Correlates of Higher-Dose Opioid Medication Use for Low Back Pain in Primary Care

Abstract

Factors associated with high-dose opioid therapy for non-cancer pain are poorly understood. We document the prevalence of high-dose opioid use, as well as associated demographic, clinical, and health service utilization correlates among low back pain patients. Patients prescribed higher-dose opioids (≥100 mg/day morphine equivalent at last dispensing; n=453) and receiving opioids for 90+ consecutive days were compared to two groups: lower-dose (1–99 mg/day; n=4,815) or no opioid use (n=10,184). Higher-dose opioid use occurred in 2.9% of patients who received any opioids and in 8.6% of patients who received opioids long-term. The median dose in the higher-dose group was 180.0 mg/day. Compared to the no opioid group, higher-dose users reported poorer health. Compared to either comparison group, patients in the higher-dose group had higher rates of mental health and substance use disorders, concurrent sedative-hypnotic use (60.5%; n=274), and health service utilization. After adjusting for select covariates, male gender (Odds ratio (OR) 1.68, 95%CI 1.37,2.06), higher comorbidity, Medicare coverage (OR 1.65, 95% CI 1.22,2.23), any mental health or substance use diagnosis (OR 1.58, 95% CI 1.28,1.95), co-prescriptions of sedative-hypnotics (OR 1.75, 95% CI 1.42,2.16), and more Emergency Department and specialty pain clinic visits were associated with higher likelihood of high-dose prescriptions.

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

“…39 Several studies have noted that noted that higher clinic utilization is associated with either increased odds of opioid prescription or higher doses of opioid prescription. 13,39 Further, low SES has been associated with higher clinic utilization for musculoskeletal problems, which is also consistent with our findings. 40 Reasons for these findings regarding odds of opioid prescription by nSES level are unclear.…”

“…These covariates were selected based on previous literature identifying them as influencing treatment offered for pain. 13,16,17 Age was coded as a continuous variable in years. Race was coded as a bivariate variable, white and nonwhite.…”

“…Specifically, patient characteristics such as sex, insurance status, and race are associated with differences in opioid prescriptions given for painful diagnoses. [12][13][14] In emergency department (ER) and primary care visits for pain, studies have demonstrated that African Americans and women are less likely to receive opioids for acute pain. 12,[15][16][17] These racial differences are thought to contribute to the disproportionate effect of the opioid epidemic on the white population.…”

US practitioner prescribing practices and patient characteristics of those newly treated with a buprenorphine transdermal patch system

“…employment, marital status, social network), and presence of medical conditions 12,17,32 . A study assessing the factors associated with higher doses of opioids in a primary care setting for lower back pain identified higher co-morbidity as an influential factor 33 . In a knowledge, attitudes, and practice study regarding management of moderate-to-severe chronic pain with opioids, physicians took into consideration sleeping, walking, maintaining an independent lifestyle, and job responsibilities when managing patients 34 .…”

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders

“…1 Persons with mental health disorders are more likely to be treated for chronic pain with high-dose opioid therapy that has also been associated with more coprescribed sedative-hypnotic therapy. 3 However, we are unaware of studies examining the risk of drug overdose for complex interrelationships of multiple drugs commonly used by persons with chronic pain and comorbid mental health disorders.…”