Opioid Use Among Social Security Disability Insurance Applicants, 2013-2018

Prescription opioids are commonly used to treat pain among Social Security Disability Insurance (SSDI) beneficiaries. Opioid use among beneficiaries is of great public health concern given that beneficiaries account for a disproportionate share of opioid-related hospitalizations and deaths. Little is understood about the trajectory of such opioid use—is it a continuation of treatment patterns initiated prior to SSDI enrollment, or is the SSDI program itself a route to obtaining affordable prescription opioids? To shed light on this question, we estimated the prevalence of opioid use among SSDI applicants at the time of application. Using newly developed SSDI administrative data, we identified applicants who were taking prescription opioids by using a novel natural language processing algorithm to precisely identify opioid analgesics in free text medication entry fields on the application. We also examined changes in opioid use among applicants over time, by applicants’ medical and demographic characteristics including their region of residence, and the association between application rates and local opioid prescribing rates. We find the prevalence of opioid use among SSDI applicants declined from 33% in 2013 to 24% in 2018. In contrast, the share of applicants reporting musculoskeletal impairments, which are commonly associated with chronic pain, was unchanged during this period. Opioid use was especially prevalent among applicants with musculoskeletal and back impairments (45% and 50%, respectively). Between 2013 and 2018, applications reporting opioid use declined across both sexes and all age groups and education levels examined. Applications reporting opioid use also declined across all regions in the US, though there was substantial variation in the magnitude of decline with the smallest declines seen in parts of the Midwest and Southeastern United States. Finally, we found that both levels and changes in the rates of SSDI applications overall, as well as applications reporting opioid use, were positively associated with local opioid prescribing rates such that communities with higher prescribing rates also had higher rates of SSDI application.