Document Type


Date of Original Version



Pharmacy Practice


Background: Overuse and misuse of prescription opioids is associated with increased morbidity and mortality, and places a significant cost burden on health systems.

Objective: To estimate annual state-wide spending for prescription opioids in Rhode Island.

Methods: A cross-sectional study of opioids dispensed from retail pharmacies using data from the Rhode Island (R.I.) Prescription Drug Monitoring Program (PDMP) was performed. The study sample consisted of 651,227 opioid prescriptions dispensed to 197,062 patients between January 1, 2015 to December 31, 2015. The mean, median and total cost of opioid utilization was estimated using both prescription dispensings and patients as units of analysis. A generalized linear model with gamma distribution with an identity link function and separately with a log link function were used to estimate the annual adjusted average prescription opioid cost and to examine potential predictors of total annual expenditure, respectively.

Results: The estimated annual expenditure for opioid prescriptions in R.I. for 2015 was $44,271,827. The average and median cost of an opioid prescription were $67.98 (standard deviation [SD] $210.91) and $21.08 (interquartile range [IQR]: $7.65, $47.51), respectively. Prescriptions for branded opioid products accounted for $17,380,279.05, which was about 39.3% of overall spending, although only 6% of all opioids dispensed were for brand-name drugs. On average, patients aged 45-54 and 55-64 years had overall adjusted spending for opioids that were 1.53 (95% confidence interval [CI]: 1.49, 1.57) and 1.75 (95% CI: 1.71, 1.80) times higher than patients age 65 years and older, respectively. Per patient Medicaid and Medicare average annual spending for opioid prescriptions were 1.19 (95% CI: 1.16, 1.22) and 2.01 (95% CI: 1.96, 2.06) times higher than commercial insurance spending, respectively. Annual opioid prescription spending was 2.01 (95% CI: 1.98, 2.04) and 1.50 (95% CI: 1.45, 1.55) times higher among patients who also had at least one benzodiazepine or sympathomimetic stimulant dispensing, respectively. Average total spending for prescription opioids per patient increased with the average daily dosage; from 3-fold for patients using 50-90 MME daily to 22-fold for those receiving 90 or more MME daily compared to those receiving less than 50 MME daily.

Conclusion: This study provides the first estimate of the state-wide direct cost burden of prescription opioid use using PDMP data and standardized pricing benchmarks. Total annual cost increased with age up to 65 years, mean daily dose, and concurrent use of benzodiazepines or stimulants. Commercial insurance bears the majority of the cost of prescription opioid use but cost per patient is highest among Medicare beneficiaries. In addition to reducing harms associated with opioid overuse and misuse, substantial cost savings could be realized by reducing unnecessary opioid utilization especially among middle aged adults.