Risk of Continued Opioid Use | May 2023 | Clinical Corner

May 15, 2023





Opioid pain medication use presents serious risks, including overdose and opioid use disorder1. In 2021 over 80,000 deaths were due to opioid overdoses in the U.S.4 Studies find a consistent link between increasing days’ supply of the first prescription with probability of continued opioid use, and the rate of opioid use at 1-year post-initial prescription increases substantially for patients with 31 or more days of opioid therapy.2,3



The percentage of members 18 years and older who have a new episode of opioid use that puts them at risk for continued opioid use. Two rates are reported:

(IPSD - Index Prescription Start Date. The earliest prescription dispensing date for any opioid during the measurement year.)

  • ≥15 Days Covered - Members who had 15 or more calendar days covered by an opioid medication during the 30-day period beginning on the IPSD through 29 days after the IPSD.
  • ≥31 Days Covered - Members who had 31 or more calendar days covered by an opioid medication during the 62-day period beginning on the IPSD through 61 days after the IPSD.


    New episode of opioid use means a period of greater than 180 days prior to a prescription dispensing date for an opioid when the member had no pharmacy claims for either new or refill prescriptions for an opioid medication.


    Tramadol is considered a mixed-mechanism opioid drug, as it is a centrally acting analgesic that exerts its effects via binding mu receptors and blocking the reuptake of monoamines. When first approved in 1995, tramadol was not considered an opiate, but because there were cases of abuse and addiction with its use, the FDA designated tramadol as a controlled substance5 in 2014. Thus, using Tramadol DOES NOT avoid this metric.



    The following opioid medications are excluded from the measure:

  • Injectables.
  • Opioid cough and cold products.
  • Single-agent and combination buprenorphine products of medication for assisted treatment of opioid use disorder.
  • Ionsys (fentanyl transdermal patch).
  • Methadone for the treatment of opioid use disorder.

Required Exclusion:

  • Members in hospice or using hospice services anytime during the measurement year.
  • Members who died any time during the measurement year.
  • Any of the following during the 12 months prior to the earliest prescription dispensing date:


  1. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
  2. Shah A, Hayes CJ, and Martin BC. Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies. The Journal of Pain. 2017; 18(11): 1374–383. doi:10.1016/j.jpain.2017.06.010.
  3. Shah A., Hayes C.J., and Martin B.C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR. Morbidity and Mortality Weekly Report. 66(10): 265-269.
  4. https://www.usatoday.com/story/news/health/2023/05/02/new-dea-rule-buprenorphine-opioid-epidemic/11715035002/
  5. https://www.health.harvard.edu/blog/is-tramadol-a-risky-pain-medication-2019061416844