Unsafe Opioid Prescribing among Patients with ESKD in 2020

Background: A large proportion of End Stage Renal Disease (ESRD) patients report moderate to severe pain. Opioid analgesics are commonly prescribed to address pain in this population. Opioid analgesic overuse and potential for abuse pose a cause for concern. This study measures the prevalence of unsafe opioid prescribing as defined by the CMS project “Practitioner Level Opioid Safety Measure Development.” Methods: We used 2020 annual data from the United States Renal Data System to estimate unsafe opioid use in Hemodialysis (HD) and Peritoneal Dialysis (PD) patients who had Medicare Part A,B and D coverage. Outcomes include chronic use of opioids (more than 90 days of opioid use in a year), concomitant use of opioids and benzodiazepines, daily morphine milligrams equivalents (MME) ≥ 50, and an aggregate of the three outcomes. We conducted a multivariate logistic regression model to identify factors associated with unsafe opioid prescribing. Results: Figure 1 shows the proportion of 176,626 beneficiaries who had unsafe opioid prescribing. Our multivariate model revealed that HD and PD patients were at an increased odds of unsafe opioid prescribing if they were non-Hispanic white, female, were un-employed prior to ESRD, were dual eligible, had an ESRD vintage of 5+ years, had a diagnosis of anxiety or depression, and a higher Charlson comorbidity index. Conclusion: The results demonstrate that unsafe opioid prescribing impacted 1 in 6 HD patients and about 1 in 7 PD patients. Given the high need for symptom management for patients with kidney failure, the results underscore the need to improve access to alternative pain management strategies and to monitor unsafe opioid prescribing for this population.