TY - JOUR
T1 - Opioid prescriptions for new low back pain
T2 - Trends and variability by state
AU - Raad, Micheal
AU - Pakpoor, Jina
AU - Harris, Andrew B.
AU - Puvanesarajah, Varun
AU - Marrache, Majd
AU - Canner, Joseph K.
AU - Jain, Amit
N1 - Publisher Copyright:
© 2020 American Board of Family Medicine. All rights reserved.
PY - 2020/2
Y1 - 2020/2
N2 - 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.
AB - 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.
KW - Low Back Pain
KW - Opioids
KW - Outpatients
KW - Physician’s Practice Patterns
KW - Prescriptions
KW - Primary Care Physicians
KW - Primary Health Care
KW - Quality of Health Care
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U2 - 10.3122/jabfm.2020.01.190254
DO - 10.3122/jabfm.2020.01.190254
M3 - Article
C2 - 31907255
AN - SCOPUS:85077608675
SN - 1557-2625
VL - 33
SP - 138
EP - 142
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 1
ER -