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Use of Opioids at High Dosage in Persons Without Cancer: Age 18 and Older

DOMAIN: Behavioral Health

Opioid use is a growing concern in the United States. The opioid epidemic continues to highlight the need for both preventing inappropriate prescribing and providing access to high quality treatment.

High dosage opioid use by people without cancer is an indicator of potential overuse and linked to an increased risk of morbidity and mortality.

Explore the percentage of adults who received prescriptions for opioids at high dosage over a period of 90 days or more in each state. Adults with a cancer diagnosis, sickle cell diagnosis, or in hospice are excluded. Lower rates are better on this measure.

The purple dashed line represents the median, or middle, of all values reported.

This measure reports state performance on the percentage of adults age 18 and older who received prescriptions for opioids with an average daily dosage greater than or equal to 90 morphine milligram equivalents (MME) for 90 days or more during the measurement year. Adults with a cancer diagnosis, sickle cell disease diagnosis, or in hospice are excluded from this measure.

States voluntarily report on Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications.

The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states.

Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years.

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2020 reporting cycle as of June 18, 2021; see 2020 Child and Adult Health Care Quality Measures. For more information on the Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) measure, visit Adult Health Care Quality Measures.


The term “states” includes the 50 states, the District of Columbia, and Puerto Rico. The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, CO, DC, FL, GA, ID, IL, IN, KY, ME, MT, NM, NV, OR, PR, RI, UT, VA, and WI.

The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: NJ, NY, OH, PA, and TX. CMS did not include the rates for these states.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on Pharmacy Quality Alliance 2020 specifications.
  • Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 2019 to October 2019. AZ reported data for FFY 2019.
  • Rates displayed in this table reflect state reporting for Medicaid enrollees ages 18 to 64 (26 states) or age 18 and older (2 states).

ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HCBS = Home- and Community-Based Services; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner.