Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings

Rafia S. Rasu, Maureen E. Knell

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Study Objectives. Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design. This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients. Subjects. Patients included in the study were age 18 years or older with NMCP diagnosis based on ICD-9 codes identified as reason for visits. Results. Approximately 690 million weighted outpatient visits related to NMCP were reported in the US between 2000 to 2007. Reported opioid use was 14.3%. Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.17-1.86) and patients age 65 years or older were 0.61 times less likely (OR=0.39, 95% CI=0.27-0.55] to receive opioids. Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR=1.83, 95% CI=1.50- 2.25) than specialty physicians. Hispanic ethnicity and patients with private insurance were less likely to receive opioids, while patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain, established patients, and the southern prescribing region were more likely to receive opioids. Conclusions. Differences exist between those prescribed and not prescribed opioids. Results from this study paired with increased education and further research regarding the appropriate prescribing and monitoring of opioids may help enhance awareness, diminish treatment disparities and improve safe and appropriate use of opioids in the NMCP population.

Original languageEnglish
Pages (from-to)524-532
Number of pages9
JournalPain Medicine (United States)
Volume19
Issue number3
DOIs
StatePublished - 1 Mar 2018

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Chronic Pain
Opioid Analgesics
Outpatients
International Classification of Diseases
Health Care Surveys
Odds Ratio
Confidence Intervals
Insurance
Primary Care Physicians
Hispanic Americans
Cross-Sectional Studies
Logistic Models
Physicians
Education
Pain

Keywords

  • NAMCS
  • Nonmalignant chronic pain
  • Opioids
  • Outpatient
  • Pain management

Cite this

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title = "Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings",
abstract = "Study Objectives. Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design. This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients. Subjects. Patients included in the study were age 18 years or older with NMCP diagnosis based on ICD-9 codes identified as reason for visits. Results. Approximately 690 million weighted outpatient visits related to NMCP were reported in the US between 2000 to 2007. Reported opioid use was 14.3{\%}. Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely (odds ratio [OR] = 1.47, 95{\%} confidence interval [CI] = 1.17-1.86) and patients age 65 years or older were 0.61 times less likely (OR=0.39, 95{\%} CI=0.27-0.55] to receive opioids. Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR=1.83, 95{\%} CI=1.50- 2.25) than specialty physicians. Hispanic ethnicity and patients with private insurance were less likely to receive opioids, while patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain, established patients, and the southern prescribing region were more likely to receive opioids. Conclusions. Differences exist between those prescribed and not prescribed opioids. Results from this study paired with increased education and further research regarding the appropriate prescribing and monitoring of opioids may help enhance awareness, diminish treatment disparities and improve safe and appropriate use of opioids in the NMCP population.",
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Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings. / Rasu, Rafia S.; Knell, Maureen E.

In: Pain Medicine (United States), Vol. 19, No. 3, 01.03.2018, p. 524-532.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Determinants of opioid prescribing for nonmalignant chronic pain in US outpatient settings

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N2 - Study Objectives. Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design. This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients. Subjects. Patients included in the study were age 18 years or older with NMCP diagnosis based on ICD-9 codes identified as reason for visits. Results. Approximately 690 million weighted outpatient visits related to NMCP were reported in the US between 2000 to 2007. Reported opioid use was 14.3%. Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.17-1.86) and patients age 65 years or older were 0.61 times less likely (OR=0.39, 95% CI=0.27-0.55] to receive opioids. Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR=1.83, 95% CI=1.50- 2.25) than specialty physicians. Hispanic ethnicity and patients with private insurance were less likely to receive opioids, while patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain, established patients, and the southern prescribing region were more likely to receive opioids. Conclusions. Differences exist between those prescribed and not prescribed opioids. Results from this study paired with increased education and further research regarding the appropriate prescribing and monitoring of opioids may help enhance awareness, diminish treatment disparities and improve safe and appropriate use of opioids in the NMCP population.

AB - Study Objectives. Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design. This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients. Subjects. Patients included in the study were age 18 years or older with NMCP diagnosis based on ICD-9 codes identified as reason for visits. Results. Approximately 690 million weighted outpatient visits related to NMCP were reported in the US between 2000 to 2007. Reported opioid use was 14.3%. Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.17-1.86) and patients age 65 years or older were 0.61 times less likely (OR=0.39, 95% CI=0.27-0.55] to receive opioids. Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR=1.83, 95% CI=1.50- 2.25) than specialty physicians. Hispanic ethnicity and patients with private insurance were less likely to receive opioids, while patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain, established patients, and the southern prescribing region were more likely to receive opioids. Conclusions. Differences exist between those prescribed and not prescribed opioids. Results from this study paired with increased education and further research regarding the appropriate prescribing and monitoring of opioids may help enhance awareness, diminish treatment disparities and improve safe and appropriate use of opioids in the NMCP population.

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KW - Pain management

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