Opioid Prescriptions by U.S. Primary Care Physicians From 1992 to 2001

Research output: Contribution to journalArticle

Abstract

Little is known about primary care physicians' (PCPs) prescribing of opioids. We describe trends and factors associated with opioid prescribing during PCP visits over the past decade. Using the National Ambulatory Medical Care Survey, we found an opioid prescribed in 2,206 (5%) PCP visits from 1992 to 2001. The prevalence of visits where an opioid was prescribed increased from a low of 41 per 1000 visits in 1992-1993 to a peak of 63 per 1000 in 1998-1999 (P <.0001 for trend) and then stabilized (59 per 1000 in 2000-2001). Several factors increased the odds of receiving an opioid: having Medicaid (odds ratio [OR] 2.09 [95% confidence interval (CI) 1.82-2.40]) or Medicare (OR 2.00 [95% CI 1.68-2.39]); having a visit between 15 and 35 minutes (OR 1.16 [95% CI 1.05-1.27]); and receiving an NSAID (OR 2.27 [95% CI 2.04-2.53]). Patients of hispanic (OR .67 [95% CI .56-.81]) or other race/ethnicity (OR .68 [95% CI .52-.90]), patients in health maintenance organizations (OR .74 [95% CI .66-.84]), and those living in the northeast (OR .60 [95% CI .51-.69]) or midwest (OR .75 [95% CI .66-.85]) had lower odds of receiving an opioid. Substantial variation exists in opioid prescribing by PCPs. Now that pain management standards are advocated, understanding the dynamics of opioid prescribing is necessary. Perspective: This study describes a decade-long increase in opioid prescribing by U.S. primary care physicians and identifies important geographic-, racial/ethnic-, and insurance-related differences in who receives these medications. Several underlying factors, including regulatory and legal pressures, attitudes and knowledge of opioids, and publicized opioid-related events, may contribute to these differences.

Original languageEnglish (US)
Pages (from-to)225-235
Number of pages11
JournalJournal of Pain
Volume7
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

Primary Care Physicians
Opioid Analgesics
Prescriptions
Odds Ratio
Confidence Intervals
Health Care Surveys
Health Maintenance Organizations
Medicaid
Non-Steroidal Anti-Inflammatory Agents
Pain Management
Medicare
Insurance
Hispanic Americans
Pressure

Keywords

  • health services
  • Opioid
  • pain
  • prescribing patterns
  • primary care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)

Cite this

Opioid Prescriptions by U.S. Primary Care Physicians From 1992 to 2001. / Olsen, Yngvild; Daumit, Gail L; Ford, Daniel E.

In: Journal of Pain, Vol. 7, No. 4, 04.2006, p. 225-235.

Research output: Contribution to journalArticle

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abstract = "Little is known about primary care physicians' (PCPs) prescribing of opioids. We describe trends and factors associated with opioid prescribing during PCP visits over the past decade. Using the National Ambulatory Medical Care Survey, we found an opioid prescribed in 2,206 (5{\%}) PCP visits from 1992 to 2001. The prevalence of visits where an opioid was prescribed increased from a low of 41 per 1000 visits in 1992-1993 to a peak of 63 per 1000 in 1998-1999 (P <.0001 for trend) and then stabilized (59 per 1000 in 2000-2001). Several factors increased the odds of receiving an opioid: having Medicaid (odds ratio [OR] 2.09 [95{\%} confidence interval (CI) 1.82-2.40]) or Medicare (OR 2.00 [95{\%} CI 1.68-2.39]); having a visit between 15 and 35 minutes (OR 1.16 [95{\%} CI 1.05-1.27]); and receiving an NSAID (OR 2.27 [95{\%} CI 2.04-2.53]). Patients of hispanic (OR .67 [95{\%} CI .56-.81]) or other race/ethnicity (OR .68 [95{\%} CI .52-.90]), patients in health maintenance organizations (OR .74 [95{\%} CI .66-.84]), and those living in the northeast (OR .60 [95{\%} CI .51-.69]) or midwest (OR .75 [95{\%} CI .66-.85]) had lower odds of receiving an opioid. Substantial variation exists in opioid prescribing by PCPs. Now that pain management standards are advocated, understanding the dynamics of opioid prescribing is necessary. Perspective: This study describes a decade-long increase in opioid prescribing by U.S. primary care physicians and identifies important geographic-, racial/ethnic-, and insurance-related differences in who receives these medications. Several underlying factors, including regulatory and legal pressures, attitudes and knowledge of opioids, and publicized opioid-related events, may contribute to these differences.",
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