Opioid prescriptions for new low back pain: Trends and variability by state

Micheal Raad, Jina Pakpoor, Andrew B. Harris, Varun Puvanesarajah, Majd Marrache, Joseph K. Canner, Amit Jain

Research output: Contribution to journalArticlepeer-review


Background: The United States is facing a widespread opioid epidemic that disproportionately affects the working-age population. In the clinical setting, new low back pain is one of the most common reasons for opioid prescriptions, despite national recommendations advising against their use until nonopioid treatments have been trialed. In this study, we aimed to examine national opioid prescribing practices among primary care physicians after the evaluation of low back pain in working-age patients. Method: This study used a national claims database’s billing codes to identify patients in the outpatient setting with a new encounter for isolated low back pain following a 1-year look-back period. The primary outcome was whether an opioid prescription was filled within 30 days after the encounter. Patients with a daily morphine milligram equivalence (MME/day) known to be associated with a higher risk of overdose were also analyzed. Results: A total of 418,565 patients between January 1, 2011 and November 30, 2016 were included. The proportion of patients with filled opioid prescriptions declined significantly between 2011 and 2016 (P < .01; 28.5% in 2011, 27.6% in 2012, 26.3% in 2013, 25.5% in 2014, 23.5% in 2015, and 20.4% in 2016). Nationally, the proportion of patients with a filled opioid prescription varied significantly between states (P < .01), ranging from 12.9% in Hawaii to 33.6% in Arkansas. Discussion: We found that the overall frequency of opioid prescriptions for low back pain is decreasing nationally, which speaks favorably for future initiatives to change physician prescribing patterns. However, we identified that there is large variation in prescribing patterns among physicians in different states.

Original languageEnglish (US)
Pages (from-to)138-142
Number of pages5
JournalJournal of the American Board of Family Medicine
Issue number1
StatePublished - Feb 2020


  • Low Back Pain
  • Opioids
  • Outpatients
  • Physician’s Practice Patterns
  • Prescriptions
  • Primary Care Physicians
  • Primary Health Care
  • Quality of Health Care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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