Analysis: Peering Into the Nation’s Opioid Crisis Through a Regional Lens

Analysis: Peering Into the Nation’s Opioid Crisis Through a Regional Lens
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The opioid crisis is national in scale, but it varies greatly at the regional level. Drawing on our national database of 23 billion private health care claims, we recently explored the regional variation in the opioid crisis during the ten-year period 2007-2016 in a new white paper. Preceded by reports on national trends in opioid-related diagnoses and on the epidemic’s impact on the health care system, this report is important because it suggests the need for policy flexibility in dealing with the varying regional manifestations of the opioid crisis.

As detailed in the new white paper, in both rural and urban areas, private insurance claim lines with opioid abuse and dependence diagnoses were found in nearly every age group. Rural and urban areas differed, however, in where the diagnoses were concentrated: among middle-aged people in rural settings, and among young and middle-aged people in urban settings.

The Five Largest Cities

Of the five most populous cities in the country—Chicago, Houston, Los Angeles, New York and Philadelphia—one city stood out when we analyzed claim lines with opioid-related diagnoses (a term that, in this paper, meant opioid abuse, opioid dependence, heroin overdose and opioid overdose, i.e., overdose of opioids excluding heroin). A claim line is an individual procedure or service provided by a health care professional as listed on an insurance claim, which helps measure the health care delivered. Philadelphia outstripped the other four cities when the number of claim lines with opioid-related diagnoses in each city were compared to the number of claim lines for all medical care in the relevant state from 2007 to 2016.

The States with the Five Largest Cities

When analyzing data from the five states corresponding to the five largest cities—California, Illinois, New York, Pennsylvania and Texas—we found great regional variation within states. San Antonio and its immediate surrounding areas constituted 5 percent of the population, but 66 percent of the distribution of claim lines with opioid-related diagnoses. From 2007 to 2016, San Antonio had the largest increase in Texas in claim lines with opioid-related diagnoses: 141,022 percent. By comparison, Houston, the largest city in Texas, had an increase of 876 percent, a relatively smaller increase in relation to the experience elsewhere.

Of six regions in California, the greatest increase in claim lines with opioid-related diagnoses from 2007 to 2016 was in southern California (including Los Angeles), where the increase was 31,897 percent. By comparison, in the Central Coast region, the increase was 353 percent.

In New York State, New York City constituted 43 percent of the population but only 13 percent of the distribution of claim lines with opioid-related diagnoses. Although New York City had a relatively small share of that distribution, a more local analysis revealed that it also had two of the top ten increasing areas in the state for claim lines with opioid-related diagnoses from 2007 to 2016: Queens and Manhattan.

In both Illinois and Pennsylvania, claim lines with an opioid dependence diagnosis occurred more frequently in males than females in all age groups. In Illinois, the gap was greatest in the age group 19-30 years (males 67 percent, females 33 percent), whereas in Pennsylvania, it was greatest in the age group 0-18 years (males 74 percent, females 26 percent). The gap narrowed, however, over the age of 50 years, with males at 55 percent and females at 45 percent in both states.

Top Procedure Codes

In the distribution of top five most frequently reported procedure codes associated with opioid-related diagnoses in 2016, only one code was shared by all five states under study—HCPCS code G0479, “drug test(s), any number of drug classes, not optical.” Beyond that, the five states varied greatly both in the distribution of top five procedure codes and in the top five procedure codes by expenditure that year. The variation suggested different approaches to the treatment of opioid-related diagnoses, with each state a laboratory for its particular strategy. For example, in California, the top code in the distribution was the rehabilitative services code H0015, “alcohol and/or drug services; intensive outpatient.” In Illinois, it was CPT® 99213, “office visit—15 minutes.” In New York, it was H0020, “alcohol and/or drug services; methadone administration.” In both Pennsylvania and Texas, it was G0479, the drug test code noted above.

As the national opioid crisis continues to simmer, policymakers, health care professionals and other stakeholders can hopefully benefit from gaining a window into the various state strategies underway in treating patients with an opioid-related diagnosis.

CPT © 2016 American Medical Association (AMA). All rights reserved.


Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to health care costs and health insurance information. FAIR Health oversees the nation’s largest collection of health care claims data, which includes a repository of over 23 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts.


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