Equity Health Report on Substance Use Disorders, Overdose Before, During Pandemic

One of the report’s key findings is that 42 states saw an increase in the proportion of opioid and opioid-like drug overdose patients compared to the total number of patients using medical services by state.

In each year from 2016 to 2021, men accounted for 62% to 63% of the gender distribution of patients diagnosed with a substance use disorder, while women made up 37% to 38%, according to a new white paper from FAIR Health.

In each year of the same period, women accounted for 60% to 61% of the gender distribution of overdose diagnoses, while men made up 39% to 40%. The white paper published on Tuesday is entitled A Comparison of Substance Use Disorders Before and During the COVID-19 Pandemic: A Survey of Private Health Care Claims.

In this report, using the nation’s largest repository of private health care claims, FAIR Health analyzes substance use disorders and overdoses before the COVID-19 pandemic compared to those during the pandemic. Trends in the percentage of patients with a substance use disorder or overdose diagnosis are analyzed, as well as aspects such as age, sex, frequency, substances involved, conditions, preexisting mental conditions, care settings, and provider specialties.

Among the key findings:

From 2019 to 2021, 42 states saw an increase in the proportion of opioid and opioid-like drug overdose patients compared to the total number of patients using medical services by state. Increases ranged from 148.4 percent in Pennsylvania to 0.7 percent in Minnesota.

During the pandemic, the percentage of patients diagnosed with a substance use disorder decreased by 4.4% from 3.5% of all patients in 2019 (before the pandemic) to 3.4% in 2021 ( during the pandemic). But in one age group, those 65 and older, the percentage of patients diagnosed with a substance use disorder increased to 5.3 percent from 3.3 percent of all patients in that age group in 2019. to 3.5% in 2021

The percentage of patients with an overdose diagnosis increased by 4.3%, from 0.56% of all patients in 2019 to 0.59% in 2021 (FIGURE 1).

FIGURE 1. Percentage of patients with an overdose diagnosis, 2016-2021.

Alcohol and opioids were the top 2 substances associated with substance use disorders in 2019-2021. However, alcohol-related substance use disorders increased during this period from 47% to 52% of distribution, while opioids dropped from 25% of distribution to 21%.

From 2016 to 2021, the proportion of patients with substance use disorders involving the use of stimulants (eg, amphetamines, methamphetamines) increased by 36.4%, from 0.046% of all patients to 0.063%; this percentage increase exceeds that of alcohol, opioids and cannabis.

In 2021, the percentage of patients with an initial diagnosis of a substance use disorder or overdose increased month over month compared to the previous 2 years.

In 2019 and 2021, New Mexico was the state with the highest proportion of patients with a substance use disorder or overdose diagnosis.

From 2019 to 2021, Nebraska was the state with the largest increase in the proportion of patients diagnosed with a substance use disorder. Maryland was the state with the largest increase in the proportion of patients diagnosed with an overdose.

Sixty-five percent of patients who had a substance use disorder or overdose diagnosis in 2021 had a preexisting mental illness. Generalized anxiety disorder and major depressive disorder, in that order, were the 2 most common mental health diagnoses in this population in 2021.

The percentage of substance use disorder services delivered via telehealth increased from 0.3% in 2019 to 11.3% in 2020, then decreased to 9.3% in 2021 (FIGURE 2).

FIGURE 2. Distribution of substance use disorder claims lines by treatment site, 2019-2021.

Psychiatrists’ share of substance use disorder claim lines increased 112.4% from 3.9% in 2016 to 8.3% in 2021.

This study is the latest in a series of FAIR Health studies on the COVID-19 pandemic. The new study also builds on a series of white papers published by FAIR Health involving substance use disorders, specifically opiate abuse and addiction. Previous entries in this series include:

  • The opioid crisis among the privately insured
  • The impact of the opioid crisis on the health care system
  • Pulling back the curtain on regional variation in the opioid crisis
  • Opiate abuse and dependence

For the new white paper, click here.

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