NB20-02: Does Opioid Receipt After Traumatic Injury Affect the Probability of Transition to DI? Evidence from the Colorado All-Payer Claims Database

Prescription opioid use and pain are both highly prevalent among Social Security Disability Insurance (DI) beneficiaries, but the causal effect of opioid use on DI enrollment remains unknown. A barrier to studying this relationship has been the unavailability of panel data on prescription opioid use by workers at risk of DI entry. State All-Payer Claims Databases (APCDs) capture patients' health care utilization over time in both private and public insurance–including, in some states, Medicare. Because nearly all non-elderly Medicare
enrollees are DI beneficiaries who have completed the Medicare waiting period, Medicare enrollment before age 65 is a proxy for DI enrollment. This study will use 2011-2017 data from the Colorado APCD to estimate how prescription opioids affect the likelihood that unanticipated health shocks resulting in pain – specifically, traumatic injuries resulting in ED visits for patients who are covered by employer-sponsored insurance – result
in DI entry, as proxied by Medicare entry within 4 years of an ED visit for trauma. The specific aims are: 1. Use geographic and insurance network variation in prescribing patterns to construct instruments for opioid prescribing after traumatic injury. 2. Provide individual-level estimates of the impact of opioid use on DI participation.