Opioid use by SSDI recipients and the effect of opioid prescribing on SSDI claims
Chronic pain is one of the main causes of incapacity for work and one of the main reasons for receiving SSDI benefits. Prescription opioids are frequently prescribed for chronic pain, but their use has come under scrutiny in recent years due to concerns about addiction and overdose. Understanding how common prescription opioid use is among SSDI recipients and how opioid use affects SSDI employment and claims is critical to the SSDI program.
Researchers Nicole Maestas, Tisamarie Sherry and Alexander Strand explore these questions in a pair of new working papers. In Opioid use among Social Security disability insurance claimants, 2013-2018 (NBER RDRC Working Paper NB19-28-1), the three researchers estimate the prevalence of opioid use among SSDI candidates at the time of application.
Developing national estimates of the prevalence of opioid use among SSDI candidates has proven difficult. The Social Security Electronic Disability Database allows applicants to indicate prescription opioid use by selecting it from a pre-populated drop-down list or entering it as free text. However, free text information is difficult for analysts to use. The authors use a new natural language processing algorithm to identify opioid painkillers in free text entry fields and apply this approach to the administrative records of all SSDI applicants who submitted an application between 2013 and 2018.
They find that the prevalence of opioid use among SSDI applicants fell from 33% in 2013 to 24% in 2018. In contrast, the share of applicants reporting musculoskeletal disorders, which are typically associated with chronic pain, remained unchanged during this period. Reported opioid use decreased in both sexes, all age groups, and all levels of education. Usage fell in all regions, although the Midwest and Southeast saw the smallest declines. Interestingly, communities that had higher levels of opioid prescribing or lower prescribing declines over time also had higher levels of SSDI apps overall and more apps reporting opioid use. opioids.
This observation motivates a second article by Maestas and Sherry, Opioid Pain Treatment and Work and Disability Outcomes: Evidence from Health Care Provider Prescribing Patterns (NBER RDRC Working Paper 19-28-2). This article explores how higher rates of opioid prescribing in a region affect employment outcomes and SSDI claims. On the one hand, opioid use may help individuals control chronic pain, leading to increased employment and fewer SSDI claims. On the other hand, the adverse medical consequences of opioid use – including, but not limited to, dependence and addiction – could backfire. Additionally, increasing the supply of opioids in a given region could negatively affect the labor supply of people who do not experience pain if it increases recreational drug use and addiction.
A fundamental challenge in estimating the relationship between opioid use and work outcomes is that opioids are prescribed for chronic pain and the areas where individuals experience more pain may have other attributes that result in less work and more SSDI applications. To overcome this challenge, the authors use variation in healthcare providers’ opioid prescribing preferences — such as the tendency to prescribe drugs at higher doses and for longer durations — that are not explained by patient characteristics. They draw on the largest database of commercial claims available in the United States to construct a measure of propensity to prescribe opioids that is independent of patient medical and demographic characteristics and labor market attachment. This approach also alleviates concerns that “doctor buying” by patients seeking opioids may blur the relationship between opioid use and other outcomes.
The authors find that in regions with higher propensity to prescribe opioids, employment and wages are lower. Specifically, 10 additional opioid prescriptions per 100 adults in a local area result in a 1.6% decrease in employment and a 6% decrease in average weekly earnings, relative to the sample average. Furthermore, an increase of 10 prescriptions per 100 adults is associated with an 8% increase in SSDI requests, a 10% increase in requests mentioning opioid use, and a 6% increase in the likelihood that ‘a request be allowed upon initial review, with respect to signify values.
The authors conclude “[o]Our results indicate that pain treatment with opioids can have detrimental effects on labor productivity and employment, even precipitating more permanent separation from the workforce through SSDI claims.…[W]here medically possible, a decrease in reliance on opioid analgesics for pain treatment (and perhaps increased use of effective non-opioid pain therapies with fewer adverse effects) may not only improve patient health, but also work-related functioning and work outcomes.
The research reported here was conducted pursuant to US Social Security Administration (SSA) grants DRC12000002-05 and RDR18000003, funded through the Retirement and Disability Research Consortium, National Institute on Aging grant P01AG005842, and a donation by Owen and Linda Robinson. The opinions and conclusions expressed are solely those of the authors and do not represent the views or policies of the SSA, any federal government agency, or the NBER. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal responsibility or liability for the accuracy, completeness or usefulness of the content of this report. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation, or favor of the United States Government. or any agency thereof.