care, the journal of the American Public Health Association.
In 1996, researchers say about 20% of disabled Americans suffered from musculoskeletal pain in their neck, spine or joints. By 2011, that number had grown to 33.8 percent.
“This shift in the composition of disabling conditions, combined with national trends of increasing prescription opioid use and prescription opioid overdose deaths, suggests the potential for substantial opioid use in the SSDI population and raises concern for the overall health and safety of these injured and ill workers,” wrote lead author Nancy Elizabeth Morden, MD, of the Dartmouth Institute for Health Policy & Clinical Practice.
Morden said the use of opioids by disabled workers “is worrisome in light of established and growing evidence that intense opioid use to treat non-malignant [non-cancer] pain may not be effective and may confer important risk.”
Morden and her colleagues analyzed trends in the use of prescription opioids among disabled Medicare beneficiaries under age 65 between 2007 and 2011. Nearly all under-65 Medicare beneficiaries are SSDI recipients.
The percentage of disabled workers taking opioids actually declined slightly during the study period, from 43.9% in 2007 to 43.7% in 2011; but chronic opioid use rose from 21.4% in 2007 to 23.1% in 2011.
The researchers defined “chronic use” as anyone who fills over six prescriptions a year for an opioid pain medication. Women were at greater risk of becoming chronic opioid users than men. Chronic users also had a high rate of depression, about 38 percent.
“A recent study of U.S. veterans showed that opioid initiation and continuation was strongly associated with greater risk of developing depression, and the association appeared dose dependent,” said Morden.
“Such evidence is worrisome given the relationship between depression and prescription opioid use in this population, and more generally, the risk of overdose and overdose death due to opioid misuse, suicidality, or hazardous combination of opioids and other sedatives commonly prescribed for mental illness.”
Although the use of opioids by SSDI recipients appears to have peaked in 2010, the average number of pills taken rose — from 239 pills in 2007 to 312 pills in 2011 — which researchers attributed to higher numbers of lower-dose pills being prescribed.
Oxycodone, the second most commonly prescribed opioid after hydrocodone, rose from 18.8% of all pills dispensed in 2007 to 24.4% in 2011.
“Our findings call attention to the complex and potentially unique health care needs of disabled workers under the age of 65 years. They suffer a high burden of illness and injury, low incomes, and now, a high burden of opioid use. Medicare administrators and clinicians must respond to the importance of high-quality pain management in this population,” wrote Morden.
Morden said drug use by disabled workers should be monitored, patients taking high doses of opioids should be referred to a pain specialist, and addiction treatment services should be provided when needed.
“Although such policies and programs might be complex and costly, evidence suggests that inaction will also come at a substantial cost,” they said.