Do Prescription Opioids After Traumatic Injury Increase the Risk of SSDI Entry? Instrumental Variables Estimates from the Colorado All-Payer Claims Database
I use panel data from the Colorado All-Payer Claims Database (CO APCD) to study how receipt of prescription opioids after traumatic injury affects the probability that workers transition from employment to Social Security Disability Insurance (SSDI). Although the CO APCD does not directly measure SSDI participation, I use Medicare enrollment before age 65 as a proxy for the event that an individual enters SSDI and remains enrolled through the 24-month Medicare waiting period. Workers who are opioid-naive at injury are much less likely to enter Medicare (0.58% at 48 months post-injury) than patients with a history of prescription opioid receipt at injury (2.21% at 48 months post-injury). Post-injury opioid receipt is also associated with Medicare entry. Opioid-naive patients who receive prescription opioids within 180 days post-injury are twice as likely (0.88%) to enter Medicare by 48 months postindex as opioid-naive patients with no opioids post-injury (0.44%), while patients with a history of prescription opioid receipt who receive prescription opioids within 180 days post-injury are about 2.5 times as likely (2.85%) to enter Medicare by 48 months postindex as opioid-naive patients with no opioids post-injury (1.11%). It is unclear if this relationship is causal, however: instrumental variables estimates provide some support for the hypothesis that opioid prescribing increases the probability of entering SSDI, but are ultimately inconclusive.
I thank conference attendees at the 2021 Conference of the American Society of Health Economists for helpful comments, especially my discussant Nicole Maestas. At RAND, I thank Colleen McCullough for constructing the analytic dataset used in this study; Katie Carman, and Asa Wilks for acquiring and processing the CO APCD files; Christine Buttorff, & Rosalie Pacula, and Asa Wilks for sharing code to measure opioid prescribing in CO APCD. At CIVHC, I thank Eddy Costa and CIVHC/HSRI team for providing data, answering questions, & reviewing output. I also thank Nicole Maestas (Harvard) & Tisamarie Sherry (RAND) for sharing a copy of their manuscript. The research reported herein was derived in whole or in part from research activities performed pursuant to grant RDR18000003 from the US Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA, any agency of the Federal Government, or 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 liability or responsibility for the accuracy, completeness, or usefulness of the contents 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 favoring by the United States Government or any agency thereof.