These measures do not necessarily indicate misuse, but many states flag these instances for review. Our analysis found that seven out of 10 Medicaid enrollees with an opioid prescription had claims in one or two months during 2012. About half (48 percent) of prescriptions were for short-term use with a day supply of two weeks or less. About one-third of opioid prescriptions were for a month’s supply (22-31 days). Nearly 300,000 enrollees had prescriptions for 12 months. Some individuals with chronic pain may receive prescriptions for a longer period of time, and could thus count towards that number. Of the 6.9 million enrollees with opioid prescriptions in 2012, about 5 percent received prescriptions from five or more prescribers and about 2 percent filled them at five or more pharmacies. About 1 percent of Medicaid opioid users received prescriptions from five or more prescribers and filled prescriptions at five or more pharmacies during the year.
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While there are clear clinical indications for opioid use, concerns arise when they are prescribed or used improperly – for example, when multiple opioids are used at once, over a long period of time, at a high dosage, with inadequate clinical oversight, or in combination with benzodiazepines. Likelihood of misuse or addiction increases with longer use or intermittent use over an extended time period. Medicaid programs use a variety of indicators to identify individuals who are potentially misusing prescription opioids. So-called pharmacy shopping, in which an individual fills prescriptions for opioids at multiple pharmacies, can be considered a proxy for potential misuse. Other proxies are the number of unique prescribers of opioids for the same individual within a specified period of time (doctor shopping), or the number of overlapping opioid prescriptions.