Abstract
Factors associated with high-dose opioid therapy for noncancer pain are poorly understood.
We documented 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 doses of opioids (≥100 mg/day morphine equivalent at last
dispensing; n = 453) and receiving opioids for 90+ consecutive days were compared
to 2 groups: lower-dose opioid group (1–99 mg/day; n = 4,815) or no-opioid group (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% confidence interval [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.
Perspective
Higher-dose opioid therapy is being prescribed to 8.6% of back pain patients who receive
long-term opioids. These patients had higher mental health and medical comorbidities
and co-prescriptions of sedative-hypnotics, raising potential safety concerns.
Key words
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Article info
Publication history
Accepted:
September 15,
2012
Received in revised form:
August 31,
2012
Received:
May 24,
2012
Footnotes
This study was supported in part by an NRSA T32 Fellowship in Health Services Research from the Agency of Healthcare Research and Quality to Dr. Kobus (5T32HS017582) and a pilot grant from the Oregon Clinical and Translational Research Institute, grant number UL1 RR024140 from the National Center for Research Resources, National Institutes of Health; and the National Institutes of Health Roadmap for Medical Research.
Conflicts of Interest: No conflicts of interest were reported by any of the authors.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
