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    AJ - BPPOPIOIDS Research Letter

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    Micheal

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    © All Rights Reserved
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    AJ - BPPOPIOIDS Research Letter

    Uploaded by

    Micheal
    26 views8 pages

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    AJ_BPPOPIOIDS Research Letter.docx

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    26 views8 pages

    AJ - BPPOPIOIDS Research Letter

    Uploaded by

    Micheal

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 8

    The Need for National Guideline Development for Opioid Prescribing for the First

    Encounter of Low Back Pain in the Primary Care Setting: Analysis of a Private Payer

    Insurance Claims Database

    Micheal Raad*, MD, Jina Pakpoor*, MD, Andrew Harris, Varun Puvaresanajah, MD, Joseph

    Canner, Khaled Kebaish, MD, Amit Jain, MD


    Methods

    This study examines opioid prescribing practices among primary care physicians after initial

    encounters for low back pain in privately insured patients. The Truven Health

    MarketScan® Commercial Claims and Encounters Database, which contains health information

    on private-payer insurance beneficiaries from approximately 350 payers was utilized for this

    study1. International Classification of Diseases 9th and 10th (ICD-9 724.2 or ICD-10 M54.4)

    edition codes were used to identify patients in the outpatient setting presenting for an initial

    encounter for isolated low back pain after a 1 year look back period. Patients with other

    diagnoses indicating any spinal pathology were excluded. Similarly excluded were patients who

    had filled opioid prescriptions in the 90 days prior to their encounter, required opioid forms

    indicating more chronic use or those who were seen by a specialist. The primary outcome was

    whether an opioid prescription was filled in the 30 days after the visit date. The proportion of

    patients with a daily morphine milligram equivalence (MME/day) known to be associated with a

    higher risk of over dose was also analyzed2. All proportions were imputed with Truven Health

    MarketScan® trends and sampling weights. The Cochran-Armitage trends test was used to

    analyze trends over time. Variation between states was analyzed using chi-square test and

    caterpillar plots showing 95% logit confidence intervals (CI). Institutional review board approval

    was obtained for this study. Significance was set at 0.05.

    Results

    418,565 patients between January 1 2011 and November 30, 2016 were included in this study.

    Age was 44.7 [95% CI: 44.6 – 44.7] and 52.7% [52.6 – 52.9] were women. 25.7% [25.6 – 25.9]

    of patients had a filled opioid prescription. Nationally, the proportion of patients with filled

    opioid prescriptions declined significantly between 2011 and 2016 (p< 0.01: 28.5% in 2011,
    27.6% in 2012, 26.3% in 2013, 25.5% in 2014, 23.5% in 2015, 20.4% in 2016). This decline was

    evident across the Northeast, Midwest, South and West. Figure 1. Of those with a filled opioid

    prescription, the proportion with > 20MME/day did not significantly change over time (p=0.16).

    This varied significantly between the four regions with a decline in the Northeast and South

    (p<0.01), no significant change in the Midwest (p=.09) and a rise in the West (p<0.01). Figure 1.

    The proportion of patients with a filled opioid prescription varied significantly between the

    various states (p<0.01), ranging from 12.9% in Hawaii to 33.6% in Arkansas. Figure 2.
    Figure 1. Regional Scatter Plots of the Annual Proportions of Patients with Any filled Opioid

    Prescription as well as the Proportion of those with a Filled Prescription Receiving More than 20

    MME/day and their associated 95% Logit Confidence Intervals.

    A. Northeast
    B. Midwest
    C. South
    D. West
    Figure 2. A Caterpillar Plot of the Proportion of Patients with a Filled Opioid Prescription

    and the Associated 95% Logit Confidence Interval by Sate.

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