The majority of Medicare opioid prescriptions originate with family practice and internal medicine providers. I show that the average number of Medicare opium prescriptions by these providers vary strongly by state and that 54% of the variance is accounted for by the state median household income. I also show that there is a very similar relationship in opioid claims per capita and per Medicare recipient. In all cases Alabama is the state with the most claims and Hawaii is the state with the least claims.
Opium for the Poor Is -Opium.
The current opiate epidemic has many reasons: pharmaceutical marketing, naïve and/or unscrupulous doctors, availability of cheap and cleverly sold Mexican heroin and inappropriate policy changes to encourage the idea that pain was something curable with drugs that were not addictive (Quinones, 2015).
In this paper I investigate how opioid claims vary by state.
Definitions & Data Sources I analyze the Medicare provider datasets for the presence of opioid prescription claims (Medicare_Part_D_Opioid_Prescriber_Summary_File.csv can be downloaded from data.cms.gov). Different types of providers will have different reasons to prescribe opioids. To simplify the analysis, I limit it to family doctors and internal medicine doctors, they are responsible for most opioid prescriptions (see Table 1). To check the result, I also calculated the per capita number of opioid claims in each state and obtained the very similar result in Fig. 2.
In both cases the functional form is a power law ~(Median household income) -n where n varies from 2.4 to 2.9.
It is clear that Medicare is not supervising the opiate claims. This is not surprising since I have found before that Medicare supervision fails when it comes to volume discounts for heart attacks, quality for higher heart attack payments, and pricing (overpays its providers; see blog at analyticsguru.us) and Medicare fraud is an all too common topic in the press. Indeed, Medicare’s attempt to supervise seems to be to release datasets and wait for others to do the supervision.
It is not clear what the reason behind the relationship between opioid claims and median household income. Is it that people in poor states tend to display their suffering higher up on the pain scale, or they benefit from or feel the need for more opioids? Is it that doctors in poor states need to create more patients for their practices? Is it that people in richer states get the same amount of opioids but can afford to get it from sources other than Medicare? A possible reason for the relationship of poor states and high opioid prescriptions is that state legislation may impact prescription behavior and poor states may be more susceptible to the largess of pharmaceutical lobbying than rich states. If that is the case, there might be a difference in prescriptive behavior also with party in power.
OPIUM FOR THE POOR IS -OPIUM 7
It turns out that states with Republican legislatures have providers that write more Medicare opioid prescriptions. This is shown in Fig. 4. In each of the panels is displayed the percent Medicare opioid claims out of all Medicare claims as a function of median household income.
The red dots correspond to Republican control and the blue dots to Democratic control. The lines are the least square fits to the dots. The top panel shows that states with Republican governors have more Medicare opioid claims than states with Democratic governors. The middle panel shows that is even more so for Republican upper houses and the bottom panel shows that it is even more so for Republican lower houses (I used the Wikipedia definition of lower and upper houses). This result is not obvious. In Fig. 5 are the data displayed for the murder rate. The murder rate is a lot less sensitive to the median household income and the variation with party is not as consistent.
OPIUM FOR THE POOR IS -OPIUM 10 Fig. 5. Murder rate as a function of median household income and party in control of the state government.
A one-way ANOVA showed that there was a significant difference between Democrat and Republican Lower Houses for opioids (F=16.7, p<0.001) but not for the murder rate (p=0.8),
Upper Houses for opioids (F=4.6, p=0.015) but not for the murder rate (p=0.67), Governor for opioids (F=4.23, p=0.045) but not for the murder rate (p=0.58).
Tables Table 1 Medicare opioid claims by provider specialty
To avoid statistical noise, I further limit the investigations to those doctors with at least 200 Medicare claims per year.
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