Opioid Prescriptions and Adverse Events Among Medicaid Enrollees with Disabilities, 2016-2021.

Abstract

Individuals with disabilities experience disproportionately high rates of prescription opioid use and opioid-related harms, yet national trends among Medicaid enrollees with disabilities remain poorly understood. This repeated cross-sectional study used data from the T-MSIS Analytical Files 2016-2021 to examine trends in opioid prescriptions and adverse events among Medicaid enrollees with disabilities. Outcomes included annual opioid prescription status (none, short-term, long-term), total opioid dosage, daily opioid dosage, and opioid-related emergency department visits or hospitalizations. Multinomial logistical regression and generalized linear models were used to estimate adjusted annual outcomes while controlling for demographic characteristics and state fixed effects. All analyses were performed in 2026. The study included 11,919,659 individual-years (mean age=45.3 years; 50.9% female). From 2016 to 2021, the proportion with no opioid prescriptions increased from 61.1% to 77.9%, whereas short-term opioid use declined from 20.3% to 12.5% and long-term opioid use declined from 18.6% to 9.5%. Among enrollees receiving opioids, total and daily opioid dosages declined significantly. In contrast, opioid-related adverse events increased by 46.2% (95% CI = 14.9%, 86.1%, p<0.01) among those with no opioid prescriptions and 23.4% (95% CI = 2.3%, 48.9%, p=0.03) among those with short-term prescriptions, while remained stable among those with long-term prescriptions (1.8%; 95% CI = -8.9%, 13.7%, p=0.75). Prescription opioid receipt declined substantially among Medicaid enrollees with disabilities, but opioid-related adverse events increased. Future research should examine whether reduced access to prescription opioids may have contributed to increased use of non-prescribed opioids in this population.