Opioids for back pain patients: primary care prescribing patterns and use of services.

Abstract

BACKGROUND:

Opioid prescribing for noncancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychologic distress, health care utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use.

METHODS:

We analyzed electronic data for 6 months before and after an index visit for back pain in a managed care plan. Use of opioids was characterized as "none," "acute" (≤90 days), "episodic," or "long term." Associations with lifestyle factors, psychologic distress, and utilization were adjusted for demographics and comorbidity.

RESULTS:

There were 26,014 eligible patients. Of these, 61% received a course of opioids, and 19% were long-term users. Psychologic distress, unhealthy lifestyles, and utilization were associated incrementally with duration of opioid prescription, not just with chronic use. Among long-term opioid users, 59% received only short-acting drugs; 39% received both long- and short-acting drugs; and 44% received a sedative-hypnotic. Of those with any opioid use, 36% had an emergency visit.

CONCLUSIONS:

Prescription of opioids was common among patients with back pain. The prevalence of psychologic distress, unhealthy lifestyles, and health care utilization increased incrementally with duration of use. Coprescribing sedative-hypnotics was common. These data may help in predicting long-term opioid use and improving the safety of opioid prescribing.

• Authors: Richard A Deyo, David H M Smith, Eric S Johnson, Marilee Donovan, Carrie J Tillotson, Xiuhai Yang, Amanda F Petrik, Steven K Dobscha
• Journal: Journal of the American Board of Family Medicine : JABFM (J Am Board Fam Med) 2011 Nov-Dec Vol. 24 Issue 6 Pg. 717-27 ISSN: 1558-7118 [Electronic] United States
• PMID: 22086815 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Analgesics, Opioid
• Hypnotics and Sedatives

Topics

• Analgesics, Opioid (therapeutic use)
• Back Pain (complications, drug therapy)
• Drug Utilization (statistics & numerical data)
• Electronic Health Records
• Emergency Medical Services (statistics & numerical data)
• Female
• Health Records, Personal
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Life Style
• Logistic Models
• Male
• Managed Care Programs
• Mental Disorders (complications)
• Middle Aged
• Patient Safety
• Practice Patterns, Physicians' (statistics & numerical data)
• Primary Health Care (statistics & numerical data)
• Stress, Psychological